Treatment Chronicle: a Tool for Assessing Health Service Utilization among Insured Individuals

Assessment of the health services utilization among the insured individuals is difficult for insurance companies because they have no integrated information. So, the aim of this study was to introduce a tool to facilitate this issue named "Treatment Chronicle". This descriptive and applied study was conducted in 2017. To investigate the health services utilization among the insured people and considering the information fragmentation in medical document system of Iran Health Insurance organization (IHIO), Treatment Chronicle was designed. Then, information was collected from medical document system of IHIO about patients' reference to physicians and paraclinics in various specialized levels in an 8-month period from the beginning of 2017. In this regard, 175 insured patients who used the health services very frequently were randomly selected and the Treatment Chronicle was drawn for them. Finally, some criteria were suggested for identifying the causes of over utilizing health services and a specific kind of service. Data in the IHIO were categorized according to patients' referral to physician, drug store, laboratory, and imaging center and were accessible in the form of tables and charts by entering the individual's national code number in the medical document system of IHIO. However, some problems existed for reviewing the health care utilization due to information fragmentation and lack of up-to-date information. Treatment Chronicle tool showed the referring information of each insured individual in a certain time period. It also represented the sequence, diversity, and combination of individuals' reference to physicians and utilization of paraclinical services. Treatment Chronicle is a useful tool for insurance organizations to monitor individuals' health services seeking behavior. It can facilitate the interpretation and analysis of the healthcare use by illustrating the sequence and combination service utilization.