Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada.
We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data.
One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94-100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of "(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with =1 by a specialist in a 2-year period)" had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date.
We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance.
Although there has been recent comparison of the Canadian and American health care systems, the issue of trauma has received little attention. Data were collected on all adult motor vehicle crash (MVC) victims admitted to the Sunnybrook Trauma Unit (CAN), Toronto, Canada, and the R Adams Cowley Shock Trauma Center (USA), Baltimore, Maryland from July 1986 through July 1990. Similar MVC victims at CAN and USA had equivalent mortality rates with similar discharge dispositions (p = NS), but patients at USA were twice as likely to be admitted to the ICU and had longer ICU stays (p
BACKGROUND AND OBJECTIVES: This study's purpose was to determine how conditions of payment influence attendance at preventive health examinations. METHODS: A multi-practice study of 65 general practitioners (GPs) was conducted in two areas in the county of Aarhus, Denmark. The GPs invited 2,452 men aged 40-49 to a preventive health examination for coronary heart disease (CHD). The examination was free in one area but cost $40 in the other area. A risk profile was estimated, based on a summation of points for risk factors for CHD, including blood pressure, serum cholesterol, smoking behavior, body mass index, and family history of CHD. RESULTS: Attendance at the examinations was 37% in the required payment area and 66% in the free area. Of the total attenders, 13% had an increased risk of CHD. A slight but significant tendency, a lower risk for developing CHD, existed among attenders who paid for the examination. CONCLUSION: A requirement for payment for health examination leads to fewer patients obtaining examinations.
We used data collected in the 2010 National Physician Survey and public payment data published in the Institute for Clinical and Evaluative Sciences report Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources 1992/93 to 2009/10 to estimate 2009/2010 net physician income from public payments for Ontario physicians by specialty. Incorporating overhead substantially affects estimates of physician income and changes relative position. For example, ophthalmologists were ranked second when only public payments were considered but eighth when overhead was included. Conversely, hospital-based specialties such as anaesthesia, radiation oncology and emergency medicine rank significantly higher after overhead is included.
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User charges in Swedish healthcare have increased during recent decades. This can be seen in terms of the recommodification of healthcare: making healthcare access more dependent on market position. This study investigates whether the increase in user charges had an impact on educational inequalities in access to healthcare in Sweden between 1980 and 2005.
Data from the Swedish Living Conditions Survey were used to calculate the odds ratios of access to healthcare for the low and higher educated in Sweden, and the results were stratified by health status (Good and Not good health) for each year 1980-2005. These odds ratios were correlated with the average user charge for healthcare.
There were no educational differences in healthcare access in the group with Good health. In the group with Not good health, the higher educated had higher rates of healthcare access than the lower educated. Inequalities in access to healthcare were relatively stable over time, with a slight increase among those with Not good health.
Recommodification has had only a small association with access to healthcare in Sweden. The Swedish system has integral protections that protect the vulnerable against rising healthcare costs. This is an important caveat for other countries that are considering introducing or raising user charges.
During the 1992 presidential debates there was considerable rhetoric on health reform. Based on the broad principles now available concerning President Clinton's plan, this article compares differences in hospital and physician use rates of the now uninsured, who would be covered by his proposal, to those who have been traditionally enrolled in health insurance plans. Numerous studies illustrate that these new insurees have historically needed more and received less health care than the insured. Hospitals and physicians will be under pressure to provide a greater volume of benefits. It is predicted that these future estimated use rates will be more akin to the Canadian single-payor rather than the German multipayor national health insurance plan.