William A. Reinke

Feasibility and validity of International Classification of Diseases based case mix indices

BackgroundSeverity of illness is an omnipresent confounder in health services research. Resource consumption can be applied as a proxy of severity. The most commonly cited hospital resource consumption measure is the case mix index (CMI) and the best-known illustration of the CMI is the Diagnosis Related Group (DRG) CMI used by Medicare in the U.S. For countries that do not have DRG type CMIs, the adjustment for severity has been troublesome for either reimbursement or research purposes. The research objective of this study is to ascertain the construct validity of CMIs derived from International Classification of Diseases (ICD) in comparison with DRG CMI.MethodsThe study population included 551 acute care hospitals in Taiwan and 2,462,006 inpatient reimbursement claims. The 18th version of GROUPER, the Medicare DRG classification software, was applied to Taiwans 1998 National Health Insurance (NHI) inpatient claim data to derive the Medicare DRG CMI. The same weighting principles were then applied to determine the ICD principal diagnoses and procedures based costliness and length of stay (LOS) CMIs. Further analyses were conducted based on stratifications according to teaching status, accreditation levels, and ownership categories.ResultsThe best ICD-based substitute for the DRG costliness CMI (DRGCMI) is the ICD principal diagnosis costliness CMI (ICDCMI-DC) in general and in most categories with Spearmans correlation coefficients ranging from 0.938-0.462. The highest correlation appeared in the non-profit sector. ICD procedure costliness CMI (ICDCMI-PC) outperformed ICDCMI-DC only at the medical center level, which consists of tertiary care hospitals and is more procedure intensive.ConclusionThe results of our study indicate that an ICD-based CMI can quite fairly approximate the DRGCMI, especially ICDCMI-DC. Therefore, substituting ICDs for DRGs in computing the CMI ought to be feasible and valid in countries that have not implemented DRGs.

FACTORS INFLUENCING CONTRACEPTION CONTINUATION RATES: THE ORAL AND THE INTRAUTERINE METHODS

The technique of multi-sort analysis was used to compare the relative duration of use of oral and intrauterine contraception among low socio-economic groups in Baltimore City. The clinical records of over 12,000 women who had received contraception through the Baltimore public services were analyzed. The type of method a woman used was found to be the most important factor affecting her probability of continuing contraception. Her age, race, and how long she had been using the method also influenced this probability. The strictness of the criteria used for the definition of continuation rates and the fact that experience was incomplete for many intrauterine contraceptors probably in part explain the somewhat low continuation rates obtained for both methods. It is suggested that the intrinsic characteristics of each method may lead to a clinical impression favoring the oral even when statistical evidence, as presented here, favors the intrauterine method.

Measurement and projection of the demand for health care: the Chilean experience.

Projection of the probable demand for health services over time is one of the most important–and difficult–aspects of the health planning process. Not only must the planner contend with many variables external to the health sector, but also with the difficult to predict correlations between the supply of health services and the resultant demand. This article briefly reviews some of the principal demand projection methods in use and then describes in detail the one adopted in the Chilean health manpower study. The demand portion of the study in Chile involved three main elements: 1) a sample survey which measured the met and unmet demand for medical, dental, and hospital services as a function of six population variables (age, sex, location, income, educational level, and medical insurance status); 2) a baseline demand projection which takes into account the probable effects of changes in these six variables over ten and 20 years on the utilization of services; and 3) an alternative projection which postulates the fulfillment of certain targets for the improvement of health care. The approach offers the planner a number of important analytical and programmatic advantages compared with other methods now available and are discussed along with their limitations.

Alternative Methods for Determining Resource Requirements: The Chile Example

Many more or less attractive techniques have been proposed for statistical analyses involving multiple sources of variation, for example in examining the possible contributors to differential patterns of health services utilization and expenditure. A large scale investigation of such patterns among 10,000 households in Chile provided a useful basis for comparison of alternative analytical approaches. The multiple regression, Automatic Interaction Detection, and Multisort techniques were applied to the survey data separately and in combination and results were compared. The Multisort technique was found to be the single most useful and convenient approach, but the most meaningful results were obtained from the systematic application of the three approaches combined.

The unment demand for health services: A vital component in planning

Consideration of unmet need as well as effective demand for health services is desirable for planning but frequently ignored. This paper reports an analysis of the findings from a national health survey conducted in Chile to obtain information on both met and unmet demand.The joint analysis proved feasible and highly informative. Total felt need tended to be relatively constant among population groups in comparison with differences in actual services utilization. Moreover, exceptions to this general finding revealed patterns that should improve our insights for health planning.

Studies of Alternative Patterns of Administrative Organization

A systematic framework is provided for the analysis of the major administrative issues of interest in the organization of family planning programs. This framework includes clarification of the problem of concern, a review of alternative means for solution, and enunciation of concrete objectives regarding program structure, process (services provided), and product (end results). Eight administrative principles that arise from the analysis are formulated. These can either be accepted as general guides for application to each unique set of circumstances or used as a basis for pinpointing sources of disagreement and subjects for further research.