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Comparability

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Welfare and Health, Social Statistics
Birgitte Schûtt Christensen and Charlotte Wind von Bennigsen
+45 3917 3608 and +45 3917 3047

bir@dst.dk and cwb@dst.dk

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Health Insurance Statistics

Data basis for assessments of visits to physicians etc. (health insurance statistics) is Det Fælleskommunale Afregningsregister (joint municipal settlement register). Delimitation and definition of contacts (or use of services instead of contacts) may result in statistics that do not seem to be directly comparable. Typically, any – often minor – differences can be attributed to method and delimitation. The overall picture is unambiguous.

Comparability - geographical

Direct comparison with international statistics is not immediately possible. For comparable international data, we recommend that you look at data from Eurostat and the OECD, which make comparable data collections and publish data (e.g. OECD´s publication Health at a Glance) that is comparable to a certain extent in this field. There are a number of organisational and institutional conditions that we must keep in mind when analysing any differences.

Comparability over time

Since an increasing number of service providers have joined the system through the years, you should exercise caution when comparing over time.

For the years 1984, 1985 and 1986, the register relies on a 10 per cent sample that contains services for persons born on day 14, 15 or 16 of a month; from 1987 onwards the register includes all services and persons covered by the agreements between the regions and the organisations representing the various service providers. Originally, it was typically physicians who held agreements with the former counties, whereas, today, a number of new service providers, e.g. psychologists and physiotherapists, have entered into agreements and accordingly, are included in the statistics.

In particular the number of contacts statistics may present difficulties when you make comparisons over time. Several methods have been applied over time to specifically delimit the services to be considered as contacts. This has involved a certain measure of data breaks in the number of contacts between the years up to 2005 and from 2006 onwards. From 2006, a revision has been made in the calculation of contacts.

From 2006, the register includes an imputed amount for the general practitioners’ basic fee etc. The total amount is broken down on the individual receivers of services from general practitioners in proportion to the gross fee. For visits to dentists, the first visit (including checkup) is registered as contact, whereas subsequent visits in the course of the same dental treatment procedure are not registered as contacts.

Physiotherapy is often administered as team training, so that the individual physiotherapist can train several persons at a time. The training of each person is assessed as a contact. For riding physiotherapy, the calculation will be uncertain for the same reasons that apply to physiotherapy.

In 2009, a large decline was seen in the number of dental contacts. This decline is not real but is owing to two types of service regarding preventive treatment ('502920', ‘502930’) which are no longer included as contacts at the recommendation of the Danish Dental Association. This does not give a true and fair view of the development in contacts with dentists from 2008 to 2009 of approximately 500,000.

In 2011, the figures indicate a major increase in contacts etc. with chiropodists, which is explained by a prolonged conflict that was resolved by a collective agreement in this field on 1 June 2011. (For a long period of time, it has not been possible to calculate the number of contacts with chiropodists for two reasons: First of all, the breakdown of services makes it difficult to determine whether it counts as contact or not and consequently difficult to calculate the number of contacts. Second, there was no collective agreement in this field from June 2005 to June 2011. During this time, the major part of the fee to chiropodists was settled without the involvement of the public health insurance system and for this reason it was not included in the statistics.)

In 2011, there is a large decline in General practitioner, prevention etc., which is due to the discontinuation of service code "0106 Aftalt forebyggelseskonsultation” (agreed preventive consultation) and the tightened requirements for using the new code "0120 Aftalt specifik forebyggende indsats" (agreed specific preventive measures).

For 2011, the number of contact to psychologists is underestimated on a scale of 20,000 (roughly estimated), because specific services not included in the tariff folder should have been included as contacts. This did not happen until 2012 onwards.

For 2012, a further number of service codes have been included for psychologists, codes that are not mentioned explicitly in the tariff folder. These service codes have not been included for previous years, which is why the development for psychologists from 2011 to 2012 is overrated.

Due to a pilot project on Bornholm in 2012, the number of contacts with general practitioners is underestimated by approximately 112,000 for that year. The tariff folder for 2012 includes Assistance from an interpreter, and this does not result in changes in the number of contacts. Upon careful consideration, it has been decided not to include the expenses for assistance from an interpreter for 2012.

In 2013, the number of dental contacts dropped by 22 per cent as this field was narrowed in 2013, so that in future reimbursement is only granted for cleaning of teeth, and reimbursement for checkup on diagnostic findings is discontinued.

For 2013, Statistics Denmark has been informed by CSC Scandihealth that they have found small inaccuracies (regarding October, November and December 2013) in the submitted data, because adjustments in Region Midtjylland (Central Denmark Region) have been assessed with incorrect operational signs.

In 2014, socio-economic groups (soc_stil to soc_status) were revised in the Register-based Labour Force Statistics, and the period 2009-2013 has been recalculated. This amounts to a break in the socio-economic grouping between 2008 and 2009.

In 2014, the income register was revised, and the period 2011-2013 has been recalculated, but it has not had any noteworthy impact on the breakdown by income quartiles.

Coherence - cross domain

Total health expenditure appears from the regional accounts, table REGR31 in Statbank Denmark. The total amount for the health insurance reimbursements appears from the regional accounts. The Danish Health Authority has previously published periodic statistics on the population’s use of the public health insurance. Both of these assessments are exclusive of the background information that exists in the Health Insurance Register of Statistics Denmark. The Danish Health Authority has incorporated a number of detailed tables on health insurance at http://www.sundhedsdata.sst.dk. Delimitations and definitions are not consistently identical with those in the assessment by Statistics Denmark. The difference concerns in particular services categorised as prevention etc., which are not included by the Danish Health Authority. Danish Regions also make an assessment of visits to physicians etc.

Coherence - internal

Data are internally consistent.