here. - Canadian Women's Health Network

APPENDIX 3:HEALTH SERVICE UTILIZATION BYMANITOBA WOMEN – EXPENDITUREBY INCOME QUINTILEWomen, Income andHealth in Manitoba63(The following description was preparedby Dr. Patricia Kaufert, Department ofCommunity Health Sciences, Facultyof Medicine, University of Manitoba)The Manitoba Health Services InsurancePlan (MHSIP) provides insurance coverageto all Canadian citizens and landedimmigrants who qualify as residents of theProvince. Coverage includes entitlementto a comprehensive range of health careservices including acute hospital care andphysician services without fees, premiumsor co-payment charges. The administrativesystem developed to run this insurancesystem has created a computerized recordof health service utilization by a completepopulation of over a million people.Extensively used in research, the reliability,concurrent validity and predictive validityof these data are now well established(Roos et al. 1987; Roos et al. 1988;Muhajarine et al. 1997).This analysis is based on three of the filescreated as part of this system; they are theRegistry file, the Physician Claims file andthe Hospital-Separation Abstract file. TheRegistry file includes information on theage and sex of every individual entitled tocoverage (virtually the entire population ofManitoba), their address and a uniqueidentifier number assigned to them byMHSIP as their Manitoba Health (MH)number. The date when an individual firstregistered with MHSIP is also entered intothe file and, if they leave the province ordie, the date when their coveragewas cancelled.A second file, the Physician Claims file, isthe product of the system of payment tophysicians. The majority of physicians inManitoba are paid on a fee-for-servicesystem with MHSIP as the unique payer.To be eligible for payment, physicians mustsubmit detailed claims cards which includetheir own code and specialty, the patient’sMH insurance number, the type of serviceprovided (tariff), the reason for the visit(diagnosis) and the date of the service.Regardless of the number of other reasonsinvolved, only the diagnosis identified bythe physician as most responsible for thevisit is entered into the file. Diagnosesare coded using the first 3 digits of theInternational Classification of Disease, 9threvision, Clinical Modification (ICD-9-CM)diagnostic codes. The Physician Claims fileincludes all claims for ambulatory care andfor care provided by physicians in hospitalon either an in-patient or outpatient basis.The few physicians who are on salarysubmit ‘dummy’ claims cards. Claimssubmitted for diagnostic imagining andlaboratory tests carried out in privatelyowned facilities are assigned a tariff codeand entered into the Physicians Claims file.Manitoba Health documents all hospitalutilization through detailed separationabstracts submitted by the province’shospitals for every patient they discharge.These abstracts include the patient’s MHnumber, the identification numbers of theattending physician(s), and up to 16 fieldsof diagnostic and procedure codes. Theseare coded using the 5-digit ICD-9-CMdiagnostic and 4-digit procedure codes.GENDER-SPECIFIC CONDITIONSWe selected all the diagnoses andprocedures specific to either women (suchas obstetric care) or men (such as testicularcancer) from the Physician Claim Fileand the Hospital Separation Abstract Fileand constructed the following categories: