Health Inequities in Manitoba: Is the Socioeconomic Gap

Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time?
• 8496—regional gynaecological exam, including cytological smear of the cervix, provided by an
OB/GYN specialist
• 8498—complete physical and gynaecological exam, including cytological smear of the cervix,
provided by a GP/FP
• 9795—cytological smear of the cervix for cancer screening
• A pathology or laboratory claim with a tariff code for a Pap test:
• 9470—Cytological Examination—Vaginal Smear
The denominator includes all Manitoba female residents aged 18–69 in the three–year period, except as
noted below.
Note that if a laboratory claim and a physician claim for a Pap test for the same individual are within 54
days of each other, they are counted as one Pap test to reduce double counting over three–year periods.
Nearly all of lab claims are within 54 days of the physician claim.
Women who have had a complete hysterectomy surgery were excluded from both the numerator and
denominator. Hysterectomy surgeries were defined by hospital separations with ICD–9–CM procedure
codes 68.4–68.9 and ICD–10–CCI codes 1.RM.89, 1.RM.91, 5.CA.89.CK, 5.CA.89.DA, 5.CA.89.GB, 5.CA.89.
WJ, and 5.CA.89.WK. These codes include only total hysterectomies, not partial, as women who have a
partial hysterectomy may still have a cervix and would require cervical cancer screening.
Rates for northern and remote areas served by nursing stations may be underestimated due to missing
data. Prior to 2005, only physicians were able to code into the administrative billing system for Pap tests.
As of 2005, nurses officially called “Nurse Practitioners” by Manitoba Health were able to record claims in
the physician data system. However, “Advanced Practice Nurses” or other designations are not included
in the Nurse Practitioner designation, despite the fact that some do Pap tests. Nurses working at
federally–operated Nursing Stations also do not record their work in the billing claims system. However,
most nurses who are not nurse practitioners would be doing Pap tests under the supervision of a
physician, who would most likely be billing for these. At the time of this study, the Repository at MCHP
did not have access to laboratory data, so Pap tests are only observable through the billing system.
Continuity of Care
The extent to which individuals see a given healthcare provider (versus one or more other providers)
over a two–year period. In this study, ‘good’ continuity of care is when a resident receives at least 50%
of his or her ambulatory care from the same healthcare provider over the time period. A provider may
be defined either as an individual physician, a physician group practice, or a clinic. Individuals with less
than three visits to a healthcare provider were excluded from analyses. Tables describing the proportion
of the population excluded from these analyses are below.
Proportion Excluded from Analyses (because they had less than three MD visits over two years)
For Children aged 14 and younger
Time Period Frequency Percent
T1: 1984/85–85/86 51954 8.78
T2: 1986/87–87/88 48278 8.16
T3: 1988/89–89/90 47291 7.99
T4: 1990/91–91/92 43987 7.43
T5: 1992/93–93/94 45908 7.76
T6: 1994/95–95/96 42425 7.17
T7: 1996/97–97/98 49001 8.28
T8: 1998/99–99/00 48720 8.23
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