European Commission - Public Health: healthindicators.org

Other outpatient visits

Definition of indicator

Mean number of contacts per capita per year, with: physiotherapist, alternative practice, maternal/child care, mental health care.

Calculation (numerator, denominator)

(1) Average number of contacts with a dentist, orthodontist or specialist per capita per year (self-reports), derived from EHIS-questions on outpatient visits (not GPs) HC.9 and 13:

HC.9: During the past four weeks ending yesterday, that is since (date), how many times did you visit a dentist or orthodontist on your own behalf? (0, 1, 2 etc)

HC.13: During the past four weeks ending yesterday, that is since (date), how many times did you consult a (medical or surgical) specialist on your own behalf? (0, 1, 2 etc)

(2) Eurostat: the average number of patient contacts to medical specialists (self reports from survey the Eurostat European Community Household Panel, ECHP) within a calendar year.

Additional underlying concepts

EHIS reference period of 4 weeks is not optimal for calculating number of visits per year. The introduction to EHIS questions (HC.12 and) HC.13 is “Next questions are about consultations with medical or surgical specialists. Include visits to doctors as outpatient or emergency departments only, but do not include contact while in hospital as an in-patient or day-patient. Also include visits to doctors at the workplace or school”

Relevant dimensions (subgroups)

Country (also region), calendar year, gender, age group.

Preferred data sources

Now: National HIS

In future: EHIS

Eurostat or OECD databases

Rationale

Indicator used in assessment of cost and (equity of) access.

Data availability, quality and periodicity

- EHIS: Reference period of 4 weeks. There is also questions on other visits and consultations with a specialist of a defined field (questions HC. 16 and HC.17), but it is questioned only whether has visited or not in the past 12 months, not number of visits.

- EHIS implemented 2007-2009. Data will thus be available in the coming years (and will be pooled by Eurostat).

- Eurostat: The data are collected from the Eurostat European Community Household Panel (ECHP) carried out during the period 1994-2001. From 2004 onwards in EU15 Member States and 2005 onwards in the new Member States, the new EU Statistics on Income and Living Condition survey (SILC) will be used. Data available at least for 11 countries.

- OECD indicator “Doctor’s consultations” is defined as “the number of contacts with an ambulatory care physician divided by the population. Contacts in out-patient wards should be included”. But in fact, several countries record only general practitioners, others include specialists. Thus, although data are available for most countries, the figures are not comparable.

- OECD also has indicator “Dentists' consultations “ defijed as “The number of ambulatory visits/consultations with a dentist divided by the population.”

- SILC: just 1 question and only in the 2009 module

- WHO-HfA has an indicator “Outpatient contacts per person per year” defined as “the total number of primary health care or ambulatory care contacts divided by the population”. It does not separate GP and other outpatient visits.

- The Mental Health project has run a pilot survey to comprehensively cover ambulatory mental health care (public and total psychiatric outpatient care, seeing health professional).

References

- EHIS standard questionnaire (version of 11/2006)

- EU-SILC, documents

- HIS-round 2004 and EU-SILC 2004 data

- Eurostat European Community Household Panel (ECHP)

Work to do

• Decide which source to use; suggestion: EHIS
• Does EU-SILC have questions? -> answer: -> only 1 question in the 2009 module
• Further development needed !