Health interventions: health services : 72(a). Selected outpatient visits: self-reported visits (I) -

1. Mean number of self-reported visits to a dentist or orthodontist per person per year. 2. Mean number of self-reported visits to a medical or surgical specialist per person per year. 3. Proportion of population reporting to have had a contact with a psychologist or psychotherapist during the past 12 months.

Calculation

1. Mean number of self-reported visits to a dentist or orthodontist per person per year, derived from EHIS questions HC08 and HC09. HC08: When was the last time you visited a dentist or orthodontist on your own behalf (that is not while only accompanying a child, spouse etc)? (1) Less than 12 months ago /2) 12 months ago or longer / 3) Never) If HC08 is 1):  HC09: During the past four weeks ending yesterday, that is since (date), how many times did you consult a dentist or orthodontist on your own behalf? (number of times). Total number of contacts reported under HC09 is extrapolated from 4 to 52 weeks, and divided by the total number of respondents in the sample.

2. Mean number of self-reported visits to a medical or surgical specialist per person per year, derived from EHIS questions HC12 and HC13. HC12: When was the last time you consulted a medical or surgical specialist on your own behalf? (1) Less than 12 months ago /2) 12 months ago or longer / 3) Never) If HC12 is 1):  HC13: During the past four weeks ending yesterday, that is since (date), how many times did you consult a specialist on your own behalf? (number of times). Total number of contacts reported under HC13 is extrapolated from 4 to 52 weeks, and divided by the total number of respondents in the sample.

3. Percentage of respondents reporting to have had a contact with a psychologist or psychotherapist during the past 12 months, derived from EHIS question HC.16 During the past 12 months, that is since (date on year ago), have you visited on your own behalf a …? (different types of health care providers are listed among which ‘psychologist or psychotherapist’). Numerator = number of respondents answering yes to the question whether they visited a psychologist or psychotherapist. Denominator = total number of respondents in sample.

EHIS data will not be age standardized.

Relevant dimensions and subgroups

Country
Calendar year
Sex
Age group (15-64, 65+)
SES (educational level. ISCED 3 aggregated groups: 0-2; 3+4; 5+6)

Preferred data type and data source

Preferred data type

HIS

Preferred data source

EHIS

Data availability

BE, BG, CZ, DE, EE, EL, ES, FR, IT, CY, LV, HU, MT, AT, PL, RO, SI, SK, CH, NO and TR conducted a first wave of EHIS between 2006 and 2010. It is noted that not in all of these countries a full scale survey was carried out; in some only specific modules were applied, in others the full questionnaire was applied in a small pilot sample. It is expected that all EU Member States will conduct EHIS in the second wave, which is planned for 2014. The results of the first wave are expected to be published in two stages, 11 countries in October 2010, the remaining countries in April 2011. EHIS data are available by sex, 8 age groups (15-24/25-34/35-44/45-54/55-64/65-74/75-84/85+) and ISCED groups.

Data periodicity

EHIS will be conducted once every 5 years. The first wave took place in 2007/2010 (with some derogations in 2006) and the second wave is planned for 2014.

Rationale

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

Remarks

According to current plans, Eurostat will probably not age-standardize EHIS data. For comparability reasons ECHIM would however prefer age-standardized data.
The EHIS instructions for question HC13 reads: this question is 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. Visits to dental surgeons should be included. Do not include visits to general dentists.
For dentists and specialists (definitions 1 and 2), EHIS asks respondents to report visits to health care providers that took place during the past four weeks, as using a relatively short time frame will prevent recall biases. A downside of using a short recall period however is that seasonal influences may bias the estimates. This should be taken into account in the design of the fieldwork, i.e. spreading the data collection over the entire year.
Extrapolating the estimate from 4 weeks to one year will enlarge the statistical error surrounding the estimate. This will in particular be a problem in case of insufficient sample sizes.
Currently EHIS does not allow calculation of the mean number of visits to mental health care providers per capita per year. Given the public health impact of mental health problems, it was decided to include the ‘proportion of population reporting contact past 12 months’ as the second best proxy. It would be preferable if the EHIS questionnaire would be adapted to make possible the derivation of the ‘mean number of visits…’ indicator.
(E)HIS-based estimates may be influenced by reporting biases and sampling related biases. Therefore they may not be an adequate reflection of the current situation in a country, and other estimates may be better for this purpose (see indicator 72b). However, as a common methodology is underlying the gathering of EHIS data, they suit well the purpose of international comparison.
The above definition and calculation are based on the first version of the EHIS questionnaire, as used in the first EHIS wave (2007/2010). The EHIS questionnaire will be revised, hence adaptations to the EHIS question underlying this indicator may occur in the second wave (planned for 2014).
The legal basis for EHIS is regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work. This is an umbrella regulation. Specific implementing acts will define the details of the statistics Member States have to deliver to Eurostat. An implementing act on EHIS is expected to come into force in 2014.

References

Work to do

Monitor EHIS/Eurostat developments

Discuss with Eurostat/technical HIS which recall period/extrapolation methods are best to apply considering the (limits to the) organization of the fieldwork in the countries.

Advise Eurostat/technical HIS group to also ask repondents to report the number of visits to mental health care providers

European Commission - Public Health: healthindicators.org

Definition