RESEARCH – January 2019

Comparing specialist care morbidity statistics on two datasets: National Institute for Health Development and Estonian Health Insurance Fund

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Background. The National Institute for Health Development (NIHD) is responsible for producing morbidity statistics in Estonia and it is based on the morbidity data collected individually from healthcare providers. This analysis compares the Estonian Health Insurance Fund’s healthcare service bills data with the NIHD morbidity statistics reported by healthcare providers.

Methods. The statistics of specialist care bills in the Health Insurance Fund’s database and the statistics of the specialist care cases reported to NIHD are compared. Since the Health Insurance Fund’s database does not contain data about cases, the corresponding cases were compiled on the basis of medical bills.

Results. In total, there were 2 345 724 morbidity cases in NIHD and 2 621 416 in the Health Insurance Fund’s database (overlap 89%). The numbers of new cases were 1 159 342 and 1 289 439 accordingly, overlap 90%. Comparison of incidences according to diagnosis groups showed that the difference between groups varied from 58% to119% for all cases and 63% to 113% for the new cases. For nearly half of the health care providers case overlap remained in the range of 95% to 114%.

Conclusion. The analysis revealed that the numbers of cases in both datasets are close (89% for all cases, 90% for new cases), but some unexplained differences within diagnosis groups and health care providers exist. To determine, which database is more accurate, the causes of the differences need to be investigated more thoroughly in the future.