Cohen M M, MacWilliam L
Clinical Epidemiology Unit, Sunnybrook Health Sciences Centre, North York, Ontario, Canada.
Med Care. 1995 Dec;33(12 Suppl):DS21-42. doi: 10.1097/00005650-199512001-00006.
A set of 102 population-based indicators was developed from multiple administrative data sources; these indicators were used to compare the health status of 1 million Manitoba residents across eight administrative regions for 1 year. Marked variations in health status were shown. Despite theoretically equal access to care in a universally insured system and high rates of utilization of hospital and physician services, residents of Manitoba's two northern, more remote regions scored most poorly--consistently and with statistical significance--across a variety of health status indicators. The strength of the various indicators was evaluated, and premature mortality emerged as the most useful "flagship" indicator for future analyses. Indicators that purport to be sensitive to how well a health care system is performing showed patterns similar to those derived from more classic measures (eg, mortality, low birth weight). Furthermore, the "system sensitive indicators" did not appear to be sufficiently independent of utilization biases.
