Newfoundland Panel on Health and Medical Care-Adult Health Survey
Segovia, Jorge, Edwards, Alison C, Bartlett, Roy F, Canadian Journal of Public Health
This paper presents some results, emphasizing regional analysis, of an adult health survey undertaken on the island portion of the Province of Newfoundland in 1994-95.
The adult health survey was the first component of the Newfoundland Panel on Health and Medical Care (NPHMC); the purpose of the NPHMC is to develop models of medical care utilization, measured by number of visits and patterns of care, over a seven-year period. This period spans a major restructuring of the provincial health care system (regionalization with five Community Health Boards and eight Institutional Boards, which began in 1994).
The NPHMC design uses the community as an epidemiological laboratory.1 It emphasizes the importance of demographic and socio-economic variables on health and medical care. This approach could be traced to Virchow as early as 1847.2 Medical sociologists such as Hollingshead,3 Suchman4 and Anderson5 made important contributions. More recently, two multidisciplinary research groups in the USA6 and the United Kingdom7 have provided new conceptual and empirical evidence. This approach has gained recognition from policy makers8 and achieved new legitimacy by the work of health economists.9
DESIGN AND METHODS
The design of the NPHMC includes a cross-sectional telephone health survey (Figure 1) that collected data on demographic, socio-economic, health, and medical care variables. Written consent was obtained to allow access to medical care utilization data. All non-institutionalized adults 20 years and older residing in a sample of households on the island portion of the Province of Newfoundland were telephoned. Labrador was excluded because it would have needed a different design and data collection procedure to respond to its specific cultural and geographical characteristics; this would have exceeded the resources of the research team. The survey also excludes members of the armed forces, RCMP, and foreign students, since they are not covered under the provincial health insurance plan. Individuals who were interviewed and who consented to access to medical care information became the utilization panel; utilization data are obtained retrospectively for three years, and prospectively for four years, by linking the Medical Care Plan (MCP) health insurance number to hospital separations and physicians' claims databases. The follow-up survey will update addresses and household composition.
The survey had two main objectives: 1) to provide descriptive and analytical data on health variables for the island of Newfoundland, allowing for regional analysis; and 2) to provide the variables for developing models of medical care utilization. This paper addresses the first objective.
The sample was designed to study possible variation in utilization by access to medical care, and to permit regional analyses. To accomplish this, in the original proposal we studied the amount and complexity of medical care resources (hospitals, physicians) in the 24 hospital districts into which the island was divided in 1992. This resulted in a division into three areas: Area 1. Tertiary care (includes metropolitan St. John's) - urbanized, tertiary care, most of the specialists, and general practitioners (GPs) on fee-for-service. Area 2. Secondary care - includes smaller towns (urban by provincial standards), regional hospitals, fewer specialists, most GPs on fee-forservice. Area 3. Primary care - includes small, isolated communities, small rural hospitals or clinics, no specialists, most GPs on salary. The sub-populations by sex in each of the three areas (1991 Census) were essentially identical. This fact and the utilization of random digit dialling pointed to the selection of a single-stage cluster (household) random sample for the whole island; in each household, subjects 20 years of age and older were interviewed. The original sample size was 15,000 respondents, reduced to 12,000 as recommended by the funding agency. …