GPs and emergency primary health care

Name: GPs and emergency primary health care
Topic: Health

Division for Health, care and social statistics

National level and county. But diagnoses and emergency health care are only published on a national level.

Annual publication.

We use doctor consultations from the KUHR database (control and payment of reimbursements to health service providers), combined with other data sources, in the variable: «Doctor consultations (in all settings) – average number of consultations/visits with a physician per person per year». The variable is reported in «Joint Questionnaire» who reports data to OECD, Eurostat and WHO-Europe.

Microdata, information on the sample and population are stored as text files.

The statistics on regular GPs’ and emergency primary health care consultations aim to provide an overview of the population’s use of GP and emergency primary health care services. The statistics are replacing the sporadic surveys and statistics publications that have not provided an adequate picture of use of these services.

Data from the KUHR database (for the control and payment of reimbursements to health service providers) and links to the variables of patients taken from Statistics Norway’s statistical registers are used to form a picture of the population’s use of regular GPs and emergency primary health care. The statistics show how often residents consult a GP or emergency primary health care, whether men or women use the service to the same extent, whether different age groups differ in their use of the service, whether there are disparities between various immigrant categories, whether immigrants with different countries of origin use the service to the same extent and how use of a regular GP or emergency wards varies according to the patient’s level of education.

Tables of diagnoses set by a GP was new in 2013, and tables of diagnosis set by an emergency doctor came in 2015. One of the most important tasks for a medical doctor is to set a diagnosis based on symptoms and / or signs on the patient. There are thousands of different diseases; some occur frequently others are rarer. By sorting the diagnoses set during a consultation in to groups or chapters based on ICPC-2 code practice, we can learn more about the most common reasons that a patient seeks their doctor. The diagnoses tables are sorted by sex and age. Since knowledge about diagnoses is regarded as sensitive health information, SSB has received these in an anonymous version. Therefore we are not able to add extra socioeconomic variables.

The public, health authorities, other public bodies, interest groups, professional bodies and researchers. Data from the doctors’ payment database combined with Statistics Norway’s statistical registers will provide new information on the use of doctors, and show variations between different groups in the population.

No external users have access to the statistics and analyses before they are published and accessible simultaneously for all users on ssb.no at 10 am. Prior to this, a minimum of three months' advance notice is given inthe Statistics Release Calendar. This is one of Statistics Norway’s key principles for ensuring that all users are treated equally.

The Norwegian Directorate of Health: http://www.helsedirektoratet.no/publikasjoner/data-fra-allmennlegetjenesten/Sider/default.aspx (in Norwegian only)

The Norwegian Health Economics Administration (HELFO) analysed 2009 data in a report on regular GPs, emergency clinics and registered specialists ( Analyserapport. Fastleger, legevakt og avtalespesialister. Aktivitetsstatistikk 2009 ). This report builds on an update of the analysis conducted by the Norwegian Labour and Welfare Service (NAV) in 2007 of KUHR data on 2006 consultation statistics ( Hva foregår på legekontorene? Konsultasjonsstatistikk for 2006 ), see NAV report 4/2007 (in Norwegian only). The analyses by HELFO and NAV include the patients’ gender and age, while Statistics Norway’s statistics include several variables relating to patients, level of education, immigrant category and country of origin.

A number of tables relating to regular GPs are published every year as part of the health care personnel publications (http://www.ssb.no/english/subjects/06/01/hesospers_en/). The statistics include variables on the regular GPs (gender, age, county of practice, immigrant category and country of birth), variables on the municipality of practice (centrality, size of municipality) and variables of patient lists (open vs. closed patient list). Data on regular GPs are also included in a range of indicators that are published in KOSTRA factsheets within the municipal health service subject area, see http://www.ssb.no/kostra/stt/index.cgi?nivaa=2&;regionstype=kommune .

In 2005, Statistics Norway carried out a project on the population’s use of general practitioner services; the SEDA project, which was based on patient data from a sample of doctors, see report 2007/15 (in Norwegian only).

Statistics are published on activity in hospitals using the Norwegian Patient Register (NPR) as a data source. Statistics Norway publishes the statistics annually at http://www.ssb.no/english/subjects/03/02/pasient_en/ . As with the KUHR database, the statistics are based on a register in which individuals can be identified.

National Centre for Emergency Primary Health Care in Bergen conducts research and promotes knowledge about emergency primary health care. For more information, articles or tables, see: http://helse.uni.no/default.aspx?site=8

In 2008, Statistics Norway published a report on the health of immigrants 2005/2006. The report presents the results of the health-related questions in Statistics Norway’s survey Living conditions among immigrants 2005/2006. The survey takes a representative sample of immigrants and descendants aged 16-70 who have lived in Norway for two years or more who have a background from Bosnia-Herzegovina, Serbia-Montenegro, Turkey, Iraq, Iran, Pakistan, Vietnam, Sri Lanka, Somalia and Chile. The report compares the immigrant population’s health with the health of the population as a whole based on the ordinary living conditions surveys in 2002 and 2005. See report 2008/35 (in Norwegian only). Different methodology and data sources for the statistics on the population’s use of GPs and questions on the use of such services in the sample survey mean that results are not directly comparable.

Statistics Act, § 3.2 (Administrative registers)

No

The statistics cover all persons who are residents of Norway. Persons living in Norway temporarily are not included in the statistics.

The data source for patient data is the KUHR database, which is an administrative register for the control and payment of reimbursements to health service providers. The Norwegian Directorate of Health is the owner of the database and it is administered by the Norwegian Health Economics Administration (HELFO). The KUHR database contains all types of patient contacts for which a fee is payable.

Data from the KUHR database is supplemented with demographic variables for the patients, which are taken from the Central Population Register (CPR) held by the Directorate of Taxes. Every day, Statistics Norway receives electronic reports from the CPR of all changes in the population. The reports are used to update a separate population database used for statistical purposes in Statistics Norway, and this forms the basis for the statistics on the composition of the population. For further details, see Statistics Norway’s Focus on Population .

The data on patients’ level of education are retrieved from Statistics Norway’s National Education Database (NUDB). NUDB contains information on all education a person has completed. For more information on NUDB, see About the statistics relating to the statistics on level of education in the population and http://www.ssb.no/vis/magasinet/slik_lever_vi/art-2006-09-14-01.html (in Norwegian only).

Total count. All persons who are residents of Norway are covered by the statistics.

The KUHR database is based on electronically submitted reimbursement claims from doctors to HELFO. Reimbursement claims sent in paper format are not included, but these make up a very small and declining share of claims. Doctors are reimbursed for patient treatment pursuant to § 5-4 of the National Insurance Act ( Folketrygdloven ). Most regular GPs submit their reimbursement claims electronically. The reimbursement claims also provide an overview of patients’ own share of costs and thereby form the basis for the allocation of health care exemption cards. In an agreement with the Norwegian Directorate of Health (register owner), Statistics Norway receives data from HELFO (register administrator) every year.

Data are subjected to controls and an internal revision by HELFO with a view to reimbursements to doctors and follow-up of patients’ own costs. Statistics Norway undertakes a further control of the data material through links to the population database and Statistics Norway’s education register, NUDB. Registered consultations that are lacking unique identifiers for patients are discarded, i.e. invoices with incomplete or incorrect personal ID numbers. Consultations for patients that do have a unique identifier but who are not Norwegian residents (according to Statistics Norway’s population database) are also discarded. This includes persons with a financial connection to Norway who can be identified with a unique D-number [1]. Non-residents also include persons who have emigrated from Norway. Around two per cent of all registered consultations are discarded (2010 figures).

The tables are based on diagnosis codes from the International Classification of Primary Care (ICPC-2). Only valid codes are included in the statistics, but small errors may still occur.

Average rates are calculated for different groups in the population.

Not relevant

Figures cannot be published where an individual’s identity could be revealed. The statistics follow Statistics Norway’s general rules on confidentiality, and figures are not published if three or fewer observations are given in a cell.

The statistics on GPs were published for the first time in 2012 for the year 2010. While consultations at emergency primary health care wards were published for the first time in January 2014 for the year 2012. Annual updates will be given on ssb.no.

Only persons resident in Norway and registered with a valid personal identification number are included in the statistics. Where a patient does not remember his/her personal identification number at the time of consultation, or gives an incorrect personal identification number, the consultation is not included in the statistics. Previously, the patient had to keep a record of payments made to the health service, but since 2010, patients’ own costs and issues of health care exemption cards have been registered electronically. There is reason to believe that this change has helped reduce errors and omissions in the registration of personal identification numbers. In 2010, one per cent of personal identification numbers given for GP consultations registered in KUHR lacked one digit. The level of personal identification numbers missing for emergency primary health care consultations in 2012 were much higher, 11 per cent. However, we still have information on age and sex for this group, but not information about education and immigration background. In 2013 it's only 3 per cent of the emergency care consultations that lack a valid identification number.

The diagnoses: of 13, 5 million main diagnoses (in 2013) set by GPs during consultation, it is assumed that about. 40 000 of these have a wrong diagnosis code. This is approx. 0.3 percent of the data.

Not relevant