Can Healthcare Premiums Improve Data Quality?

Christopher Smith Archive

With the Alberta government’s announcement that the province faces a $7 billion shortfall this year, it is not surprising to see the debate about healthcare premiums once again hit the front page. The premise that the health budget will be “saved” by the reintroduction of healthcare premiums is worthy of skepticism. The chance to revisit the discussion on healthcare premiums presents another, unexpected, opportunity. One that most people would not even consider.

Can we improve data quality through the reintroduction of healthcare premiums?

The reason I raise this question relates to planning activities and analyses being done in bone and joint health. As we look forward to the next 30 years of health service delivery in Alberta, we are being asked many questions relating to demand and need:

  • How many surgeries will be needed in five years to serve population X?
  • How many implanted devices will fail over the next 10 years?
  • How many patients visit a specialist more than once per year for condition Y?
  • What percentage of Albertans diagnosed with Z are prescribed medication A?
  • What proportion of Albertans seeking treatment B received magnetic resonance imaging?

To answer these questions, ABJHI looks at multiple data sources to understand the needs and behaviours of the population. One of these data sources is the patient registry, the database of all Albertans who interact with the health system. Every person with an Alberta Health Card has an entry in the patient registry – although under our privacy and data agreements, ABJHI has access only to a small subset of it for a limited group of patients, and under the strictest access provisions to protect the identity of Albertans.

The patient registry includes three pieces of information that are key for planning purposes:

  1. The unique lifetime identifier, or ULI, which uniquely identifies the person across all health databases;
  2. The date of migration in to and out of Alberta; and
  3. The date of death.

The reason that these data points are so relevant is they enable us to use Alberta data to project things like survival rates (i.e. the proportion of people that receive a particular treatment that will still be alive in Alberta in 5 years, 10 years, 15 years, etc). This is essential when planning service capacity in order to ensure the province is adequately resourced to meet the needs of its future population.

So what does this have to do with healthcare premiums, you may ask yourself?

The primary trigger for entry into the patient registry is application to receive an Alberta Health Card, or admission to a hospital for a non-resident. The primary trigger for updating the patient registry used to be to ensure that healthcare premiums were no longer charged when a person died or migrated out of province. Since healthcare premiums were eliminated, the motivation to alert Alberta Health that a person has died or moved away has been greatly diminished and the reliability of the patient registry has suffered ever since.

As we project forward, we are necessarily using imperfect data to determine how many patients will continue to need specialist services, or how long a particular implant will last before needing replacement, or what proportion of patients continue to adhere to their care plans. The further out we project, the more of an impact the imperfect information will have, because the data under-reports death and emigration, which can dramatically alter the long-term outlook.

I sincerely doubt that many will entertain the notion of reintroducing healthcare premiums to improve data quality. It may be helpful, though, to consider some of the upsides before dismissing the idea outright.