Enhancing European Health Information System: Technical Group Recommendations 2011

1. Agenda item 5 EHIS wave II Technical Group HIS – March 2011

2. General comments • Average interview duration around 50 mns • Differ among countries (mode of data collection) • Aim for EHIS-2 30-40 mns  Reduction of the questionnaire • Criteria to check the relevance of each question • Policy relevance (link to an EU policy; used to produce indicators) • No overlap with other data sources (except if cross-analysis needed with other EHIS variables) • Avoid low frequency variable • Suitability for cross European comparability • Core social variables Technical Group HIS – March 2011

3. General comments • Criteria taken on board for the new proposal • Answer to EU needs • Eurostat set priorities "high, medium" and "low“ • many indicators  priority clear (ex. ECHI indicators) • for others we want to be sure that Eurostat aligns to SANCO and EMPL objectives • National needs/supplementary questions under the responsibility of each MS Technical Group HIS – March 2011

4. General comments • Changes between EHIS-1 and EHIS-2 (table 2) • From 213 (or 207) #Q to 131  cut of 38% (no optional #Q) • Health status module • #Q 80 to 55  cut of 31% • In all sub-modules but pain and MH • Mainly in domestic activities (HA questions) Technical Group HIS – March 2011

5. General comments • Changes between EHIS-1 and EHIS-2 (table 2) • Health care module • #Q 88 to 50  cut of 43% • Mainly due to • unmet needs (HC) • satisfaction with health care services (#5  0) • out-of-pocket expenditures (#3  0) • Health determinants • #Q 45 (or 39) to 26  cut of 42% • Mainly due to social support (#13  3) and drug use • PA and alcohol consumption ± same number Technical Group HIS – March 2011

6. General comments • Feedback from 21 MS /organisations (thank you!) • BI documents available on CIRCA? • Implement the relevant filters in EHIS-2 • Self-completion form  no filter • Comparability/break in series between EHIS-1 & EHIS-2 • EHIS-2 question name/numbering? Same name, EHIS2 as prefix? • Ensure comparability for trend calculation • Easy if the question is dropped or not changed! • If slight modification, need to state whether or not it’s comparable Technical Group HIS – March 2011

7. General comments • Recall periods – harmonisation needed !!! • 12 months, 3 months, 2 weeks … • Need to use so many different periods? • May cause difficulties for the respondents • Refusal and DK answers • Not answer categories themselves (not given to the respondents) • Option for the interviewer when coding (instead of missing values) • In EU data analysis ‘Refusal’ and ‘DK’ coded in a same category Technical Group HIS – March 2011

8. General comments • Need to change/improve EHIS guidelines (definitions) • Need to know what we want to measure before designing a new question / instrument Technical Group HIS – March 2011

9. Health Status module • MEHM HS01, HS02, HS03 • SILC main source to compute HLY and dissemination of MEHM • Definition of longstanding illness needed • HS03 difficult to translate but split not feasible • Chronic conditions HS04-HS05-HS06 • Purpose of the list? • give an overview of the health profile of individuals? • monitor the prevalence of selected diseases?  Build the list accordingly Technical Group HIS – March 2011

10. Health Status module • Chronic conditions HS04-HS05-HS06 • ICD10 codes?  NO • List of conditions • COPD : make sure that emphysema is included in the translation at national level • Infarctus : keep infarctus and angina pectoris separated • Drop Coronary heart disease (angina pectoris) (overlaps with myocardial infarction) • Add “heart failure” • Kept Cancer since registries have irregular coverage Technical Group HIS – March 2011

11. Health Status module • Chronic conditions HS04-HS05-HS06 • Keep "Cirrhosis of the liver, liver dysfunction" (alcohol-related problems) • Keep "Urinary incontinence, problems in controlling the bladder" (important due to ageing population) • Keep “Rheumatoid arthritis” (inflammation of the joints) • Arthrosis : specify that arthritis is not included • Drop items on low back and neck disorders: too general and will bring difficulties in comparison • Information about other mental diseases is necessary because prevalence is getting higher • Why has 'severe headache such as migraine' been dropped ? Technical Group HIS – March 2011

12. Health Status module • Chronic conditions HS04-HS05-HS06 • Lifetime prevalence, last year prevalence, diagnosed condition • Difference for some conditions whether HS5, HS6 • 3 #Q a lot  non response (FR) • Consensus for last year prevalence • Injuries HS07-HS08 • Recall period 12M  bias , change to 3M? • Keep only injuries requiring treatments by health care professionals Technical Group HIS – March 2011

13. Health Status module • Injuries HS07-HS08 • Drop road traffic accidents and use the community database on accidents on the roads in EU • HS08 not serious but most recent accident • HS08 could be dropped • Work absenteeism HS09, HS10, HS11 • Not clear what is in LFS • Data needed for OECD Health Data • Comparability problem, national characteristics • Combine the 2 questions and don’t ask for specific number of days Technical Group HIS – March 2011

14. Health Status module • Activity limitations • Welcome BI questions • BI rationales on CIRCA and p12 (document 12) • Selection unbalanced (2 vision, 3 hearing, nothing on upper body) • Contact lenses missing • PL1-PL2 not designed for blind people • PL4-PL5 not designed for deaf people • 2 questions on walking to catch variation in walking ability  create a severity scale Technical Group HIS – March 2011

15. Health Status module • Activity limitations • Climbing stairs with or without aid? • Bending and kneeling dropped • BI test walking question identifies most of the people with lower body problems • Self-care activities • Decision in Berlin workshop: drop PC questions • Disagreement from CG HIS • Keep information on 3 aspects • Presence of difficulties • Need help • Receive help Technical Group HIS – March 2011

16. Health Status module • Self-care activities • To what extent the EHIS questionnaire should deal with long-term care burning issues? • PC question more in a disability survey • SHARE as another source for LTC • Filter on elderly only irrelevant question for many people, could lead to frustration and irritation • Proposal from BE (see page 15 – 16) Technical Group HIS – March 2011

17. Health Status module • Domestic activities • Same rationales as for self-care activities • Should be removed, prevalence too low • Combine different types of housework not evidence based • Pain • SF36 better • Measure intensity of pain • Impact on daily life • ECHI computed • No added value from BI questions Technical Group HIS – March 2011

18. Health Status module • Mental well being • What do we want to measure? • Depression  PHQ9 • Psychological well-being  SF36 • Important to measure positive MH • Need to test the new instrument (F2F and phone) • Validated tool, measure depression even without the 9th question? Technical Group HIS – March 2011

19. Health Care module • Health care use (HC questions) • Hospitalisation • Recall period too long  bias (omission) • 2 groups of countries • Better to use administrative data • MS with bad registers, keep HC1 to HC3 (intervals for number of nights) • Definition of “day case” needed • Unmet need • Comparability problem  features of national health care system measured! • But health inequalities issues Technical Group HIS – March 2011

20. Health Care module • Health care use (HC questions) • Unmet need • Too much focus on financial barriers in the proposal • Include unmet needs for dentist, specialist, GP, hospitalisation in SILC • Alternative - 2 questions • HC6 (version EHIS-1) for all medical or health care • Main reasons (could not afford, waiting list …) • Visit to medical professionals • Distinction GP and specialist difficult in some MS • Recall period 12M or 4 weeks? Bias • List of paramedics (dietician for obesity and see p26) Technical Group HIS – March 2011

21. Health Care module • Medicine use • Aim of the questions? • Link with the list of conditions • Change HS4 accordingly otherwise double questioning “Have you been treated for this disease/condition in the past 2 weeks? Yes-No • To know the nature of the drugs prescribed to people change M2 (FR proposal p28) • Adapt the list of medicines accordingly Technical Group HIS – March 2011

22. Health Care module • Preventive services • No need for “ever vaccinated against flu” • Information on last season only (drop PA1) • Split answer categories “1-5 years ago” into “1-2 years ago”; “2-5 years ago” • Group “never” and “>5 years ago” (small groups) • No consensus on grouping some questions • Go back to EHIS-1 phrasing for PA4,PA6,PA8 • Apply same rule for PA5 to PA11, PA14 • Important for cancer policy to know whether tests were carried out under a screening programme Keep PA12, PA15 Technical Group HIS – March 2011

23. Health Care module • Preventive services • Recommended interval between 2 cervical smear tests • Generally 3 or 5 years • Split interval "Not within the past 3 years" into "More than 3 years, but not more than 5 years" and "Not within the past 5 years” • Faecal occult blood test only or endoscopic test (colonoscopy) also? • Council recommendation on FOBT • Take into account the fact the recommendations varies across countries? Technical Group HIS – March 2011

24. Health Care module • Satisfaction with health care services • Poor quality of the current question due to an absence of filter (only those having been used those services) • Out-of-pocket expenditures • Agreement!! Technical Group HIS – March 2011

25. Health Determinants • BMI • How to take into account pregnancy • Physical activity • Mix of ≠ instruments (IPAQ and GPAQ)  validity of the tool? • Period of time different (week, day) • Which indicators worked out based on those questions? • Find a solution by answering to “What do we want to measure “? Technical Group HIS – March 2011

26. Health Determinants • Fruit and vegetables consumption • Seasonality effect (summer vs winter) • Reverse the scale to avoid overestimation of intake • Need a good definition of “portion” • Add soup in FV2 • Social support • Not an appropriate scale to measure social support on the 4 dimensions (emotional, informative, material and self esteem) • Comparability problems due to translation and how questions are understood Technical Group HIS – March 2011

27. Health Determinants • Smoking • Proposal focuses on current smoking behaviour (and quantity) and on passive smokers  other questions optional • 2 types of products because of low prevalence • Proposal to group current and past smoking (SK1 and SK4) • Reconsider answer categories for passive smoking Technical Group HIS – March 2011

28. Health Determinants • Alcohol consumption • Definition of week and weekend days can be problematic • What about workers with special working hours • Difficult in defining a common “standard drink” • Too many answer categories • Seasonality effect (holidays) • Proposals • SMART (almost the revised instrument) • AUDIT-C (permit to design different patterns of alcohol consumption (Non drinkers; Moderate drinkers; Episodic drinkers; Chronic drinkers) providing essential information for prevention policy • Agreement on AL1 and AL6 Technical Group HIS – March 2011

29. Health Determinants • Use of drug • Email exchanges between EMCDDA and Eurostat (p40) • CN.2   'During the past 12 months, have you taken any cannabis?' is the most useful question to retain, if only one is to be kept • Not in favour of a warming question • Move CN2 to the smoking part Technical Group HIS – March 2011

30. Core social variables • 16 core social variables • Guidelines under revision (March DSS meeting) • Ready for EHIS fieldwork • EHIS-1 problem with some CSV IM list of variables • National focal point   Technical Group HIS – March 2011