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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Health Economics Information Resources: A Self-Study Course

Module 2 - Sources and Characteristics of Information Relating to Health Care Financing in the US

Alerting Users to Data Source Issues

Whenever directing users to data sources, however, be sure to alert them to the relevant documentation for an explanation of scope of study, definitions of populations and variables, and details of data collection methodology.

As we consider what care we must take when using data sources, we can multiply the level of complexity very quickly when we turn our attention to international statistical information.

International Data Providers

Earlier, I made reference to Organization for Economic Co-Operation and Development (OECD) and World Health Organization (WHO) reports that compare and even rank the health care systems of various countries. Certainly OECD and WHO are respected data providers.

Practicing and certified nurses per 1,000 population, late 1990s

Practicing and Certified Nurses per 1,000 population, late 1990s

Let us look now a little more closely, however, at an OECD report . Here is a chart entitled “Practicing and Certified Nurses per 1,000 population, late 1990’s” from Health At a Glance, 2001, OECD – from Source OECD, accessed March 12, 2002. Does it appear from this chart, dated in the late 1990s, that Finland had approximately three times as many nurses per 1,000 as did the United Kingdom? You might think so, too – unless you look at next chart which tells you something very important.

Practicing physicians per 1 000 population, late 1990s

Practicing Physicians per 1,000 population, late 1990s

When you look at this chart “Practicing Physicians per 1,000 population, late 1990s” you will see a footnote that indicates that in Finland the count of physicians includes not only all actively practicing physicians but also those entitled to practice. Could this also be true of counting nurses in Finland too? On the previous page of the report is the definition of the variable “practicing nurse”. “The numbers of actively practicing certified/registered nurses employed in public and private hospitals, clinics and other health facilities.”

It goes on to say, “Nursing assistants (also called licensed practical nurses or enrolled nurses) are not included in nurse numbers in some countries such as Australia, Austria, Canada and the United States.

That items or people are counted differently in different countries is something to remember if you are comparing this statistic in the U.S. with the same figure for another country that does include nursing assistants or licensed practical nurses in their count of “practicing nurses.”

The definition continues, “Most countries report head-count numbers, while the Czech Republic, France, Germany, Hungary and the United Kingdom report full time equivalents.”

Could this make a difference? Think about what, if any, are the implications of this.

And more-
“The United Kingdom and Spain provide only publicly employed nurses (nurses employed in the National Health System). Are there others?

Further on–
“Finland reports all nurses entitled to practice.”

It is easy to see that in reporting the numbers for one seemingly straight-forward variable, that countries are, in fact, measuring differing populations. It is easy to imagine now much more complicated defining and measuring variables might be when you move into the realm of health care financing.

When you are dealing with international comparisons in health care financing you need also to consider differing monetary systems and currencies. The mechanism for accounting for these differences and thus for rendering comparable statistics for expenditures is called Purchasing Power Parity. As the name implies PPP is used as a conversion factor so that internationally comparable price and volume figures can be established. To see exactly how this conversion is made, check the glossary.

The main point in this discussion of international health care statistics is documentation, documentation, documentation!! It is of the utmost importance that you direct your users to it. A seemingly simple endeavor like counting nurses can be fraught with danger of misunderstanding. A reading of the fine print is in order!

 

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