Methods

Data Sources

The data presented is based on information from patients’ electronic medical records provided by Israel’s four health plans. As part of their active and voluntary participation in the QICH program, the health plans provided data for quality indicators that were then aggregated into the national set. Data provided was therefore anonymous and did not include any personal identifiers, ensuring confidentiality.

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Population

The program is based on information which originated in the computerized databases of each health plan, for the entire insured population; hence including all Israeli residents, except for soldiers and prisoners. Additionally, members with incomplete membership in a given health plan during the study period are not included in the report; comprising those deceased and those born during the measurement year, individuals who switched health plan, and Israelis who live abroad for more than two years. A study conducted in the setting of Clalit Health Services has shown, however, that the majority of insured individuals visit their family doctor regularly, with over 90% of insured persons having at least one annual visit and 97% with at least one visit within a five-year period [1].

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Variables

Indicators are presented as rates for the overall population over the measurement period, as well as stratified by sex, age groups, and socio-economic position (SEP). SEP was classified based on geographical areas. The Israel Central Bureau of Statistics (CBS) classifies all neighborhoods in Israel into Geographical Statistical Areas (GSAs), ranging from 1 to 20, based on financial and social information gathered during census [2]. This classification is further refined, and information for new neighborhoods is completed by POITNS, a privately-owned company, which gathers data from multiple sources (including various consumers’ and commercial data), and classifies all GSAs on a scale of 1 to 10. This classification is included in the aggregative data which is reported by all four HMOs to QICH, and was available for 96.7% of all health plan members in 2017. The small percentage of missing data on SEP classification (3.3% of the population), may be responsible for some discrepancies between graphs and tables presenting information with and without SEP.

All measures are presented while stratified into 4 SEP levels: SEP 1 (representing the lowest socio-economic position) represents POINTS classes 1 to 3, and includes 21.4% of the population; SEP 2 represents POINTS classes 4 and 5 and includes 28.5% of the population; SEP 3 represents POINTS classes 6 and 7 and includes 30.0% of the population; and SEP 4 (representing the highest socio-economic position) represents POINTS classes 8 to 10, and includes 16.2% of the population.

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Data Quality

The data is based on the entire population of Israeli residents, not a representative sample. Thus the data presented here are not susceptible to sampling error. However, other sources of error are possible. The methods created for data collection includes an extensive evaluation program intended to minimize the chance of various errors, including differences between health plans in documentation and coding of their insured population’s characteristics, and is based on recommendations noted in the US Agency for Healthcare Research [3]. This method has certainly led to fewer errors, but is unable to eliminate them entirely.

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Refrences:

[1] Rosen D, Nakar S, Cohen AD, Vinker S. Low rate of non-attenders to primary care providers in Israel - a retrospective longitudinal study. Isr J Health Policy Res. 2014; 3: 15.

​[2] אפיון יחידות גאוגרפיות וסיווגן לפי הרמה החברתית-כלכלית של האוכלוסייה בשנת 2008. הלשכה המרכזית לסטטיסטיקה 2013.

http://www.cbs.gov.il/webpub/pub/text_page.html?publ=100&CYear=2008&CMonth=1

[3] MW. F, Damberg C. Methodological considerations in generating provider performance scores for use in public reporting: a guide for community quality collaborative. Rockville, MD: Agency for Healthcare Research and Quality. 2011.