Validation and application of a needs-based segmentation tool for cross-country comparisons.

Lize Duminy,Abhijit Visaria,David Bruce Matchar,Carl Rudolf Blankart,Lukas Schoenenberger,John Pastor Ansah,Nirmali Ruth Sivapragasam

doi:10.1111/1475-6773.13873

Abstract

ObjectiveTo compare countries' health care needs by segmenting populations into a set of needs‐based health states.Data sourcesWe used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data.Study designWe developed the Cross‐Country Simple Segmentation Tool (CCSST), a validated clinician‐administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self‐reported physician diagnosis of chronic disease, and performance‐based tests conducted during the survey interview, individuals were assigned to 1–5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross‐sectionally to assess cross‐country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death.Data collection/extraction methodsWe segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories.Principal findingsThe CCSST is a valid tool for segmenting populations into needs‐based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country‐specific areas for analysis of ecological and cultural risk factors.ConclusionsThe CCSST is an innovative tool for aggregate cross‐country comparisons of both health needs and transitions between them. A cross‐country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high‐need, high‐cost patients.

Highlights

Chronic conditions have been called “the healthcare challenge of this century” by the World Health Organization.[1]
Self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1–5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs)
The Cross-Country Simple Segmentation Tool (CCSST) is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them

Summary

| INTRODUCTION

Chronic conditions have been called “the healthcare challenge of this century” by the World Health Organization.[1]. Lynn et al.[5] developed a needs-based population segmentation approach for improving a health system's effectiveness and efficiency in meeting the needs of the population it serves Within a population, this approach identifies segments or clusters of individuals with similar care goals and similar types and intensity of needs. While no clear definition of a “need” exists, a service is defined as “needed” when a typical individual with a set of characteristics that define a segment will likely benefit from receiving that service (in terms of reducing the likelihood of experiencing a more adverse health state).[6] To date, the operationalization of population needs-based segmentation has been restricted to specific subgroups (e.g., the frail elderly or individuals with possible palliative care needs)[7,8,9,10] or to datadriven approaches relying on electronic records to cluster individuals according to the risk of both poor outcomes and high cost.[8]. The objective of this article is to present the CCSST and demonstrate a cross-country benchmarking application, comparing countries according to (1) the fraction of individuals with high medical needs and (2) the relative hazards of transitioning between lower and higher needs segments, and between those segments and death

| METHODS

| RESULTS

| Strengths and limitations of the study

Findings

| CONCLUSIONS