Infographics
Data Visualisation
The Netherlands
Because of privacy issues it is not easy to acquire and use actual medical datafiles in The Netherlands. In the past I worked with invoices from Health Insurance Companies. Always there were ways for declarants to bypass and ‘defeat’ the system. This is a ‘historical’ Excel Datafile of 2002-2005 for some Hospitals. By using Fusiontables I can select the 480 files of code C105190305 (= Total Hip) and 291 files of C106190306 (= knee prosthesis).
Example (Fusiontables) ‘Total Hip’
Details
The price of the total hip (activity C105190305) = 2000 Euro. In the middle the column with the time stamp. In the right column the code of the declarant.
With these type of files it was possible to benchmark and find anomalies. This is history……
Oorsmeer (ear wax =cerumen) Gate (Source: Volkskrant Jan. 13th 2013)
Recently there was much to do about upcoding (=high declarations) by E.N.T. specialists.
Why these Ear Wax Problems?
Nowadays there is another Invoice system. The DBC (Diagnose Behandel Combinatie = Diagnosis Treatment Combination). There is one price for a certain DBC. Registration is very important now, because treatments can be different within the same DBC . Some simple treatments (like the removal of debris = cerumen from the ear ) however are free of charge. So often an existing other activity (like code 12) is administered by E.N.T. specialists …. In this DBC (code 12) belongs policlinical treatments like removal of a corpus alienum or a polyp from the external ear. In the graph one can see that the percentage of this treatment group (code 12) is rising from 18% to 24 % within 4 years (Source NZA). Probably this is partly upcoding practice ( when actually only ear wax is removed).
Excel (Data Source NZA)
Graph
Of course this graph (code 12) only reflects a percentage of a group of DBC’s which all are also rising in this period from 2008-2011. However, it is said by Health Authorities that code 12 is rising relatively fast. So E.N.T. specialists are ‘in the picture’ now. Your comment please! (My final work in the MOOC course Infographics)
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Quote “Als deze gegevens bekend zijn bij de NZa dan moet u deze inderdaad opvragen via een Wobverzoek. Dit kan nog steeds niet met een e-mail. U kunt de NZa een brief toesturen met uw verzoek. Dat moet wel voldoende specifiek zijn. Als er enige haast is dan adviseer ik u om het verzoek ook per fax in te dienen.”
en
“Het is uiteraard niet zeker dat de NZa de gegevens aan u verstrekt. Als dat niet het geval is dan kunt u na afwijzing van het verzoek (ook schriftelijk) bezwaar maken.
Leuk idee om daar iets mee te doen in het kader van een infographics-cursus! Het lastige is alleen dat uit dit voorbeeld de rol van het grafische element niet zo duidelijk is, maar dan zou je beschikking moeten hebben over veel meer data met allemaal codes die dezelfde trend vertonen en dan code 12 die daar opeens als een irritante puist uitspringt of zo.
Ik wil hierbij een lans breken voor het vrijelijk ter beschikking stellen van medische data ter analyse. Uiteraard met de nodige waarborgen. Een goed voorbeeld is de aanpak van het CBS. De ‘open data movement’ dient naar mijn smaak een betaalbare zorg. Ik zal dit idee dan ook inbrengen bij het Ministerie van VWS (betaalbarezorg@minvws.nl) dat een oproep heeft gedaan.
Waarom?
1) Er zijn minder dure analysten nodig (toch al een schaars goed)
2) Ongetwijfeld komen er nieuwe bevindingen (wisdom of the crowd)
3) Draagvlak verbreding
Misschien toch hoog tijd voor een ministerie van gezonde economische prikkels. Er valt veel te winnen.