A Brief Introduction to Four National Health Databases in the United States

Health and medical care pervade every aspect of our lives. As the world population ages, an entirely new demographic stress will be put on healthcare systems. Some estimates project healthcare costs in the United States to account for 20% of GDP in the next few years. In comparison, China’s total expenditure on health as a percentage of GDP has risen steadily and it is currently below 6%. However, with the rise of life expectancy, an aging population and higher living standards, health expenditure in China will continue to rise.  Another challenge China faces is healthcare system reform to ensure equity and to reduce health disparity. To solve these challenges, accurate collection of health statistics at the national level is needed. In this article, we introduce and compare four national health databases in United States, which are pillars for evaluating national health profile and for formulating national health policies. The four databases are National Health Interview Survey (NHIS), Medical Expenditure Panel Survey (MEPS), National Health and Nutrition Examination Survey (NHANES) and Behavioral Risk Factor Surveillance System (BRFSS). As an example, we illustrate how to derive the prevalence of cholesterol screening from the four databases. Despite differences, the overall distributions follow similar patterns across four datasets. These databases can be linked with other data sources to answer more complicated questions in health and healthcare. We hope that this article can draw the attention of Chinese health researchers and policymakers on the importance of health surveillance and can lead to more discussions and interest on how China can benefit from the U.S. experience in conducting health surveillance at the national level

The effect of patient satisfaction with pharmacist consultation on medication adherence: an instrumental variable approach

RESUMEN Hay pocos estudios que cuantifiquen el impacto de la satisfacción del paciente con la consulta farmacéutica sobre la adherencia a la medicación. Objetivos: El objetivo de este estudio es evaluar el efecto de la satisfacción del paciente con los servicios de consulta farmacéutica sobre la adherencia a la medicación en una gran organización de gestión de cuidados. Métodos: Analizamos datos de un cuestionario de satisfacción de 6.916 pacientes que habían usado consultas farmacéuticas de la Kaiser Permanente Southern California desde 1993 a 1996. Comparamos, tratando la satisfacción del paciente como exógena, en un modelo probit de una ecuación, con un modelo proibit bivariado donde la satisfacción se trató como endógena. Se utilizaron diferentes conjuntos de variables, incluyendo medidas del bienestar emocional de los pacientes y propensión de los pacientes a adquirir sus medicamentos en una farmacia no Kaiser Permanente (KP). Se usó el test Smith-Blundell para probar si la satisfacción del paciente era endógena. Se usaron test de sobre-identificación para probar la validez de las variables instrumentales. El instrumento débil de Staiger- Stock fue utilizado para evaluar el poder explicativo de las variables instrumentales. Resultados: Todos los métodos indicaron que el método de variables instrumentales utilizado tuvo poder explicativo. El modelo probit de una ecuación indicó que el efecto de la satisfacción del paciente con la consulta farmacéutica fue significativo (p<0,010). Sin embargo, el modelo probit bivariado revela que el efecto marginal de la consulta farmacéutica en la adherencia a la medicación fue significativamente mayor que en probit de una ecuación. El efecto se incrementó del 7% al 30% (p<0,010) después de controlar el sesgo de endogenicidad. Conclusión: Después del adecuado ajuste del sesgo de endogenicidad, los pacientes satisfechos con los servicios de sus farmacias tiene sustancialmente más probabilidad de cumplir su medicación. Los resultados tienen importantes implicaciones políticas dado el creciente enfoque en los papeles del farmacéutico y los cambios reglamentarios en el ámbito del ejercicio profesional.ABSTRACT* There are limited studies on quantifying the impact of patient satisfaction with pharmacist consultation on patient medication adherence. Objectives: The objective of this study is to evaluate the effect of patient satisfaction with pharmacist consultation services on medication adherence in a large managed care organization. Methods: We analyzed data from a patient satisfaction survey of 6,916 patients who had used pharmacist consultation services in Kaiser Permanente Southern California from 1993 to 1996. We compared treating patient satisfaction as exogenous, in a single-equation probit model, with a bivariate probit model where patient satisfaction was treated as endogenous. Different sets of instrumental variables were employed, including measures of patients' emotional well-being and patients' propensity to fill their prescriptions at a non-Kaiser Permanente (KP) pharmacy. The Smith- Blundell test was used to test whether patient satisfaction was endogenous. Over-identification tests were used to test the validity of the instrumental variables. The Staiger-Stock weak instrument test was used to evaluate the explanatory power of the instrumental variables. Results: All tests indicated that the instrumental variables method was valid and the instrumental variables used have significant explanatory power. The single equation probit model indicated that the effect of patient satisfaction with pharmacist consultation was significant (p<0.010). However, the bivariate probit models revealed that the marginal effect of pharmacist consultation on medication adherence was significantly greater than the single equation probit. The effect increased from 7% to 30% (p<0.010) after controlling for endogeneity bias. Conclusion: After appropriate adjustment for endogeneity bias, patients satisfied with their pharmacy services are substantially more likely to adhere to their medication. The results have important policy implications given the increasing focus on the roles of pharmacists and regulatory changes in professional scope of practice