Medical Services

Original Source: Ontario Health Insurance Plan (OHIP) Approved Claims files
Distributed by: Provincial Health Planning Database (PHPDB), Ontario MOHLTC
Suggested citation (see Data Citation Notes):
Medical Services [years], Provincial Health Planning Database (PHPDB) Extracted: [date], Ontario MOHLTC

Data Notes

• Medical services represents is a newly available source of morbidity information. Other components of morbidity include hospitalizations and ambulatory care visitis. Both are also available through the Provincial Health Planning Database (PHPDB).
• Medical services information is obtained from the Ontario Health Insurance Plan (OHIP) Approved Claims files.
• The Approved Claims contains service and payment information for both fee-for-service claims submitted by physicians and other licensed health professionals and some of the "shadow billings" by providers in organization covered by alternate payment arrangements. Included in a typical claim is information about the patient, provider, Fee Schedule Code/procedure preformed, number of services/units delivered and some "diagnostic" information.
• Since only some of the claims from the MOHLTC's various alternate payment programs or "shadow billers" are included there may be undercounting of total volume of certain services.
• OHIP had developed a unique coding system for diagnosis. Although some of the codes do bear a resemblance to equivalent International Classification of Disease codes, they should not be confused with any other diagnostic coding system.
• Some diangnosis codes may have completely different meanings depending on the specialty of the provider and should therefore always be used in conjunction with the diagnosis type field.
• Aproximately 50% of diagnosis codes are missing from the medical claims data since there is no requirement to include them.
• Geographic information for residence of patient must be interpreted with extreme caution. OHIP does not collect any geographic information on either the patient or the provider as part of the claim. The location of the patient in the PHPDB is based on the address of the person recorded in the Registered Persons Database. Many of these addresses have never been updated since they were first enetered in the early 1990's.
• Rates and proportions based on counts less than 5 must be suppressed. This is specified in the Ontario Provincial Health Planning Database User Agreement.

References and Resources

1. Ontario Ministry of Health and Long-Term Care. PHPDB - Medical Services User Guide . Toronto, ON: Ontario Ministry of Health and Long-Term Care.
2. Hux JE, Tang M. Chapter 1: Patterns of Prevalence and Incidence of Diabetes. In: Hux JE, Both GL, Slaughter PM, Laupacis A (editors). Diabetes in Ontario. AnICES Practice Atlas. Toronto: Institute for Clinical Evaluative Sciences. 2003. 1.1-1.18. URL: http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=67&morg_id=0&gsec_id=0&item_id=1312&type=atlas