THE HEALTH SYSTEM MATRIX 6.1:
Understanding the Health Care Needs of the
British Columbia Population through Population
Segmentation
February 2015
Health Sector Planning and Innovation Division,
British Columbia Ministry of Health
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
HEALTH SYSTEM MATRIX 6.X VERSIONS
Version
6.0
Date
Dec 30 2014
6.1
Feb 02 2015
Changes
Major Update Version from 5.0 updating all data (2002/03 to 2012/13) and adding
2013/14 data. Changes from the 5.0 are highlighted as NEW in this document
Added information from Inpatient care in 13/14 reported in hospital discharges in
2014/15 based on DAD file received from CIHI in January 2015. This additional
information impacted 2013/14 population segments and summaries of inpatient
hospitalizations.
The Health System Matrix is a project of the Health System
Planning and Innovation Division, British Columbia Ministry of
Health. The Matrix database, definitions and insights evolve
version to version as updates are available and as further
insights are gained. Therefore, comparisons should be made
within a Matrix version, and not between Matrix versions.
For further information please contact:
Martha Burd [email protected] or 250-952-2842
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
THE HEALTH SYSTEM MATRIX 6.1: UNDERSTANDING THE HEALTH CARE NEEDS OF
THE BRITISH COLUMBIA POPULATION THROUGH POPULATION SEGMENTATION
CONTENTS
HEALTH SYSTEM MATRIX 6.X VERSIONS....................................................................................... 2
INTRODUCTION ............................................................................................................................ 5
MAJOR CHANGES IN MATRIX 6 ..................................................................................................... 7
Figure 1: Impact from Change to Episodic Depression Registry ........................................................................7
BENEFITS OF USING A POPULATION SEGMENTATION APPROACH .................................................... 9
INSIGHT FROM THE HEALTH SYSTEM MATRIX: POPULATIONS AND THEIR USE OF HEALTH CARE
SERVICES ..................................................................................................................................11
Figure 2: Use of Publicly Funded Health Care, 2013/14, by Population Segment and Major Service Lines .... 12
Figure 3: Use of Publicly Funded Health Care Per Person, 2013/14, by Population Segment and Major
Service Lines .................................................................................................................................................... 12
Figure 4: Distribution of Age Groups within Population Segments, 2013/14 ..................................................... 13
Figure 5: Per Capita Use of Health Care by Population Segments and Age Groups, 2013/14 ......................... 13
HEALTH SYSTEM MATRIX: POPULATION SEGMENT DEFINITIONS ...................................................15
PS14 End of Life ...................................................................................................................................................... 15
PS13 Frail in Care (In Residential Care) .................................................................................................................. 16
Figure 6: Residential Care Clients: Defining sub groups ................................................................................... 17
PS09 Frail in the Community ................................................................................................................................... 17
Populations with Chronic Conditions: PS11 Frail with High CC, PS10 High (without HCC), PS06 Medium CC, and
PS05 Low Complex Chronic Conditions .................................................................................................................. 18
Figure 7: Highlighting 6.1 Change in Population Segments from Using the Episodic Depression Registry ..... 20
Figure 8: Chronic Conditions: Defining High, Medium, and Low Complex Chronic Conditions Sub Groups ..... 20
Figure 9: Distribution of BC Residents with Diabetes across the Population Segments ................................... 21
Figure 10: Distribution of Chronic Condition Populations across the Population Segments ............................. 21
Figure 11: Percent of BC Residents in Each Population Segment who have Specific Chronic Conditions....... 22
PS12 Cancer ........................................................................................................................................................... 22
PS08 Maternity & Healthy Newborns ....................................................................................................................... 23
PS07 Mental Health & Substance Use .................................................................................................................... 23
Figure 12: Hospitalization Diagnosis Codes used to Identify Severe Mental Health and Substance Use
Population ......................................................................................................................................................... 23
Dividing the Remaining Population into Population Segments based on Utilization ................................................ 24
Figure 13: Allocation of the BC Population by Population Segments, 2013/14 ................................................. 24
PS03 Adult Major Conditions Age 18+ .................................................................................................................... 25
PS04 Child and Youth Major Conditions .................................................................................................................. 25
PS02 Healthy & Low User ....................................................................................................................................... 25
PS01 Non User ........................................................................................................................................................ 26
Assignment to a Unique Population Segment each Year ........................................................................................ 26
Figure 14: Unique versus Overlapping Population Segments: Counts of BC Residents ................................... 27
Figure 15: Unique versus Overlapping Population Segments: Distribution of BC Residents ............................ 27
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
SERVICE LINES ...........................................................................................................................28
Figure 16: Crosswalk between Databases and Service Lines .......................................................................... 30
Figure 17: Definition of Service Lines ............................................................................................................... 31
ESTIMATING THE PUBLIC EXPENDITURES ON HEALTH CARE IN DOLLARS .......................................33
Figure 18: Estimation of Dollar Value of Health Care Services ......................................................................... 33
Figure 19 Unit Costs used in the Health System Matrix 6 ................................................................................. 34
BEHIND THE NUMBERS – DATA SOURCES, INCLUSIONS AND EXCLUSIONS .......................................35
Figure 20: Summary of Publicly Funded Health Care Expenditures in the Health System Matrix, as a share of
Provincial Government Health Expense by Function, 2013/14 ......................................................................... 35
Figure 21: Estimate of BC Government Health Function Expenditures Included or Missing from the Health
System Matrix 6, 2013/14 ................................................................................................................................. 36
BACKGROUND: INTRODUCTION TO THE BRITISH COLUMBIA HEALTH CARE SYSTEM .......................37
GLOSSARY .................................................................................................................................38
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
INTRODUCTION
The Health System Matrix is the BC Ministry of Health Services’ unique and innovative
approach to understanding the current and future health care needs of the province’s residents.
Now in its fourth year, the Matrix project is also a demonstration of how data from divergent
administrative databases can be transformed into information and insight into the health of the
population and their use of health care services.
During a year, a patient may have multiple encounters with
the health system, and information on the encounters may
be collected in separate databases. This presents a huge
challenge, for both providers and those managing the
health care system, because every encounter may only tell
part of the story. The Health System Matrix created a
summary view of a person’s encounters with the health
system over the year, to be able to put the pieces together
to show the trajectory story.
To create the Matrix, we started with a question: “If you were creating an annual profile for each
BC resident, what information would you want to know?” Our answer was to bring together into
a single database, basic socio-demographics, chronic conditions, and summaries of health care
services each resident used each year. Then we asked ourselves “How can we use this data to
identify the different health care needs within our population.” With analysis and consultation,
we developed a population segmentation approach, dividing the population into 14 health status
categories ranging from Healthy to End-Of-Life according to their highest health care need each
year and categorized the health care services they used into 25 service lines.
The Matrix works on three levels. First, as a concept it emphasizes the importance of thinking
across the health care system, and the different populations that use services. Second, as Big
Data, it is a database summarizing selected information from linkage between all major BC
public health system data sources available to the Ministry (services provided by physicians,
hospitals, community pharmacies, residential care facilities and other community supports for
activities of daily living; information from chronic condition registries; and socio-demographic
information from registration administrative data). And third, as an interactive analysis tool which
summarizes information from the ‘big data’ to show how the population segments use health
care service lines over time.
The key learning from the Heath System Matrix approach is that the population is not
homogeneous – it is made up of groups who have different
health care needs, using different bundles of services, that
transition between health states at different rates. This
insight has helped to focus the Ministry’s strategic
planning agenda, especially on prevention, care for people
with chronic conditions, and those on the trajectory to
residential care. The matrix has been used in modelling
health care and estimating future demand for health care,
and has been incorporated into the Population Needs
Based Funding Allocation Model which is one of the
Ministry tools uses to fund health authorities.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
The Health System Matrix is widely known as The Blue Matrix. High level summaries of
population segments and their use of publicly funded services in the fiscal year are distributed in
a user-friendly interactive Excel analysis tool. The Excel version of the matrix presents
population segments in rows, and health care services divided into 25 broad service lines
presented in columns. The cells of the matrix presents the populations’ use of services with
blue shading indicating the intensity of use – hence the name ‘The Blue Matrix’.
In building the Health System Matrix, many choices had to be made. The main decision was to
take a patient-centred approach in building the underlying database and summarizing how
people use health care services each year. From that perspective, the Matrix can explore how
BC Residents use publicly funded services anywhere in the province, disaggregated by
population groups, age group, where they live in the province, whether they have a regular
family doctor, or other characteristics. As a result, the underlying Matrix data cannot provide a
provider view – who provided the services, or where and when they were provided within the
fiscal year.
In this document, unless otherwise stated, the analysis refers to information at the BC level in
2013/14.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
MAJOR CHANGES IN MATRIX 6
The definitions of Population Segments are updated with each version of the matrix, as more
data becomes available. For this reason, analysis should always use the same version of the
matrix throughout, and not combine results from different versions.
Major Update 6.0 (December 2014)
 Data has been added for 2013/14, and updated for 2002/03 to 2012/13;
 List of BC residents and their demographic information based on updated/revised Client
Roster.
 Population segments regenerated back to 2002/03 based on updated data.
Major Changes in Population Segments Matrix 6
 Population segments re-numbered because High Complex Chronic Conditions was
split into two populations: Frail with High Complex Chronic Conditions (with HCC) and
High Complex Chronic Conditions (without HCC) to identify the population segment with
high complex chronic conditions who are also ‘frail’. The definition of ‘frail high complex
chronic’ are people with high complex chronic conditions who use services to support
activities of daily living – home support, assisted living, adult day services, short term
convalescent care.

Low Complex Chronic Conditions definition: Matrix 6 used a new Episodic
Depression Registry which counted 359,000 BC residents with depression in 2012/13.
This replaced the previous Depression Registry which counted over 1,142,000 BC
residents with depression.
Figure 1: Impact from Change to Episodic Depression Registry
The difference between the two
registries are the time frames
used in the definitions. While the
previous Depression Registry
counted people who had been
treated for depression at any time
(from the mid-1990s onwards),
the new Episodic Depression
Registry counts only those with
recent treatment. Consequently,
the large number of BC residents
who were previously in Low
Complex Chronic Conditions
population solely because of
depression have moved to lower (healthier) population segments in Matrix 6.1. The
change to the Episodic Depression Registry was applied to all years 2002/03 to 2013/14.
Major Changes in Service Lines
 Change in how hospitalizations are counted in fiscal years: For hospitalizations
which span two fiscal years, Matrix 6 has split the hospitalization to count the days in the
year they occurred. Earlier versions of the matrix followed standard practice for hospital
analysis which allocates all hospital days to the year of discharge. For the matrix, this
created problems for patients who were hospitalized over the March 31 to April 1 date.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population





For example, if they entered hospital March 22, 2012 and were discharged April 5, 2012,
their entire 15 day stay would be reported in 2012/13 while the physician costs related to
that hospitalization would be counted correctly in each fiscal year (physician care
provided in hospital for 10 days in 2011/12 and 5 days in 2012/13). To address this issue
Matrix 6.1 has counted all hospital days in the year they occurred, and adjusted the
count of cases (hospitalizations) and hospital costs to reflect this split. This change will
have a small impact on all population segments that use hospital data in the definition.
See introduction to Service Lines for more information.
SL01 Primary Health Care: Professional Home Nursing. In Matrix 6 rehabilitation
services provided by the health authorities have been separated out and moved to SL20
Rehabilitation.
SL02 Obstetrics: Matrix 6.1 excludes abortions.
SL20 Rehabilitation: Now includes rehabilitation services (physiotherapy, occupational
therapy) provided by the health authorities.
SL22 Community Supports for Daily Living: Case Management has been added to
the service line.
Changes in cost estimates
 All hospital service lines: Unit costs have been revised for hospital care (cost per
weighted case)
 SL01 and SL22: Unit costs have been revised for the home and community care
services provided by the health authorities.
 SL24: The dollar value of drugs used by residential care clients in extended care
facilities associated with acute facilities have been estimated based on a regression
analysis of drug costs used by residential care clients in publicly paid stand-alone
licensed facilities.
 SL07: The dollar value of physician costs of emergency department visits have been
estimated for APP ED shadow billings and NACRS ED visits, based on the average
dollar billings by 3 levels of care and 3 times of day (day/evening/night) recorded in MSP
ED physician billings.
Minor Update 6.1 (February 1 2015)
 Added inpatient hospitalizations in 2013/14 for cases that were discharged in 2014/15,
based on the January 2015 DAD files. Resulted in revised hospitalization summaries for
2013/14 and minor changed in assignment to population segments that use hospital
data in their definitions.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
BENEFITS OF USING A POPULATION SEGMENTATION APPROACH
In analysis of the health system, population segmentation is a useful tool to describe the health
and health care needs of groups in a population, and understand how they differ from one
another. The initiative to develop a population segmentation methodology was inspired by the
“Bridges to Health”1 article by Joanne Lynn et al, published in the Milbank Quarterly in 2007.
The article outlined “how the concept of segmenting patient populations can lead to more
creative and effective strategies for safe, efficient, effective, timely, patient centered, and
equitable health care and thus a better understanding of how to achieve better health for both
the individual and all people.2”
Why create another system of population segmentation? In hospital care, there are many well
established ‘case mix groupers’ which categorize hospitalizations into a groups that share
similar clinical characteristics and costs, and which are different from other groups. Although the
strength of these groupers is their ability to categorize thousands or millions of hospitalizations
into a smaller number of meaningful categories, the groupers have a significant shortcoming they cannot describe the health of an entire population because the grouping methodology can
only be applied to hospitalizations, not people, and only a small portion of the population is
hospitalized in any year. In contrast, a Population Risk Adjustment Grouper provides a broader
approach, as it segments the entire population into different groups, usually based on
information from health care encounters with physicians, hospitals, and prescription drugs in
one or multiple years. Population groupers, such as the John Hopkin’s Adjusted Clinical Groups
(ACG) methodology and 3M’s Clinical Risk Grouper (CRG), have many uses for policy makers
and researchers, including risk adjusting indicators and estimating prospective health care costs
for funding models. Although the complexity and detailed methodology is a strength of these
population groupers, it is also a weakness since it is difficult for a layman to understand the
differences between the groups, and specific characteristics which cause a person to be
assigned to a specific group. In developing our own population segmentation model, we could
see the need for a simpler approach which would have a relatively small number of intuitively
different segments, each defined by easy to understand and measure characteristics.
The Health System Matrix project developed our own population segmentation approach,
dividing the entire provincial population into 13 categories that represented different health
status or health care needs. The number and definition of the segments, and the segmentation
methodology is intentionally simple, following the approach in the Bridges to Health:
1. “The set of population segments must be limited if the health care system is to
offer a sensible array of integrated services for each segment and to make those
services available almost everywhere.
2. The set of population segments should include everyone; that is, at every point in
his or her life, every person should fit into one of these categories.
3. The people in each population segment must have sufficiently similar health care
needs, rhythms of needs, and priorities to make the segment useful for planning,
3
but each segment must be different enough to justify separate consideration. ”
1
Using Population Segmentation to Provide Better Health Care for All: The “Bridges to Health” Model
Joanne Lynn, Barry M. Straube, Karen M. Bell, Stephen F. Jencks, and Robert T. Kambicps13, The
Milbank Quarterly, Vol. 85, No. 2, 2007 (pp. 185–208)
2
IBID, pp 186.
3
IBID pp 187.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
For the Health System Matrix, we derived a list of potential population segments that had
different health care needs, and could be identified through data in the Ministry’s administrative
databases. The resulting segmentation approach is based on 20+ chronic condition registries,
diagnoses from physician or hospital encounters, or use of specific services in single or over
multiple years. The list has evolved over time, and is expected to continue to evolve as
additional information becomes available. The following lists the 14 population segments in the
Matrix version 6.1. People with multiple conditions can ‘qualify’ for multiple population
segments, but for most analysis people are assigned to the population segment which
represents their highest need for health care in the year, in the order shown below. Please refer
to Assignment to a Unique Population Segment Each Year for details of the unique assignment.
PS14 End of Life
PS13 Frail in Care (In Residential Care)
PS12 Cancer
PS11 Frail with High Complex Chronic Conditions (with HCC)
PS10 High Complex Chronic Conditions (without HCC)
PS09 Frail In The Community
PS08 Maternity and Healthy Newborns
PS07 Mental Health and Substance Use
PS06 Medium Complex Chronic Conditions
PS05 Low Complex Chronic Conditions
PS04 Child and Youth Major <18 years
PS03 Adult Major Age 18+
PS02 Healthy
PS01 Non User
In Ministry Strategic Planning, the population segments are grouped into Staying Healthy,
Getting Healthy, Living with Illness and Chronic Conditions, and Towards the End of Life.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
INSIGHT FROM THE HEALTH SYSTEM MATRIX: POPULATIONS AND THEIR USE OF
HEALTH CARE SERVICES
The Health System Matrix provides insight into the health of British Columbians and an
overview of their use of publicly funded services.
It is very important to note that the Health System Matrix includes only selected publicly
funded health services - those that are reported to the Ministry on a person specific
basis. The BC Government’s total Health Expense by Function was forecast at $18.2
billion for 2013/144, of which the Health System Matrix summarizes approximately $11
billion in publicly funded services. Important services are not included, such as salaried
physician services, and BC Cancer Agency activities. See the Behind the Numbers –
Data Sources, Inclusions and Exclusions section for data sources and a table of
included/excluded services.
The accomplishments from the Health System Matrix project can be grouped into three levels.
First, it has provided a common language or categorization to describe the different populations
who use publicly funded health care services. It has moved analysis away from age-based
analysis which tended to group all seniors into high users of health care, towards understanding
the health conditions that drive the need for health care. The second accomplishment was
creating the underlying database that combined person-based fiscal year summaries from the
separate administrative databases into a common data structure and common terminology,
making it easier to undertake cross program and time series analysis. Although the Health
System Matrix cannot answer questions about where services were delivered, or the
chronological order of services used within a fiscal year, it can provide a view across the health
care system that is not possible from any individual database. The third accomplishment is the
set of high level analysis tools and summaries from the Matrix project team, and the insights
gained from them.
One of the first and most important insights from the matrix was being able to measure the use
of major health care services by the population segments. In 2013/14, the matrix could track
$11 billion of selected publicly funded health care services provided to BC residents. This
summary, shown in figures 2 and 3 for 2013/14, highlight the key populations for strategic
planning – the frail populations living in the community or in residential care, and those with
chronic conditions. The fact that these were high user populations was not a new discovery; the
contribution of the Matrix was to provide a way to measure the size of these populations, and
put a dollar value on their use of health care services. It focused attention on the care for
people with chronic conditions, and raised the profile of prevention activities. By summarizing
the use of health care over the entire year, the matrix showed that people in residential care
were the highest cost group per person; although they made up less than 1% of the population,
they used 20% of the services tracked in the matrix. On average, people in residential care
used over $60,000 of health care services per person. Further analysis showed that for those
entering residential care during the year, hospital costs accounted for almost two thirds of their
total costs in the year. This focussed attention on the need for care in the community that would
improve quality of life and allow people to remain in their homes for longer, delaying entry into
residential care.
4
Budget and Fiscal Plan 2014/15 – 2016/17, Table 4.9 2013/14 Expense By Function, p 99.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Figure 2: Use of Publicly Funded Health Care, 2013/14, by Population Segment and Major Service Lines
A major strategic planning document from the British Columbia Ministry of Health ‘Setting
Priorities for the B.C. Health System’ can be found on the Ministry’s website at
http://www.health.gov.bc.ca/library/publications/year/2014/Setting-priorities-BC-Health-Feb14.pdf
The section on Health Outcomes in the document (page 21 onwards) shows how the insight
from the Matrix’s population segments has been used in the province’s strategic planning.
Figure 3: Use of Publicly Funded Health Care Per Person, 2013/14, by Population Segment and Major Service Lines
The Matrix approach has shown the insight that can be gained categorizing people by health
status rather than age. Figure 4 shows the age distribution in each population segment. As
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
expected, it shows the increasing age of the low, medium and high chronic condition
populations and those populations receiving assistance with activities of daily living – but it also
shows the range of ages in these populations. Just as it is misleading to make broad
statements about the health of ‘seniors’, it is also inaccurate to assume that all people receiving
supports for daily living are seniors.
Figure 4: Distribution of Age Groups within Population Segments, 2013/14
The importance of using population segments rather than age to understand health care
utilization is shown in figure 5, which presents per person health care services by age. While
the average services used increased dramatically by population segment, there was much less
variation between the age groups within each population segment.
Figure 5: Per Capita Use of Health Care by Population Segments and Age Groups, 2013/14
The Health System Matrix project has shown the insight that can be gained from using
population segments as an analysis approach. It has also shown the benefits that analysts
have gained from summarizing and synthesizing information into a single database. For others
who do not have access to the underlying database, the matrix data is summarized into an
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
analysis tool in Microsoft Excel that shows summaries of population size by population segment,
broad age groups, and health region of usual residence in the province for each fiscal year.
Utilization data for each of the detailed services lines is summarized into number of users of
each service line, percent of the population using the service, number of encounters for that
service line (generally days, but also visits and hours), average number of encounters per user
of the service line, estimated dollars of service, average dollars of service per user of the
service line, and summaries by broad service lines. For most analysis we have found that
‘Users’ is more informative when examining specific service lines than calculations ‘per capita’;
service providers only see ‘users’, not the entire population that could use the service, and
therefore their notional estimate of average use is actually the average per user.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
HEALTH SYSTEM MATRIX: POPULATION SEGMENT DEFINITIONS
The definition of each population segment is outlined below. The process of assigning people
to population segments begins after all the data is compiled. Then the definitions of the
population segments are applied, and each person is flagged for each of the population
segments they ‘qualify’ for each year, based on information available in the Ministry’s
administrative databases. Then, they are assigned uniquely to the single population segment
which represents their highest need for health care in the year. For most analysis, these
‘unique population’ assignments are used to avoid double counting people, encounters and
dollars. Please refer to Assignment to a Unique Population Segment Each Year for details of the
unique assignment.
In this definition section, some population segments are discussed out of order for ease of
explanation. See Glossary for terminology used in descriptions.
The definitions of Population Segments are updated with each version of the matrix, as more
data becomes available. For this reason, analysis should always use the same version of the
matrix throughout, and not combine results from different versions. Changes to the definition in
Matrix 6 are highlighted throughout the definitions.
 New to 6: For hospitalizations which span two fiscal years, Matrix 6 has split the
hospitalization to count the days in the year they occurred. Earlier versions of the matrix
followed standard practice for hospital analysis which allocates all hospital days to the year of
discharge. For the matrix, this created problems for patients who were hospitalized over the
March 31 to April 1 date. For example, if they entered hospital March 21,2012 and were
discharged April 5, 2012, their entire 15 day stay would be reported in 2012/13 while their
physician costs related to the hospitalization were properly reflect hospital care for 10 days in
2011/12 and 5 days in 2012/13. To address this issue Matrix 6 has counted all hospital days in
the year they occurred, and adjusted the count of cases (hospitalizations) and hospital costs to
reflect this split. This change will have a small impact on all population segments that use
hospital data in the definition.
PS14 End of Life
Living in the Community with Palliative Needs
Broad Category: Towards End of Life
People who received any health care services specifically for palliative care in the year.
Detailed Definition: This includes palliative care services from physicians (based on physician’s
MSP FFS billing for palliative care), were hospitalized specifically for palliative care (CMG810),
received palliative services from health authority’s home and community care programs (HCC),
or were registered in PharmaCare’s BC Palliative Care Benefits Program (Plan P) for BC
residents who have reached the end stage of a life-threatening disease or illness with a life
expectancy of up to six months and who wish to receive palliative care at home.
 New to 6: People receiving HCC palliative care services from health authorities are
included in definition.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
The main reason for creating a separate End of Life population segment was to be able to count
the number of people who were receiving palliative care from the different parts of the health
care system, and to measure their service utilization in the year, separately from the rest of the
population. It is widely recognized that service utilization rises in the last year of life; the matrix
summarizes services by fiscal year so it is not a perfect reflection of services in the last year of
life.
This population segment is highest in the priority assignment to a person’s unique population
segment. Therefore, a person who received palliative care in the community and then entered
residential care will still be counted in the End of Life population segment.
PS13 Frail in Care (In Residential Care)
Frail Population, Living in Residential Care
Broad Category: Towards End of Life
People in the Frail in Care (Residential Care) population are permanent residents of a
residential care facility that provides 24 hour nursing care and assistance with activities of daily
living.
Detailed Definition: People in this segment are either registered with PharmaCare’s Plan B
which covers prescription drugs for Permanent Residents of Licensed Residential Care
Facilities, or they are long term residential care clients in the Health Authorities residential care
reporting system.
Ideally, the description of a population segment should be based on clinical, functional or
cognitive assessments, rather than use of specific services. In this case, however, there were
solid reasons for creating a separate population segment for permanent residential care clients.
First, since health authorities use specific physical / cognitive assessment tools to determine
clinical need and eligibility for publicly funded residential care, being in residential care can be
used as a proxy measure of assessed need for complex care. Second, since people in
residential care have 24 hour nursing, they use health care services differently than the frail
population living in the community, and should be separated out in any planning for community
based services.
Past analysis of the residential care population found that within the group, there are different
patterns of health care use depending on the type of residential facility. The Matrix found that
valuable insight can be gained by sub-dividing the population into three separate groups: Public
Stand Alone Residential Care facilities, Public Extended Care, and Privately funded Residential
Care. Residential care clients in these different categories use health care services differently


Publicly funded Stand Alone Residential Care facilities are licensed residential care
facilities located in the community which are registered under the PharmaCare Plan B.
Regardless of whether the facility is privately owned or owned by the health authority,
clients’ publicly funded residential care days are reported to the Ministry through the Home
and Community Care reporting systems.
Publicly funded Extended Care facilities are attached to an acute care facility or colocated on the same grounds. Regardless of whether the facility is owned by the health
authority or religious affiliates, the clients’ publicly funded residential care days are reported
to the Ministry through the Home and Community Care reporting systems.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population

Private Residential Care: BC resident’s have the option of choosing private licensed
residential care. PharmaCare Plan B covers the drug cost of all residents in licensed
residential care facilities, regardless of whether their care is publicly or privately funded.
Although the privately funded residential care days are not reported to the Ministry through
the health authorities, the Matrix project has estimated the number of privately funded
residential care days based on the start and end dates of private care based on the dates of
Plan B prescriptions. It is important to be able to exclude this group from the denominator
when calculating publicly funded residential care indicators.
Further analysis into the residential care population highlighted the importance of separating the
‘new entrants’ in a population segment from those who were in that segment in the previous
year, since those that enter residential care during the year user services very differently; a
large portion of their health care costs come from hospitalization, compared to people who
entered residential care the previous year.
Figure 6: Residential Care Clients: Defining sub groups
Residential Care Client Group
Publicly funded in Extended Care associated with acute facility
Publicly funded in stand-alone RC facility
Privately funded in stand-alone RC facility
Long Term RC flag
from Health Authority
Y
Y
N
PharmaCare
Plan B
N
Y
Y
For these sub-category assignments, clients with only publicly funded days in the year are
assigned to the Extended Care group; clients with only Plan B coverage in the year are
assigned to the Private Care group. Clients with both publicly funded days and Plan B in the
year are assigned to the Public Stand Alone group; since the Matrix project only looks at annual
use of services, anyone who used two types of residential care in the year will be assigned to
the Public Stand Alone category.
The Frail in Residential Care population segment (PS14) only includes people who were
permanent residents of residential care at any time in the year. Use of short term residential
care, such as transitional care / convalescent care (usually following a hospitalization) or respite
care, would ‘qualify’ the person for Frail in the Community population segment (PS09).
PS09 Frail in the Community
Frail Population, Living in the Community
Broad Category: Towards End of Life
People who live in the community and receive professional home care services or publicly
funded services to assist with activities of daily living.
Definition: For adults, the following services reported to the Ministry through the Continuing
Care reporting system are used to identify this population:

Professional home care services provided by the health authorities, delivered to clients
in the community by registered nurses and rehabilitation therapists.

Home support services provide personal assistance with the activities of daily living to
seniors and adults with disabilities living in their homes, such as bathing, dressing,
grooming and, in some cases, light household tasks that help maintain a safe and
supportive home. This includes CSIL (Choice in Supports for Independent Living) which
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
is a program in which the client can independently manage their publicly funded home
support services.

Adult Day programs for seniors and adults with disabilities provide community-based
supportive group programs and activities that assist with daily activities or give clients a
chance to be more involved in their community, including personal care services,
therapeutic recreation, social activities, and caregiver respite.

Assisted living residences provide housing and a range of supportive services for
seniors and people with disabilities, including personalized assistance with activities of
daily living.

 New to 6: Case Management services, even if they did not use other publicly funded
HCC services.

Short term residential care including convalescent and transitional care (usually following
a hospitalization), and respite care.
Definition: For children age 18 and under, the Ministry of Children and Family Development
(MCFD) provides community-based, family-style care for severely handicapped children age 18
or under who would otherwise become reliant on institutional care. The Frail in Community
population segment identifies these children and youth through registration in the PharmaCare
At Home Program of the Ministry of Children and Family Development (Plan F). However, the
services provided by MCFD are not included in the services summarized in the matrix.
Populations with Chronic Conditions: PS11 Frail with High CC, PS10 High (without HCC),
PS06 Medium CC, and PS05 Low Complex Chronic Conditions
Frail in the Community with High Complex Chronic Conditions
High Complex Chronic Conditions without Frail ADL supports
Medium Complex Chronic Conditions
Low Complex Chronic Conditions
Broad Category: Towards End of Life
Living with Illness and Chronic Conditions
Living with Illness and Chronic Conditions
Living with Illness and Chronic Conditions
The Chronic Condition populations are based on 23 specific chronic condition registries.
The Ministry of Health’s Chronic Disease Management program
develops and maintains a set of ‘virtual’ registries for selected
chronic conditions. Identifying chronic conditions within
administrative databases has its challenges. A chronic condition
may be recorded in administrative data when initially diagnosed
but may not appear on later encounters if the condition is stable,
especially if the data set only collects a single diagnosis per
encounter. Therefore, in identifying chronic conditions it is
necessary to look across encounters and across years. The
Ministry’s chronic condition registries are lists of BC residents who
are likely to have a chronic condition based on national definitions/algorithms applied to multiple
years of data in Ministry databases (such as two diagnoses recorded on physician encounters in
a 365 day period or a single instance of a diagnosis recorded on a hospitalization, or use of
specific drugs). Two physician encounters are used to eliminate the ‘suspect’ diagnoses; the
second encounter within 365 days is considered to be the confirmation of the condition. For all
registry definitions except the new Episodic Depression Registry, once a person is added to a
registry, they remain in the registry for their lifetime. For the Matrix, Cystic Fibrosis is added to
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
the list of chronic conditions based on people registered in the PharmaCare Cystic Fibrosis plan
D for that year.
Chronic Conditions included in the definition of Chronic Condition Population Segments:
Acute Myocardial Infarction (AMI, heart attack)
Alzheimer’s
Angina
Asthma
Chronic Kidney Disease on Dialysis
Chronic Obstructive Pulmonary Disease (COPD)
Coronary Artery Bypass Graft
Cystic fibrosis (PharmaCare Plan D)
Dementia
Depression
Diabetes
Epilepsy
Heart Failure
Hypertension
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Kidney Transplant
Multiple Sclerosis
Osteoarthritis
Osteoporosis
Parkinson’s
Pre-dialysis Chronic Kidney Disease
Rheumatoid Arthritis
Stroke
In the first version of the Matrix, there was a single population segment for all Chronic
Conditions. Analysis and common sense pointed out that this broad chronic conditions group
was not homogeneous, and needed to be divided into more meaningful populations. Although
many studies use the number of chronic conditions to distinguish groups (typically 1, 2, or 3+
chronic conditions), expert advice in the ministry made the point that we needed to consider the
specific condition, rather than the number of conditions; for example, heart failure alone would
put a person in the ‘high complex’. Based on expert advice and analysis, the chronic condition
population was divided into three population segments - High, Medium, and Low Complex
Chronic Conditions - based on specific conditions or interventions and combinations of
conditions/interventions. The registries for interventions almost entirely overlap the registries for
specific diagnoses, but are included to ensure that total number of patients aligns with
information presented by the Chronic Disease Management branch.
 New to 6: The Matrix now uses the new Episodic Depression Registry to identify people
with depression.
The new Episodic Depression Registry identifies approximately 360,000 BC residents (2013/14)
with depression. Previous versions of the Matrix used a broad Depression Registry (approx. 1.3
million BC residents) that contained all people who had ever met the criteria for inclusion (one
hospitalization or two physician billings in 365 days with specific depression/anxiety diagnoses).
The new Episodic Depression Registry is a subset. The nationally developed criteria for adding
a person to the registry is the same as the broad Depression Registry. The difference is that
once added the person will remain in the registry for following years as long as they have at
least one condition-related code or condition-related service (such as a prescription for the
condition) in that year; if they don’t, then they ‘drop out’ of the Episodic Depression Registry and
will need to meet the full inclusion criteria to be included again. For that reason, the Low
Chronic Condition registry is significantly smaller in Matrix 6 since the large number of BC
residents who were previously in Low Complex Chronic Conditions population solely because of
depression have moved to lower (healthier) population segments in Matrix 6. The change to the
Episodic Depression Registry was applied to all years 2002/03 to 2013/14.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Figure 7: Highlighting 6.1 Change in Population Segments from Using the Episodic Depression Registry
 New to 6: Previously, combination of osteoporosis and rheumatoid arthritis would put the
person in High Complex Chronic Conditions. Based on analysis, this combination remains in
Medium Chronic Conditions in Matrix 6.
The definition of the High, Medium, and Low chronic condition categories are shown in the
following table that outlines the single or combinations of conditions that would assign a person
to a specific level.
Figure 8: Chronic Conditions: Defining High, Medium, and Low Complex Chronic Conditions Sub Groups
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Using the 3-level approach has also provided an insight into comorbidities, beyond the specific
combinations used in the definitions, because people are assigned to the chronic condition level
that represents their ‘highest’ chronic condition.
For example, in 2013/14 there were 402,200 diabetics in British Columbia, 46% of which were
uniquely assigned to the Low Chronic Condition population. Those with specific comorbidities
were assigned to ‘higher’ population segments, most notably 17% to Medium and 24% to High
Complex Chronic Condition populations. The other 13% of diabetics were uniquely assigned to
other population segments (from Mental Health to End of Life), based on their highest need for
care in the year. Please see Assignment to a Unique Population Segment Each Year section
for an explanation of how people with multiple health care needs were assigned to a single
population segment for analysis purposes.
Figure 9: Distribution of BC Residents with Diabetes across the Population Segments
The following table shows the distribution BC residents in the chronic condition registries across
the population segments in 2013/14. In the table, people are counted in the population segment
that represents their ‘highest’ need in the year, and each row in the table sums to 100%.
Figure 10: Distribution of Chronic Condition Populations across the Population Segments
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Figure 11 presents another view of the information: the percent of BC residents in each
population segment with the specific chronic condition. Because people can have multiple
conditions, these percentages are not summable. This table shows, for example, that 69% of
the population living in residential care (PS13) have dementia, compared to those who live in
the community, for example 41% of the Frail with High Complex Chronic Condition population
(PS11) and 11% of the High Complex Chronic population without supports for daily living.
Figure 11: Percent of BC Residents in Each Population Segment who have Specific Chronic Conditions
It is recognized that the current population segment definitions do not adequately identify
children and youth with chronic conditions. The Health System Matrix team is working with
groups such as Child Health BC to develop better ways of identifying chronic conditions for
children and youth.
PS12 Cancer
Population with Cancer
Broad Category: Living with Illness and Chronic Conditions
A separate population segment was created for people with cancer because people in this
group require a specific set of health care services, and there is a gap in the information
available through ministry administrative databases.
The best way to identify people undergoing active treatment for cancer would be through the
cancer registry maintained by the BC Cancer Agency. However, since the Ministry does not
have access to this database, the health system matrix project needed to create a ‘virtual’
cancer registry to estimate the number of people receiving cancer treatment each year.
Following the same approach as the Ministry’s chronic disease registries, the matrix flagged a
person for the cancer registry for that year if they had specific malignant diagnoses (non-skin
cancer) recorded on two physicians’ Fee for Service billings in a year or a hospitalization.
A person is assigned to the cancer population segment for the year in which they meet the
cancer registry criteria, and for the following year. Adding the second year was necessary
because of the way cancer specialists are paid in the province. Physicians working for the BC
Cancer Agency (BCCA) are not paid through the MSP FFS billing system, and their patient
encounters (and diagnoses) are not reported to Ministry administrative databases. Therefore,
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
once a family physician refers a patient to a BCCA physician, most of the interventions with
BCCA physicians are missing from ministry databases, and it will appear as if the patient has
concluded their cancer treatment. The Matrix assumes that cancer treatment continues in the
year after the original diagnosis and therefore a person is identified in the cancer population
segment in the year of diagnosis and the following year.
PS08 Maternity & Healthy Newborns
Maternity and Healthy Newborns
Broad Category: Staying Healthy
Women who were pregnant or delivered in the fiscal year, and healthy newborns.
Detailed definition: Women who received obstetric services from a physician (MSP FFS billing)
or a hospital during the fiscal year and their ‘healthy’ newborns. Healthy newborns are defined
as normal newborns in singleton vaginal deliveries (CMG576), normal newborns in multiple or
caesarean deliveries (CMG 577), newborns who had a typical length of hospital stay, newborns
who did not use any of the 16 flagged interventions, and newborns who had no special care unit
days. (Newborns who did not meet these ‘healthy’ criteria are assigned to the Child and Youth
Major Conditions population segment (PS04), unless they had other conditions which would
assign them to a higher population segment).
Since this population segment includes mothers, most of the newborns, and pregnant women,
the total population of this group will not match statistics from other sources that count
newborns and deliveries.
PS07 Mental Health & Substance Use
Mental Health and Substance Use Needs
Broad Category: Living with Illness and Chronic Conditions
People who suffer from severe mental illness or drug addiction.
Detailed definition: People who were hospitalized with a specific range of mental health
conditions (such as schizophrenia, bipolar affective / mood / manic or depressive disorders) or
drug addiction (recorded as most responsible diagnosis in the hospital abstract) in the fiscal
year or in the previous 4 years. Or in the fiscal year, they were in the methadone replacement
program, or were registered in the PharmaCare No-Charge Psychiatric Medication Plan (Plan
G) which provides coverage of certain psychiatric medications for people registered in a mental
health services centre and demonstrate clinical and financial need.
 New to 6: The ICD10 codes used in the definition of this population have been simplified
Figure 12: Hospitalization Diagnosis Codes used to Identify Severe Mental Health and Substance Use Population
Categories
ICD10 Codes
Substance-related
Disorders
Severe Mental
Illness
Mental and behavioral disorders due to psychoactive substance use (F10 to F19)
Mild cognitive disorder (F06.7)
Organic personality disorder (F07.0)
Postconcussional syndrome (F07.2)
Other organic personality and behavioural disorder due to brain disease, damage and dysfunction (F07.8)
Unspecified organic personality and behavioural disorder due to brain disease, damage and dysfunction (F07.9)
Schizophrenia, schizotypal and delusional disorders (F20 to F29)
Mood [affective] disorders (F30 to F39)
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
There is no available measure of severity for the mental health population in the Ministry’s
administrative databases. As a proxy for ‘severe’, the population segment definition used
hospitalization for these specific diagnoses anytime in a 5 year period. The 5 year period was
chosen because these conditions are considered to be chronic (i.e. long duration).
Subsequently, we found that a 5 year period was used by the National Health Service in
England to determine if a mental health condition was in remission5. Therefore the definition of
this population segment was based on people hospitalized for these specific mental health and
substance use issues in the current year or anytime in the previous four years.
Data from the Mental Health and Substance Use Community services and services provided by
Psychiatrists were not available and therefore were not used in the definition of this population
segment, and are missing from the summary of utilization of mental health and substance use
services.
Dividing the Remaining Population into Population Segments based on Utilization
People in these four populations do not have any of the health conditions that would have
assigned them to any of the population segments discussed above. In 2013/14, 40% of the BC
population were identified in one or more of the population segments described above, leaving
60% to be separated into the four population segments based on age and the dollar value of
publicly funded health care services used.
 New to 6: Replacing the former Broad Depression Registry with the new Episodic
Depression Registry has moved many BC residents who were in the Low Chronic Conditions
population (PS05) in Matrix 5.0, to the ‘remainder’ population divided between healthy, major
conditions and non-user populations in Matrix 6.
Figure 13: Allocation of the BC Population by Population Segments, 2013/14
5
2013/14 General Medical Services (GMS) Contract Quality And Outcomes Framework (QOF), p. 20,
National Health Service, England, March 2013. The NHS considered mental health conditions to be in
remission if, in a 5 year period, the person did not have a hospitalization, have an antipsychotic
medication, or have contact with a community mental health centre.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
PS03 Adult Major Conditions Age 18+
Major or Significant Time-limited Health Needs: Adults
Broad Category: Getting Healthy
Detailed definition: BC residents who are 18 years old or older with major health conditions that
were not identified in other population segments. They are identified as having a major condition
if they were hospitalized in the year as an inpatient or day surgery patient, or used more than
$1,500 of physician services (including family physicians, specialists, lab, diagnostics), or used
more than $1,000 of prescription drugs dispensed from a community pharmacy (PharmaNet
claimed amount which includes both government paid and out-of-pocket / extended benefits
prescription drugs dispensed from a community pharmacy), or died during the year.
PS04 Child and Youth Major Conditions
Major or Significant Time-limited Health Needs: Children and Youth < 18 years
Broad Category: Getting Healthy
Detailed definition: For BC residents under 18 years of age with the same definition as PS03
Adult group.
“Healthy” newborns are excluded from this group and assigned to the PS08 Maternity & Healthy
Newborn population segment. The newborns in PS04 Child and Youth Major Health Conditions
population segment are defined as newborns hospitalized with any hospital case mix group
other than singleton vaginal delivery (CMG576) or normal newborns in multiple or caesarean
delivery (CMG 577), or newborns who had atypical length of stay in a hospital, or newborns who
used any of the 16 flagged interventions (Cardioversion; Cell saver; Chemotherapy; Dialysis;
Feeding tubes (PEG); Heart resuscitation; Invasive ventilation greater than or equal to 96 hours;
Invasive ventilation less than 96 hours; Paracentesis; Parenteral nutrition; Pleurocentesis;
Radiotherapy; Tracheostomy; Vascular access device; Non-invasive biopsy; Per orifice
endoscopy), or newborns who were hospitalized one day or more in a special care unit.
It is recognized that the current population segment definitions do not adequately identify
children and youth with chronic conditions. The Health System Matrix team is working with
groups such as Child Health BC to develop better ways of identifying chronic conditions for
children and youth.
PS02 Healthy & Low User
Healthy / Minor Episodic Health Needs
Broad Category: Staying Healthy
BC residents of any age who were ‘low users’ of publicly funded services, and did not have any
health conditions that were identified in other population segments. The term ‘low user’ was
arbitrarily determined, defined as using only a limited dollar value of physician services
(including specialists, labs, and diagnostics) and/or a limited dollar value of prescription drugs
from community pharmacies, and they were alive at the end of the year.
Detailed definition: This population is comprised of all BC residents who annually used less than
$1,500 of physician services and less than $1,000 of prescription drugs dispensed from a
community pharmacy (PharmaNet expenditures which includes both government paid and outof-pocket / extended benefits prescription drugs), did not use any other health care services
tracked in the Health System Matrix, and were alive at the end of the year.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
PS01 Non User
Healthy Non-Users
Broad Category: Staying Healthy
BC residents of any age who used none of the health care services in the year which were
tracked in the Health System Matrix, and did not have any health conditions which would assign
a person to a higher priority population segment.
Assignment to a Unique Population Segment each Year
People with multiple conditions can ‘qualify’ for multiple population segments each year. For
analysis that requires a ‘unique’ assignment to a single population segment, the Health System
Matrix uses the following hierarchy to assign each BC resident to the population segment that
represents their highest need for health care in the year. This priority order was established by
consensus.
PS14 End of Life
PS13 Frail in Care (In Residential Care)
PS12 Cancer
PS11 Frail High Complex Chronic Conditions (with HCC)
PS10 High Complex Chronic Conditions (without HCC)
PS09 Frail in the Community (with HCC)
PS08 Maternity & Healthy Newborns
PS07 Mental Health & Substance Use
PS06 Medium Complex Chronic Conditions
PS05 Low Complex Chronic Conditions
PS04 Child and Youth Major
PS03 Adult Major Age 18+
PS02 Healthy & Low User
PS01 Non User
The following table compares the ‘overlapping’ population segments which counts all people
who met the definition for the segment, with the count of people ‘uniquely assigned’ to the
segment. Because people with multiple conditions are counted multiple times in the table, the
user needs to understand which cells can be summed, and which cannot. By definition, there is
never an overlap between High, Medium and Low Complex Chronic Conditions (PS11, PS10,
PS06 and PS05), and between Major Conditions, Healthy & Low Users, and Non-Users (PS04,
PS03, PS02 and PS01)
In the table, the ‘overlapping’ population segments are shown in the columns:
 The last row in each column shows the total number of people who qualified for that
population segment, while the yellow cell shows the final number ‘uniquely assigned’ to
the population segment. For example, of the 39,640 BC residents who met the definition
for PS13 Frail in Care (in Residential Care), 36,950 were uniquely assigned to that
population segment because it represented their highest need for care in the year.
 The pink cells in the column above the yellow cells show the ‘unique’ count of people
who were assigned to a higher priority population segment, and are therefore summable.
For PS13, 7% were uniquely assigned to a ‘higher’ population segment: 2,690 people to
PS14 End of Life.
 The light gray cells in the column below the yellow cells show the number of people in
the segment that also had any ‘lower’ priority condition(s). The counts in the light gray
cells cannot be summed, because people with multiple conditions will be counted in
multiple segments. For example, continuing in the PS13 column, 25,090 people also met
the criteria for PS10 High Complex Chronic Conditions (without HCC), and 2,620 met
the criteria for PS07 Severe Mental Health and Substance Use. These cannot be
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
summed, because people meeting both criteria are already counted in both PS13 and
PS07. From our definition of the population segments we know the 400 who also met
the criteria for PS02 Healthy & Low Users (low use of only physician and community
pharmacy health care services in the year) must be in private residential care because
they did not use any publicly funded residential care.
Figure 14: Unique versus Overlapping Population Segments: Counts of BC Residents
The table shows the importance of creating separate population groups for either frailty or high
complex chronic conditions or both. For service planning purposes, it is important to know that
of the 58,240 people who receive supports for daily living, 21,470 are uniquely assigned to
PS09 because they do not have dementia, Alzheimer’s, heart failure or other high complex
chronic conditions, while 27,060 are assigned to PS10 because they do have one or more of
these conditions.
Figure 15: Unique versus Overlapping Population Segments: Distribution of BC Residents
27
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
SERVICE LINES
The Health System Matrix Services presents a view of how publicly funded services are used
across the BC health system. To do that, the underlying database brings together information
from the separate administrative databases for physician and hospital care, community
services, and prescription drugs, and summarizes fiscal year utilization by specific service lines.
SL01 – Primary Health Care
SL02 – Obstetrics
SL03 – Gynaecology, excluding Oncology
SL04 – Mental Health & Substance Use
SL05 – Medical Specialists
SL06 – Oncology
SL07 – Emergency Dept.
SL08 – In Hospital Medical
SL09 – Ambulatory Surgical
SL10 – Inpatient Elective Surgical
SL11 – Transplant Surgery
SL12 – IP Trauma and Emergency Surgery
SL13 – Palliative Care
SL14 – Pathology/Laboratory
SL15 – Diagnostics
SL16 – Ambulatory Support Therapies
SL17 – Pharmaceuticals
SL18 – Anaesthesia
SL19 – Hospital Outpatients
SL20 – Physical Medicine and Rehabilitation
SL22 – Community Supports for Daily Living
SL24 – Residential Care
SL25 – Paediatrics
SL30 – Surgeons
SL99 – Other Physicians
Missing from matrix
Healthy living (Population Health)
Environmental Health
Health Emergency Management
Community Mental Health
Emergency Transport
Services not reported to the Ministry’s
administrative databases
The service line categories are based on services of interest and data availability. Not all
publicly funded health care services appear in the Matrix. For a further discussion of the
missing services, please see section Behind the Numbers – Data Sources, Inclusions and
Exclusions.
 New to 6: Hospital workload is counted in the year in which the hospital days occurred.
This is a very different approach than used in all other analysis of hospital care.
Former versions of the Matrix (and most analysis of hospital care in Canada) count hospital
inpatient and day procedure cases, days and dollars (based on resource intensity weights)
following a standard analysis practice which allocates all workload to the year of discharge. For
the Matrix which summarizes health care utilization by BC resident, this presented a problem in
analyzing services for people whose hospitalization spanned the March 31 to April 1 cut-off
between two fiscal years; their physician costs were counted accurately in both fiscal years, but
their entire hospitalization was attributed to the year of discharge.
For hospitalizations which span two fiscal years, the Matrix 6 has split the hospitalization the
fiscal year they occurred, based on admit and discharge dates. The matrix database uses the
label ‘adjusted’ to differentiate from the standard ‘DAD FY’ count of days). To make the split, a
number of assumptions were made. 1) Any intensive care unit (ICU) days were assumed to
occur at the start of the hospitalization. 2) Any alternate level of care (ALC) days were assumed
to occur at the end of the hospitalization. 3) Resource Intensity weights (used to estimate costs)
were divided between two fiscal years in the same proportion as hospital days.
28
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Figure 16: Counting Hospitalizations in year of care
 New to 6: SL01 Primary Health Care: Professional Home Nursing.
In Matrix 6 rehabilitation
services provided by the health authorities have been separated, and moved to SL20.
 New to 6: SL02 Obstetrics: Matrix 6 excludes abortions.
 New to 6: SL20 Rehabilitation: Now includes rehabilitation services (physiotherapy,
occupational therapy) provided by the health authorities.
 New to 6: SL22 Community Supports for Daily Living: Case Management has been added
to the service line.
 New to 6: Methodology has been revised for estimating unit costs for hospital care for the
home and community care services provided by the health authorities
 New to 6: SL07: The dollar value of physician costs of emergency department visits have
been estimated for APP ED shadow billings and NACRS ED visits, based on the average dollar
billings by 3 levels of care and 3 times of day recorded in MSP ED physician billings.
The major administrative databases held by the Ministry contain patient level records of
physician care (mostly Fee for Service billings), hospital inpatient care and day procedures,
emergency department visits, prescription drugs dispensed in community pharmacies, and
services provided in the community to support activities of daily living. Because data are
housed in separate databases, there has been a tendency to do analysis in the silos. Even
though the Ministry databases can be linked, the different data structures make it challenging to
work with more than one database at a time. One of the goals of the Matrix approach was to
encourage analysis across the health care system, and therefore across the databases. The
Matrix project accomplished this by summarizing service utilization by service lines, rather than
databases. In this way, the Matrix shows the entire cost of care from physicians, hospitals,
publicly funded prescription drugs and services provided in the community. The following table
outlines how service lines are built from data from each database.
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The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Figure 16: Crosswalk between Databases and Service Lines
Service Lines
SL01 – Primary Health Care
SL02 – Obstetrics
SL03 – Gynaecology, excluding
Oncology
SL04 - Mental Health &
Substance Use
SL05 – Medical Specialists
Physician Care
Medical Services
Plan (1)
Originating Database
Hospital Care
Prescription Drugs
Discharge Abstract
PharmaCare (3)
Database (2)
GP & Family
Physicians
GP and Specialists
GP and Specialists
GP and Specialists
Professional Home
Care Nursing
Inpatient
Inpatient & Day
Procedures
Inpatient & Day
Procedures
GP and Specialists
Inpatient & Day
Procedures
SL07 – Emergency Dept. (5)
GP and Specialists
ED visits in NACRS
SL08 – In Hospital Medical
Inpatient
SL09 – Ambulatory Surgical
Day Procedures
Inpatient
Specialists
Inpatient
Inpatient
SL13 – Palliative Care
Inpatient
SL14 – Pathology / Laboratory
Specialists
SL15 – Diagnostics
Specialists
SL16 – Ambulatory Support
Therapies (Dialysis)
PharmaCare Plan G
Specialists
SL06 – Oncology
SL10 – Inpatient Elective
Surgical
SL11 – Transplant Surgery &
aftercare
SL12 – IP Trauma and
Emergency Surgery
GP and Specialists
PharmaCare Plan P
Day Procedures
PharmaCare,
PharmaNet
SL17 – Pharmaceuticals
SL18 – Anaesthesia
GP and Specialists
SL19 – Hospital Outpatients
GP and Specialists
SL20 – Physical Medicine and
Rehabilitation
GP and Specialists
Inpatient
Community Rehab
Home Support,
Assisted Living,
Adult Day Program
Case Management
SL22 – Community Supports for
Daily Living
SL24 – Residential Care
Physician visits to
RC
SL25 - Paediatrics
GP and Specialists
SL30 – Surgeons
GP and Specialists
SL99 – Other Physicians
GP and Specialists
1)
2)
3)
4)
5)
Home and
Community Care
(4)
PharmaCare Plan B
Residential Care
Inpatient
MSP: Paid dollars, and estimated encounter days are mainly based on Fee for Service billings. Any shadow billings from
physicians in Alternate Payment programs have been included; standard fee codes have been used to estimate a dollar value
of these services. Physicians on alternate payment programs who do not submit shadow billings are not included; for example,
excluded APP physicians are psychiatrists, oncologists at the BC Cancer Agency, specialists at Women’s and Children’s
hospital.
DAD: Days of care, cases, and resource intensity weights (RIWs) for Inpatient and Day procedure discharges are allocated to
year of discharge. Dollars of hospital care (excluding physician costs) have been estimated from RIWs and estimates of annual
cost per weighted case.
PharmaCare: Dollars of publicly funded prescription drugs dispensed in a community pharmacy. Specific plans are used in the
definition of specific service lines. PharmaNet summarizes dollar value of all prescription drugs dispensed in a community
pharmacy regardless of payer.
Home and Community Care: Health authorities report publicly funded work load units (hours of home support, days of assisted
living, days of Adult Day Programs, Case Management visits, and days of residential care for short term convalescent patients
and long term permanent RC residents. Dollars of care have been estimated from workload units based on estimated BC level
unit costs for each year.
ED visits are compiled from all visits in MSP billings and APP shadow billings, and all other ED visits reported in National
Ambulatory Care Reporting System (NACRS) for the patient, not already counted. Estimated dollars of ED physician care
based on average MSP billings for 3 levels of care and 3 times of day. ED facility costs estimated from HAMIS data.
30
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Figure 17: Definition of Service Lines
Service Line
Type
SL01 – Primary
Health Care
SL01 Physicians
FFS+
SL01 Home
Nursing
Definition ( to uniquely assign physician services to services lines, assignments were made in the
priority order stated)
GP and family practice physicians’ services. Identified by speciality code 0, assigned in priority 18.
Therefore, does not include services for obstetrics, gynaecology, mental health, oncology, palliative
care, rehab, emergency department, and paediatrics and visits to people in residential care which are
counted in other service lines.
Home Care Nursing: Professional home nursing care provided in the patient’s home by the Health
Authority.
SL02 –
Obstetrics
SL02 Physicians
FFS+
SL02 Hospital
SL03 –
Gynaecology,
excluding
Oncology
SL03 Physicians
FFS+
SL03 Hospital
SL04 - Mental
Health &
Substance Use
SL04 Physicians
FFS+
SL04 Hospital
Physician: GP and specialist physician services for mental health.
SL04
PharmaCare
PharmaCare Mental Health Plan: Publicly funded prescription drugs paid under the PharmaCare NoCharge Psychiatric Medication Plan (Plan G)
SL05 – Medical
Specialists
SL05 Physicians
FFS+
Physician Speciality Care: GP and specialist physician services by priority 17. Therefore, services do
not include obstetrics, gynaecology, mental health, oncology, palliative care, rehabilitation, paediatrics
and surgery which are counted in other service lines.
SL06 –
Oncology
SL06 Physicians
FFS+
Physician: GP and specialist care for the treatment of malignant cancer (based on reported diagnosis
code of cancer), assigned in priority 11. Note, does not include services by physicians on salary with
the BC Cancer Agency.
Hospital: Inpatient and day procedure hospital care for the treatment of cancer based on a most
responsible diagnosis of cancer or a chemotherapy/radiotherapy received (excluding skin cancer).
Note, radiation and chemotherapy services provided by the BC Cancer Agency are not reported to the
Ministry's administrative databases.
Physician: Services provided by FFS emergency medicine specialists or GP or specialists in the
Emergency Department (based on FFS location code and fee-for-service fee items, assigned in priority
5); and ED visits reported in NACRS for facilities which do not report FFS encounters.)
SL06 Hospital
SL07 –
Emergency
Department
SL07 Physicians
FFS++
SL07 ED Hosp
Cost
Obstetrics Physician: GP and specialist physician services for obstetrics (service codes 13, 42
assigned in priority 2. Includes midwifery services and excludes abortions.
Obstetrics Hospital: Inpatient hospital care related to pregnancy and childbirth, including services to
healthy newborns. Excludes abortions. Note: Hospital services to unhealthy newborns are in
Paediatrics (hospital) service line.
Gynaecology Physician: GP and Specialist Physician care related to gynaecology, excluding oncology.
Identified by fee items, assigned in priority 12.
Gynaecology Hospital: Inpatient care and day procedures for gynaecology.
Hospital: Inpatient care and day procedures for mental health (Major Clinical Classification 17)
For total cost and average costs per user tables only: estimated hospital facility costs of emergency
department visits, based on an estimated facility cost for ED visits reported physician encounters (MSP
and APP) and ED visits reported in NACRS for facilities which do not report FFS encounters.
Hospital: Inpatient hospital care for medical patients (i.e. non-surgical patients), excluding obstetrics,
gynaecology, mental health, oncology, palliative care, rehab, and paediatrics which are counted in
other service lines.
SL08 – In
Hospital
Medical
SL08 Hospital
SL09 –
Ambulatory
Surgical
SL09 Hospital
SL10 – Inpatient
Elective
Surgical
SL10 Hospital
Hospital: Day procedures performed in hospitals. Includes all day procedures, therapeutic and
diagnostic, elective and emergency, except those reported in other services lines: renal dialysis
(SL16), physician rehab (SL20), oncology (SL06), and gynaecological surgery (SL03). Most day
procedures are elective.
Hospital: Elective inpatient surgeries.
SL11 –
Transplant
Surgery and
after care
SL11 Physicians
FFS+
SL11 Hospital
Physician: Specialist care related to transplant surgery and post surgical care identified by fee items or
diagnostic codes, assigned in priority 1.
Hospital: Inpatient hospital care related to solid organ transplants and post transplant care.
SL12 – IP
Trauma and
Emergency
Surgery
SL12 Hospital
Hospital: Inpatient admissions for trauma or emergency surgery (MCC
SL13 –
Palliative Care
SL13 Physicians
FFS+
SL13 Hospital
Physician: Palliative care provided by GP and specialist physicians identified by fee items or diagnostic
codes, assigned in priority 9.
Hospitalizations for Palliative Care: Inpatient hospital care for patients specifically admitted for palliative
care (CMG810). Does not include patients admitted for other treatment and subsequently receive
palliative care.
PharmaCare: Publicly funded prescription drugs paid under the PharmaCare BC Palliative Care Drug
Plan (Plan P)
SL13
PharmaCare
31
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Service Line
Type
SL14 –
Pathology/Labo
ratory
SL14 Physicians
FFS+
SL15 –
Diagnostics
SL15 Physicians
FFS+
SL16 –
Ambulatory
Support
Therapies
(Dialysis)
SL16 Physicians
FFS+
SL16 Hospital
Hospital: Inpatient and day procedures cases which had renal dialysis performed in hospital. Note,
does not include BC Renal Agency services.
SL17 –
Pharmaceutical
s
SL17
PharmaCare
SL18 –
Anaesthesia
SL18 Physicians
FFS+
PharmaCare: Total publicly funded prescription drugs from community pharmacies, i.e. paid by Ministry
under Fair PharmaCare and other PharmaCare plans, except plans counted in other service lines:
Mental Health (Plan G, SL07), Palliative Care (Plan P, SL13) and Residential Care (Plan B, SL24).
Only publicly funded PharmaCare is included in cost totals. For comparison, the PharmaNet total is
also reported in the Total cost and Cost per user tables; PharmaNet includes the total cost of all drugs
dispensed in community pharmacies regardless of payer.
Physician: GP and specialist physician anaesthesiology services (in hospitals and all other locations)
.
SL19 – Hospital
Outpatients
SL19 Physicians
FFS+
Physician: GP and Specialist services reported in a hospital Outpatient setting.
SL20 – Physical
Medicine and
Rehabilitation
SL20 Physicians
FFS+
Physician: rehabilitation services provided by rehabilitation specialist physicians. Identified by physician
speciality, assigned in priority 8.
SL20 Hospital
Hospital: Inpatient care for patients admitted for rehabilitation services (CMG 805).
SL20 HCC
Community Rehabilitation services (Physiotherapy, Occupational therapy)
SL22 Assisted
Living
SL22 Home
Support
Assisted Living: publicly funded home support services (support for activities of daily living) provided in
assisted living settings.
Home Support: Publicly funded home support services (support for activities of daily living), provided in
the home.
SL22 Home
Support CSIL
Home Support for Community Services for Independent Living: Public funding to CSIL clients to enable
them to arrange their own home support program.
SL22 Adult Day
Services
SL22 Case
Management
Adult Day Care: Home and Community Care adult day care program provided by health authorities.
SL24 Physicians
FFS+
SL24
Prescription
Drugs
Physician: GP visits to residential care facilities, based on fee items, assigned in priority 10.
SL22 –
Community
Supports for
Daily Living
SL24 –
Residential
Care
SL24
Residential Care
SL25 Paediatrics
SL25 Physicians
FFS+
SL25 Hospital
SL30 –
Surgeons
SL30 Physicians
FFS+
SL99 – Other
Physicians
SL99 Physicians
FFS+
Definition ( to uniquely assign physician services to services lines, assignments were made in the
priority order stated)
Laboratory Services: physician services based on FFS billings identified by service codes, assigned in
priority 14.
Diagnostic Imaging: physician services based on FFS billings identified by service codes, assigned in
priority 15
.
Physician: Specialist physician services for dialysis and transfusion services identified by service code
assigned in priority 7. Note, does not include BC Renal Agency services.
Case Management: Health authority case management for home support and assisted living clients.
Prescription drugs for permanent residents of RC. Publicly funded prescription drugs to permanent
residents of stand alone licensed residential care facilities under PharmaCare Plan B. Plus estimates
of prescription drugs used by RC clients in extended care associated with acute care facilities, where
the drugs are dispensed from the hospital pharmacy.
Residential Care: publicly funded residential care including long term and short term (convalescent
care, transition care, respite).
The residential care days used by all population segments except PS13 and PS14 will be short term
RC, by definition. Note: Frail in Care population segment (PS13) includes people in privately funded
residential care. Their private days of care are NOT included in this service line.
Physician: services provided by paediatricians identified by most recent physician speciality, assigned
in priority 3.
Hospital: Inpatient paediatric care (defined by patient service paediatrics) and all inpatient care for
'unhealthy' newborns defined as a newborn hospitalization with any hospital case mix group other than
singleton vaginal delivery (CMG576) or normal newborns in multiple or caesarean delivery (CMG 577);
or who had an atypical length of stay in hospital; or used any of the 16 flagged interventions; or had 1+
special care unit days.
Physicians: surgical services by GP and surgeon specialists, in hospitals, clinics, and offices, identified
by service codes, assigned in priority 13. Therefore, does not include services for obstetrics,
gynaecology, and oncology which are counted in other service lines.
All Other Physician Services: This is the FFS billings for all other services not included in any other
service line, assigned in priority 19.
32
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
ESTIMATING THE PUBLIC EXPENDITURES ON HEALTH CARE IN DOLLARS
Many of the health care services reported in Ministry databases are in terms of units of service,
such as days, hours, visits, or resource intensity weights (used in hospital services). In order to
summarize use of services across the health care system, the Health System Matrix has used a
set of standard unit costs to convert the service units to dollars. The unit costs developed for
the Health System Matrix are BC level values only, intended for analytic purposes of health care
costs, to estimate the relative values of services in a health care bundle across the health care
spectrum. They are not intended to be a measure of the actual cost of providing the service, nor
reflect the variation in the cost of providing services to different populations, or in different
regions, as they do not reflect differences in costs related to the specific delivery / treatment
programs, acuity of patient, regional cost differences, ownership (health authority
owned/operated, not for profit, contracted out, etc.). Very different assumptions were used for
each health care service, and the availability and quality of supporting data varied significantly.
Workload from the Medical Service Plan database (physicians who are remunerated by Fee for
Service) and the PharmaCare / PharmaNet database (prescription drugs dispensed in
community pharmacies) are already measured in dollars. All other services in the Matrix are
reported to the Ministry in terms of workload units. Because the physician and prescription
drugs expenditures include inflation (increases in the fee schedule for physicians, or prices of
drugs over time), it was necessary to determine unit costs for all other services for each fiscal
year. Where available, the unit costs are standard rates used that year or calculated from
administrative data. For others, different approaches were used to determine unit cost time
series. Estimates for hospital costs for inpatient care, day procedure and emergency
department visits include direct and indirect costs, excluding physician costs. (A separate
document is available on the methodology used to estimate unit costs.)
Figure 18: Estimation of Dollar Value of Health Care Services
Administrative database
Hospital inpatient care
(Discharge Abstract Database)
Hospital day surgery
(Discharge Abstract Database)
Physician care (MSP
Physicians on Fee for Service)
Physician care (MSP shadow
billings)
Physician Care in Emergency
Departments
Encounters
Inpatient Total Days by service line
Utilization measures: Cases (discharges),
Acute/rehab days, Intensive Care Unit days, Alternate
level of care days. For hospitalizations spanning two
fiscal years, the utilization has been ‘adjusted’ - split
between the two fiscal years based on dates. ICU
days are assumed to be at the start and ALC days at
the end of the hospitalization, and the hospitalization
counted as a case in both years.
Days based on Cases (discharges)
Estimated encounter days based on unique dates of
physician encounters (from fee-for-service billings), by
service line
Estimated encounter days based on unique dates of
physician encounters (from shadow billings), by
service line
ED visits in Matrix is combination of ED visits from
Fee for Service physicians, MSP ED shadow billings,
and any other ED visit in NACRS facility not already
counted by date.
33
Dollar value of services
Resource Intensity Weight x BC
average cost per weighted case.
For hospitalizations spanning two
fiscal years, the total cost has
been split between the two fiscal
years in proportion to the days.
Resource Intensity Weight x
estimated cost per weighted case
Actual Billed dollars
Estimated dollars based on fee
code
MSP FFS: actual billed dollars.
MSP shadow billings and NACRS
visits: estimated based on
average MSP billings for 3 levels
of care and 3 time of visit (day,
evening, night).
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Administrative database
Prescription drugs dispensed
from community pharmacy:
Publicly funded (PharmaCare)
Prescription drugs dispensed
from community pharmacy:
Total (PharmaNet)
Encounters
No measure of drug encounters
No measure of drug encounters
Prescription drugs dispensed
from Hospitals for Residential
Care clients in Extended Care
facilities
(for SL24 residential care, the dollar value of drugs
dispensed for residents of stand-alone facilities is
reported in PharmaCare. Cost of drugs to RC
patients in extended care facilities was estimated to
avoid undercounting the full publicly funded cost of
their care.)
Community services provided by Health Authority
Home support
Hours
Assisted living
Days
Adult day program
Days
Residential care
Days
Professional home care
Visits
Case Management
Visits
Dollar value of services
Actual paid dollars (This publicly
paid portion of prescription drugs
is included in Matrix total costs.
Actual claimed dollars (This total
includes publicly funded and
privately paid, and is not included
in Matrix total costs)
Estimate based on a regression
analysis including the following
characteristics: age, whether the
patient was new or
Hours x estimated unit cost
Days x estimated unit cost
Days x estimated unit cost
Days x estimated unit cost
Visits x estimated unit cost
Visits x estimated unit cost
The Health System Matrix 6 summarizes data from 2002/03 to 2013/14. Different unit costs
were used for each year for comparing the cost of different services, and bundles of services in
the year. Since the unit costs reflect very different assumptions of ‘inflation’, for comparisons
over time, users are recommended to focus on the number of encounters, rather than dollars.
Figure 19 Unit Costs used in the Health System Matrix 6
34
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
BEHIND THE NUMBERS – DATA SOURCES, INCLUSIONS AND EXCLUSIONS
Health System Matrix summarizes almost all patient level data reported to the Ministry of
Health’s administrative databases. Each database contains a summary of the publicly funded
health care encounters, such as diagnosis, intervention or care provided, and limited
anonymized information about the patient (such as age, gender, region where they live). By
looking across the different databases, the Health System Matrix project provides insight into
the health of BC residents and their annual use of selected health care services by specific
services lines, to provide a view of the different bundles of services by different health status
groups.
The term selected services is used intentionally; it is important to state that the Matrix
summaries do not reflect all publicly funded health care services provided in the province. The
BC Government’s Health Expense by Function was an estimated $17.862 billion in 2013/146.
This estimate includes expenditures by the Ministry of Health (Medical Services Plan and
PharmaCare), the health authorities, and payments for healthcare services by the Ministry of
Social Development and the Ministry of Children and Family Development made on behalf of
their clients. The Matrix summarizes approximately $11.164 billion of publicly funded health
care services provided to BC residents or 62% of the total provincial government Health
Function expenditures.
Figure 20: Summary of Publicly Funded Health Care Expenditures in the Health System Matrix, as a share of
Provincial Government Health Expense by Function, 2013/14
The following table outlines the health care services included and missing from the Health
System Matrix work:
6
Source: Health Function Expenditures, BC Government Budget and Fiscal Plan – 2015/16 to 2017/18,
2013/14 Actual, page 120, February 2015.
35
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
Figure 21: Estimate of BC Government Health Function Expenditures Included or Missing from the Health System
Matrix 6, 2013/14
36
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
BACKGROUND: INTRODUCTION TO THE BRITISH COLUMBIA HEALTH CARE
SYSTEM
British Columbia
 Province on the west coast of Canada.
 Population 4.6 million (2014, BC Stats, PEOPLE 39)
 Large urban population (2.8 million) in the Greater Vancouver area
Ministry of Health
7
 Annual Ministry Budget $16.9 billion (Canadian dollars) 2014/15
 Sets policy, legislation, strategic direction and planning
 Directly funds Physician services, and PharmaCare publicly funded drug
 Funding to regional health authorities, approximately $11.5 billion, is mainly ‘global’ funding, not
separated by specific services
 The Matrix summarizes approximately $11 billion of publicly funded health care services provided
to BC residents. This represents 61% of the total provincial government Health Function
8
expenditures of $18.2 billion in 2013/14 . Health function expenditures is an estimate of the
expenditures on health care services including payments for healthcare services by the Ministry
of Social Development and the Ministry of Children and Family Development made on behalf of
their clients.
Physician services:
 In 2012/13, there were 10,199 physicians in BC, of which 39.8% were paid entirely through Fee
for Service billings, 16.8% were paid entirely through alternative payment programs, and 44.5%
9
paid through a combination of Fee for Service and alternative payments .
Prescription drugs dispensed from community pharmacies
 PharmaCare program: publicly paid portion of prescription drugs. Largest program is Fair
PharmaCare which covers a formulary of drugs and medical devices, with an income based
threshold for coverage for all ages.
 PharmaNet: all community pharmacies are linked electronically through PharmaNet. Therefore
the Ministry has access to all prescription drugs dispensed in community pharmacies, both
publicly and privately paid.
Five Regional Health Authorities provide the following services
 Hospital care
 Integrated community care services (major services: long term residential care, assisted living,
home support for activities of daily living)
 Population health and wellness
 Community mental health
The sixth health authority, the Provincial Health Services Authority operates the Women’s and Children’s
hospital, and co-ordinates major provincial services (Cancer Agency, Renal Agency, provincial
ambulance service, etc.)
7
BC Government, Ministry of Health 2014/15 to 2016/17 Service Plan, February 2014, 2014/15 Estimates
of Operating Expenses, page 19.
8
Source: Full Year Forecast 2013/14 Health Function Expenditures, BC Government Budget and Fiscal
Plan - 2014/15 to 2016/17, 2013/14 Revised Financial Forecast (Third Quarterly Report), page 99.
9
Physicians in Canada 2014, Physician payment data table 2.4, Canadian Institute for Health
Information, 2014.
37
The Health System Matrix 6.1: Understanding the Health Care Needs of the British Columbia Population
GLOSSARY
BCCA
BC Cancer Agency
CMG+
Case Mix Group Plus: a hospital case mix grouper system used in Canada and
developed by the Canadian Institute for Health Information.
HCC
Health authority’s home and community care programs (home support, assisted
living, adult day services, professional home care)
MSP FFS
Medical Services Plan physician Fee for Service Billings. FFS physicians are
paid based on the billings they submit for each patient encounter.
PharmaCare Publicly funded prescription drugs dispensed in community pharmacies. Most
BC residents are under the Fair PharmaCare plan which publicly funds all or part
of the cost of eligible prescription drugs and designated medical supplies, based
on family net income. BC Residents may be eligible for other PharmaCare plans.
PharmaNet
All prescription drugs dispensed in community pharmacies, regardless of payer.
38