ArticleHealth services research2021
Validation and application of a needs-based segmentation tool for cross-country comparisons.
Article in Health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Mapping Healthcare Needs: A Systematic Review of Population Stratification Tools.Medical sciences (Basel, Switzerland) · 2025Pooled it
- Clinical and cost-effectiveness of an acute medical unit model in Singapore: protocol for a pilot prospective cohort study.BMJ open · 2026Article
- Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons.The bone & joint journal · 2022Article
- Validation and application of a needs-based segmentation tool for cross-country comparisons.Health services research · 2021Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare countries' health care needs by segmenting populations into a set of needs-based health states. DATA SOURCES: We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data. STUDY
designWe developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1-5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death. DATA COLLECTION/EXTRACTION
methodsWe segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories. PRINCIPAL
findingsThe CCSST is a valid tool for segmenting populations into needs-based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors.
conclusionsThe CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients.
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