Ambtelijke registraties voor een evaluatief gezondheidsbeleid. Aspecten van beleidsonderbouwing op landelijk, intermediair en lokaal niveau.

摘要

A need-driven and population-directed health policy requires a reliable health information system. Herein secondary databases may play an important part. Indeed they contribute to the assessment of the health status of the population and allow health services to be accountable for the use of the resources, placed at their disposal, and the quality and outcomes of the care they offer. Based on the literature, a frame of reference has been elaborated to assess the quality of data laying an emphasis on the potential negative influence of the financing mechanism of the hospitals hereupon.;We examined to which extent quality of care could be analysed using administrative data. The main results of our analysis regarding the cesarean section rate in low risk deliveries are important and unexplained differences in rates exist between hospitals, a national upward trend of 2% per semester and a pervading medicalization of childbirth. An organized approach on local, intermediate and central level will be required to stop the rise of the cesarean section rate. The main results of the analysis of the in hospital case fatality rate of AMI point to the limitations of the data. The need of a univocal definition of an AMI, the completeness of the data, the traceability of transferred patients and an adequate risk adjustment draw particular attention. Although difficult to interpret, the between hospital differences seemed sufficiently important to be investigated.;The Neerland study, regarding an excess of cases of congenital anomalies in a community living in the neighbourhood of two household refuse incinerators, highlighted the need for the authorities of listening to and communicating with a community about its health risks. It made it clear that linking of data between existing registries may provide the needed information.;Concluding, one may argue that administrative data allow to a certain extent the underpinning of a policy on all the levels of the health care system. The quality of data and hence their policy-sustaining potential will increase if the data are used in a perspective of public health, wherein quality of care constitutes an important domain.