Frequencies of diagnoses in the Eye Clinic of Zurich 1992-96 the problem of statistics and planning of health care
F.-M. Sens, B. P. Gloor
Background: For the year 1999 the health authorities of Zurich declared statistics of diagnoses following ICD-10 as mandatory, as a mean to allocate resources. The statistics following ICD-9 used earlier are evalu-ated, for recognizing if they achieve what the governement expects.
Methods: The diagnostic charts of the out-patients seen from 1992-96 were evaluated at the computer centre of the Association of Swiss Hospitals (VESKA). Frequencies of 21 main diagnostic groups and of single diagnosis made at the first consultation weree listed. The datas were evaluated to see how useful they are for 1st clinical research the primary goal of the statistic when introduced - 2nd as account of per-formance; 3rd for comparison with other institutions; 4th for epidemiologic purposes and 5th as a mean to allocate resources.
Results: 76 874 patients were treated and 125 010 diagnoses were made during 1992-96. Most frequent causes for consultations were conjunctivitis, injuries of the cornea and cataract resp. the groups lens, injuries and diseases of the retina and vitreous. The statistics according to ICD-9 brought easy acces to the charts of patients for clinical studies, allowed partially to report on performance, the comparison with other institutions and only marginally epidemiologic statements, but gave no clues for a serious distribution of resources .
Discussion and summary: Because fundamentally statistics according to ICD-10 differ not from statistics following ICD- 9, it becomes evident, that the statistics as imposed by the health authorities of Zurich, can not bring what the governement expects. Because the introduction of these statistics provoked a strike of the residents and a cascade of consequences of industrial law, the governement has reduced the specifity of the statistics to such an amount, that it became even useless for clinical research. Read Barbara Tuchman: "The March of Folly" or "The Folly of Governors".
Augenklinik, Universitätsspital, CH 8091 Zürich