CIHI is still under-reporting abortion statistics

Abortion statistics are getting more confusing.

The Ministry of Health and Long-Term Care (MOHLTC) reported a total of 44,430 abortions for 2015/2016.

CIHI reported a total of 39,679 abortions for 2015.

That's a total difference of 4,751 abortions for one year.

To add to the confusion, MOHLTC reports using seven abortion codes (S752A, S785A, P054A, S770A, S783A, P001A, A920A), while CIHI reports using only two abortion codes (S752A and S785A):

"The enhanced methodology implemented in CIHI’s 2015 report for estimating the volume of induced abortions in Ontario incorporates NPDB (1) data selected using two fee codes for surgical abortions only. The report you shared includes seven fee codes and CIHI reports using two....the data sources for CIHI’s report are DAD, NACRS, and NPDB, while it appears that the Claims History Database was the source for the report you shared [from the MOHLTC]. (2)

If we only compare CIHI with MOHLTC for the same two codes that CIHI reports, we get CIHI at 39,679 abortions, and MOHLTC at 37,806 abortions. for a difference of 1,873 more than MOHLTC.

Neither CIHI nor MOHLTC could explain these differences.

Therefore CIHI reports 4,751 overall less than MOHLTC, but reports 1,873 more than MOHLTC if we only look at the same two codes.

Very confusing I know.

MOHLTC full fee code descriptions here.
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Additional Notes

Both CIHI and MOHLTC use these two codes:
S752A and S785A (surgical abortions)

The five codes not used by CIHI data, but are used in MOHLTC data are:
A920A (MEDICAL MANAGEMENT OF EARLY PREGNANCY - 5933)
P001A (MEDICAL MGMT FETAL DEMISE BETWEEN 14‐20 WKS GESTATION - 556)
P054A (fetal reductions - 115)
S770A CORPUS UTERI‐HYSTEROTOMY (16)
S783A CORPUS UTERI‐HYSTEROTOMY WITH TUBAL INTERRUPTION (4)

Those five additional codes used at MOHLTC add up to 6,624 abortions (115+16+4+556+5933). The Ministry also tells us that the S770A and S783A codes can be used for procedures other than abortions, but give me no indication as to which of these codes are not abortions. When I asked the Ministry to clarify medical abortions and identify which diagnostic codes are used for them, I was informed that:

"The OHIP claims system does require a physician to submit a fee code for payment however it is optional for a physician to submit a diagnostic code with the fee code and there is no rule that the diagnostic code needs to relate to the fee code."

Therefore it looks like the diagnostic codes are useless. So until the Ministry can tell me otherwise, I will assume that all of these additional procedures are also for abortions.

A920A and P001A codes are both used for medical abortions (556+5933=6,489 medical abortions), and CIHI isn't capturing these numbers. CIHI is also not capturing P054A for fetal reductions (115)

Note that CIHI doesn't report "medical" abortions or "fetal reduction" abortions.

That's 6,624 additional abortions being performed in Ontario for 2015/2016 (i.e. the five missing codes), than is officially being reported by CIHI.

(1) "The National Physician Database (NPDB) is a CIHI database that contains physician billings for publically funded insured medical services. Physicians do not report to it directly.  Physicians submit claims to the Provincial/Territorial medical care plans to be paid.  All provinces submit data from their claims systems to the National Physician Database." personal correspondence July 12, 217 with CIHI
(2) personal correspondence June 23, 217 with CIHI