Canadian abortion statistics: who does, and who does not, report medical abortions

This is an update of all the different kinds of abortions reported by CIHI, vs the provinces. (Further to this post which is starting to confuse even me.)

CIHI only reports these abortions: S752 - induced - by any surgical technique up to and including 14 weeks gestation, S785 - induced - by any surgical technique after 14 weeks of gestation (CIHI does not report medical abortions)

Quebec Health has confirmed that their abortion numbers do not include medical abortions.

Alberta Health has confirmed that their abortion numbers do not include medical abortions.

Ontario Ministry of Health and Long Term Care does report medical abortions:

MOHLTC reports all these types of abortions (at this point Ontario has the most comprehensive reporting of abortion numbers in Canada):
A920A - MEDICAL MANAGEMENT OF EARLY PREGNANCY - INITIAL VISIT (medical abortions)
P001A MEDICAL MGMT FETAL DEMISE BETWEEN 14-20 WKS GESTATION
P054A FETAL MANAGEMENT-SGL/MULT-INTRACARDIAC KCL INJECTION
S752A FEM.GENITAL SYST.-INDUCED-CURRETINTRA-AMNIOTIC INJ.
S770A CORPUS UTERI - HYSTEROTOMY.
S783A CORPUS UTERI - HYSTEROTOMY WITH TUBAL INTERRUPTION.
S785A FEM.GENITAL SYST.-INDUCED-INTRA-AMNIOTIC INJ. (INCOMP.)

BC does report medical abortions

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

Clinic/physician office and hospital abortions performed in Ontario for 2014/2015

Well I finally received the abortion statistics I had asked for from Health Minister Eric Hoskins. Here they are:
https://drive.google.com/file/d/0B_QDsYLWnwO6QWs1NzAwY1NGWTg/view?usp=sharing

The chart includes (direct) costs. These amounts are what the doctor bills OHIP for, but there are other costs associated with abortions.

The numbers are broken down by Hospital (18,491 abortions) and Clinic/Physician Office (27,082 abortions).

Notes from the table:

1) The figures provided are limited to the fee codes for abortions in Ontario for fiscal year 2014-2015 based on the following codes:

a. A920A - MEDICAL MANAGEMENT OF EARLY PREGNANCY - INITIAL VISIT

b. P001A - MEDICAL MGMT FETAL DEMISE BETWEEN 14-20 WKS GESTATION

c. S752A - FEM.GENITAL SYST.-INDUCED-CURRETINTRA-AMNIOTIC INJ.(COMP.)

d. S785A - FEM.GENITAL SYST.-INDUCED-INTRA-AMNIOTIC INJ. (INCOMP.)

e. P054A - FETAL MANAGEMENT-SGL/MULT-INTRACARDIAC KCL INJECTION

f. S770A - CORPUS UTERI-HYSTEROTOMY.

g. S783A - CORPUS UTERI-HYSTEROTOMY WITH TUBAL INTERRUPTION.

Note: S770A and S783A may be claimed for purposes other than Therapeutic Abortion

2) 2014 Abortion Number of Services based on the list of codes above = 45,573

(Note that I originally reported 45,471 abortion which is the number the Ministry gave me in court. I assumed the difference (102) must be because of codes S770A and S783A as noted above, but when you look at the chart, there were only a total of 24 procedures done under these two codes, so that's not it. I will try and get an answer from the Ministry of Health--no easy task.)

3) 2014 Abortion Fee Billed based on the list of codes above = $5,690,931.99

4) Service Location - Hospital Services: report the services that based on the claims submission were rendered in a hospital setting.

5) Service Location - Physician Office (PHY): report the that based on the claim submissions were rendered in non-hospital settings (Clinics/Physician offices) 

Sources:

a) Claims History Database: billing data Data for Fiscal Years 2014/15 is M7 data (complete data.) 

b) Schedule of Benefits Physician Services under the Health Insurance Act, Ministry of Health and Long Term Care