Assessment of Medical Certificates with a Diagnostic Outcome Method

Abstract

This study which focused on the 169 approved certificates for patients applying for the right for “free” medication in a sickness insurance district during one year in Finland shows two interesting findings. These, cannot of course be generalized because of the low number of observations and of doctors involved (total of 17, of whom three had written the majority of the certificates): 1) the strict application of the official criteria to the certificates would have caused 93% of them to be turned down as very deficient, i.e. not qualifying for insurance fund coverage of medication costs, compared with the 33% when using the generally accepted and tested valid criteria. The proportion of the false negatives when using the minimum number of the official criteria would have been 89%. However, all the 169 certificates had been accepted by the sickness insurance board on the advice of the physician member of the board; 2) It was also found that the control of the BP after a treatment period of four months or longer before qualifying for “free” medication was far from adequate according to these data. Indeed, the longer the treatment period the worse the level of control. Although this does not tell anything about the level of control after granting the right for “free” medicines, it raises very serious questions and obviously needs a thorough clarification. If this finding were to be generalised which as yet it is not, it would mean that the whole system of free medication for chronic hypertension became questionable and that urgent measures would be needed to correct this weakness. The problem is of considerable importance from the economic point of view.

Key Words:

• Quality assurance
• General practice
• Medical audit
• Diagnostic outcome
• Medical certificates