Linked surveys of health services utilization

The linked population/establishment survey (LS) of health services utilization is a two-phase sample survey that links the sample designs of the population sample survey (PS) and the health-care provider establishment sample survey (ES) of health services utilization. In Phase I, household respondents in the PS identify their health-care providers during a specified calendar period. In Phase II, health-care providers identified in Phase I report the variables of interest for all or a sample of their transactions with all households during the same calendar period. The LS has been proposed as a potential design alternative to the PS whenever the health-care transactions of interest are hard to find or enumerate in household surveys and as a potential design alternative to the ES whenever it is infeasible or expensive to construct or maintain complete sampling provider frames that list all health-care providers with good measures of provider size. Suppose that the non-sampling errors are ignorable, how do the LS, PS and ES sampling errors compare? This paper addresses that question by summarizing and extending recent research findings that compare expressions of the sampling variance of (1) the LS and PS of equivalent household sample size and (2) the LS and the ES of equivalent expected health-care provider and transaction sample sizes. The paper identifies the parameters contributing to the precision differences and assesses the conditions that favour the LS or one or the other surveys. Published in 2007 by John Wiley & Sons, Ltd.