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Information-rich environments, with access and funding provided by government, make it possible to organize longitudinal administrative data to support analyses of policy-relevant questions. This paper describes insights into children's well-being and social equity obtained from data available in Manitoba, Canada, and highlights findings that have engaged policymakers. Analyses draw on Manitoba-linked data providing information over time (going back to 1970 in some files) and across space (with residential location documented every six months) for each provincial resident. Routinely collected data from the Ministries of Health, Education, and Family Services and Consumer Affairs have been integrated with a population registry. Identifying risk factors and presenting outcomes by social groups and by local communities capture the attention of policymakers. Linking an individual's area of residence to census and health data has led to developing measures of population health status and socioeconomic status. These measures focus on whether delivery patterns track health and educational needs, and a population registry makes it possible to describe who is (and is not) served by each program. The nature of health and social research has been changed by the development of information-rich environments. Many findings in Manitoba could not be replicated without a population registry. Engaging decision makers through effective presentations can ensure continuing support for diverse efforts based on these environments, and this article suggests ways of better communicating with policymakers. [ABSTRACT FROM AUTHOR]

Objectives: To assess the ability of an Adjusted Clinical Group (ACG)-based morbidity measure to assess the overall health service needs of populations. Data Sources/Study Setting. Three population-based secondary data sources: registration and health service utilization data from fiscal year 1995-1996; mortality data from vital statistics reports from 1996-1999; and Canadian census data. The study included all continuously enrolled residents in the universal health care plan in Manitoba.Study Design: Using 60 small geographic areas as the units of analysis, we compared a population-based "ACG morbidity index," derived from individual ACG assignments in fiscal year 1995-1996, with the standardized mortality ratio (ages < 75 years) for 1996-1999. Key variables included a population-based socioeconomic status measure and age- and sex-standardized physician utilization ratios.Data Extraction Methods: The ACGs were assigned based on the complement of diagnoses assigned to persons on physician claims and hospital separation abstracts. The ACG index was created by weighting the ACGs using average health care expenditures.Principal Findings: The ACG morbidity index had a strong positive linear relationship with the subsequent rate of premature death in the small areas of Manitoba. The ACG index was able to explain the majority of the relationships between mortality and both socioeconomic status and physician utilization.Conclusions: In Manitoba, ACGs are closely related to premature mortality, commonly accepted as the best single indicator for health service need in populations. Issues in applying ACGs in settings where needs adjustment is a primary objective are discussed. [ABSTRACT FROM AUTHOR]

Compares the health care system between Canada and the United States. Evidence on comparative system performance; Association between income distribution and health status on health care allocated by Canadians; Differences between Canadian and American systems in the access to care and outcomes for people with lower incomes.

Investigates how a universally insured health care system delivers care that are related to health status. Characteristics of residents in Winnipeg, Canada, by relative affluence of neighborhood; Differences in age and sex-standardized death rates across the population; Hospital use by relative affluence of neighborhood, using Winnipeg's type of hospitalization.

Presents information on the development of a population health information system (POPULIS) in regions of Manitoba, to help the United States public understand that more health care is not necessarily better and help planners identify the levers for combing the concerns of population health and cost containment. Steps for developing a population-based system to compare health status, various critical risk indicators and hospital use.

The article examines whether a small proportion of the elderly is responsible for a large share of health care expenditures in the U.S. and in Canada by studying data on a representative cohort group in Manitoba over a 16-year period starting in 1970. The data indicate that the average older person's risk of using hospital and nursing home services is notably higher than reported, but 50 percent of the elderly make relatively minimal demands on the health care system.

The article reports that conflicts between evaluators and administrators are endemic to policy research. Although considerable attention has been paid to problems of administrator acceptance of research designs involving randomization, the more mundane problems arising from day-to-day interaction between evaluators and administrators have received less attention. These comments will treat a number of the problems which can generate friction in the researcher-practitioner relationship.

This article focuses on guidelines for evaluation research. It is possible to separate out two different factors to be considered in designing an effective evaluation strategy. On the one hand, behavioral, political, structural, and methodological problems must be addressed. Monitoring becomes appropriate when there is little agreement upon what the objectives of the program are, where there is little understanding of the effect a program is likely to have or where the anticipated effects are so wide-ranging that only an arbitrary focus would be possible.