Validation and application of a needs-based segmentation tool for cross-country comparisons.



To compare countries' health care needs by segmenting populations into a set of needs-based health states.

Data sources

We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data.

Study design

We developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1-5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death.

Data collection/extraction methods

We segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories.

Principal findings

The CCSST is a valid tool for segmenting populations into needs-based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors.


The CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients.





Published Version (Please cite this version)


Publication Info

Duminy, Lize, Nirmali Ruth Sivapragasam, David Bruce Matchar, Abhijit Visaria, John Pastor Ansah, Carl Rudolf Blankart and Lukas Schoenenberger (2021). Validation and application of a needs-based segmentation tool for cross-country comparisons. Health services research, 56 Suppl 3(S3). pp. 1394–1404. 10.1111/1475-6773.13873 Retrieved from

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