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Beyond the Market: Designing Nonmarket Accounts for the United States
focus on the health of the least well-off members of society or consider an index that focuses on those with the poorest health.
Some of the data required for a satellite health account are already collected, but these data are not necessarily available in the form required for such an account. Before a credible health account can be produced, new data will be needed to measure the population’s health status on a regular and continuing basis. For some years, the United States has had relatively good data on health status, such as those from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey. Until 1999, NHANES—designed specifically to obtain information on the health status of the U.S. population—was conducted only once a decade. Now, however, it is an ongoing data collection program, and survey results are published more frequently; some are available annually. This is an important step toward developing a national health account. Output measurement will require more research that attaches meaningful physical health status data to monetary measures, including work to produce better data on the link between health and earnings (and vice versa). Data sources also will need to be developed that track changes in the relationship between prevalence of disease and years of healthy life and between medical interventions and health outcomes.
Health accounts also will require improved measures of the inputs to health. Better organized and more accurate data on medical care spending, aggregated by disease treatment, are part of what is needed. Improved data on care time, such as will be produced in the ATUS, also are necessary for developing the input side of the health account.
Measuring the quality of both the inputs to and the outputs of improved health is a further area for needed research. The statistical agencies are working to develop approaches for handling difficult-to-measure changes in the quality of health treatments. The Bureau of Labor Statistics, for example, is working on experimental medical care price indexes based on disease- and diagnosis-based units. Currently, data on medical care prices are organized primarily by institutional provider (e.g., payments to hospitals, doctors, or drug companies), not by treatment. If new treatments are developed for particular conditions that require fewer resources, this is not reflected in the form of a lower price level. Focusing on the cost of treating diseases or diagnoses allows prices to reflect changes in the mix of inputs used to treat particular conditions. Quality-corrected data on the full range of complete treatments do not yet exist—and as Triplett (2002) points out, we are still very far from having this information on per-case cost trends by disease. Such data would be extremely useful, even for conventional accounting of the medical care sector but also for the development of the health satellite account contemplated here.