Appendix A
The Potential Role of Various Data Sources in a National Health Account

This appendix is a partial list of data sources that could play roles in a national health account program as identified by panel members David Cutler and Allison Rosen.

The Current Population Survey (CPS) is a monthly sample survey of about 50,000 households conducted by the U.S. Census Bureau for the Bureau of Labor Statistics. The CPS (see http://www.census.gov/cps/) is the primary source of information on labor force characteristics of the U.S. population. Monthly estimates from the CPS include employment, unemployment, earnings, hours of work, and other indicators. The annual March supplement produces national and state estimates on health insurance coverage, including private health insurance, Medicare, Medicaid, and military health care (CHAMPUS).

The Health and Retirement Study is a longitudinal cohort study of health, retirement, and aging and is designed to assess changes in physical and mental functioning, family support resources, insurance coverage, financial well-being, labor market participation, and retirement planning in the elderly. The data provide mental health diagnoses, risk factors, and costs not available in other national data sources. Funded by the National Institute on Aging, this study administers surveys on more than 22,000 Americans over the age of 50 every 2 years (beginning in 1990). See http://hrsonline.isr.umich.edu/ for more information and public-use files.

The Healthcare Cost and Utilization Project (HCUP), conducted by the Agency for Healthcare Research and Quality (AHRQ), consists of several databases, including the State Inpatient Database (SID) and the Nationwide Inpatient Sample (NIS). SID contains data on all hospitals and all discharges from 39 participating states. AHRQ receives the data from each statewide data



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Appendix A The Potential Role of Various Data Sources in a National Health Account This appendix is a partial list of data sources that could play roles in a national health account program as identified by panel members David Cutler and Allison Rosen. The Current Population Survey (CPS) is a monthly sample survey of about 50,000 households conducted by the U.S. Census Bureau for the Bureau of Labor Statistics. The CPS (see http://www.census.gov/cps/) is the primary source of information on labor force characteristics of the U.S. population. Monthly esti - mates from the CPS include employment, unemployment, earnings, hours of work, and other indicators. The annual March supplement produces national and state estimates on health insurance coverage, including private health insurance, Medicare, Medicaid, and military health care (CHAMPUS). The Health and Retirement Study is a longitudinal cohort study of health, retirement, and aging and is designed to assess changes in physical and mental functioning, family support resources, insurance coverage, financial well-being, labor market participation, and retirement planning in the elderly. The data pro - vide mental health diagnoses, risk factors, and costs not available in other national data sources. Funded by the National Institute on Aging, this study adminis - ters surveys on more than 22,000 Americans over the age of 50 every 2 years (beginning in 1990). See http://hrsonline.isr.umich.edu/ for more information and public-use files. The Healthcare Cost and Utilization Project (HCUP), conducted by the Agency for Healthcare Research and Quality (AHRQ), consists of several databases, including the State Inpatient Database (SID) and the Nationwide Inpatient Sample (NIS). SID contains data on all hospitals and all discharges from 39 participating states. AHRQ receives the data from each statewide data 0

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0 ACCOUNTING fOr HeALTH AND HeALTH CAre organization, processes them into a uniform format, and then returns the uniform SID files to the statewide data organization. Beginning in 1988 with inpatient data from 8 hospitals, the NIS database has grown to cover 38 states in 2006. The NIS comes with weights that can be used to produce national, regional, and state estimates for participating states. See http://www.ahrq.gov/data/hcup/datahcup. htm for the complete list of databases that constitute the HCUP. The Medical Expenditure Panel Survey (MEPS) collects data similar to those of its predecessor, the National Medical Expenditures Survey. Beginning in 1996 and repeated on an annual basis, the MEPS samples a portion of the households that participate in the prior year’s National Health Interview Survey. The household component of MEPS collects data continuously at both the person and household levels using an overlapping panel design. In 2002, approximately 18,000 households, consisting of nearly 40,000 individuals, were included in the survey. MEPS data are publicly available via download from the AHRQ website (see http://www.meps.ahrq.gov/mepsweb/). Medicare claims are comprehensive medical claims records from 1991 through 2007 for about 50 million older Americans that are available to qualified entities from the Centers for Medicare & Medicaid Services (CMS). The files contain information on all Medicare-covered services (inpatient, hospital outpa - tient, ambulatory and physician care, durable medical equipment, home care, hos- pice care, skilled nursing care, rehabilitation care, etc.) and include information on diagnoses, treatments and procedures, discharge, Medicare and out-of-pocket expenditures, demographic characteristics, and managed care enrollment. The Medicare Current Beneficiary Survey (MCBS), sponsored by CMS, is a nationally representative survey of aged, disabled, and institutionalized Medi- care beneficiaries. Panelists are followed over the span of 4 years and are inter- viewed three times each year, regardless of whether they live in a household or a long-term care facility or switch between the two during the course of the survey period. The MCBS began in 1991; it is a patient-level comprehensive source of information on the health status, health care utilization, and expenditures of fee- for-service Medicare beneficiaries, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries. Self-reported utilization and expenditure information undergoes extensive vali - dation using Medicare claims data. The cost and use data are available through 2006; data on access to care are available through 2008 at http://www.cms. gov/mcbs/. The Medicare Denominator File, maintained by the University of Minne- sota’s Research Data Assistance Center, contains demographic and enrollment information about each beneficiary enrolled in Medicare during a calendar year. Information contained in this file includes the beneficiary unique identifier, infor- mation on residence, date of birth, date of death, sex, race, and age. The files can be used to follow the vital status of the former respondents to the MCBS beyond

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0 APPeNDIX A their 3-year survey window. For the complete file’s descriptions of data variables and terms of use, see http://www.resdac.umn.edu/ddde/dd_de.asp. The National Ambulatory Medical Care Survey is designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services. Findings are based on a sample of visits to nonfederally employed office-based physicians who are primarily engaged in direct patient care. Physician subspecialists in anesthesiology, pathology, and radiology are excluded from the survey, which was fielded in 1973-1981, 1985, and 1989- present (most recent data are for 2007). Data are available at http://www.cdc. gov/nchs/ahcd.htm. The National Comorbidity Survey (NCS)/National Comorbidity Survey- Replication (NCS-R) are nationally representative surveys of the mentally ill in the United States. These surveys use a structured diagnostic interview to mea - sure the prevalence and correlates of mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Third edition, revised. The NCS was conducted in 1990-1992; the NCS-R was conducted in 2000-2002. The NCS and NCS-R make it possible to impute the prevalence of mental health disorders among the elderly and adult populations. See http://www.icpsr.umich. edu/cocoon/cpes/ncsr/sections/all/sections.xml for more information. The National Health Care Survey (NHCS) is a family of National Center for Health Statistics (NCHS) provider-based surveys designed to meet the need for objective, reliable information about the organizations and providers that supply health care, the services rendered, and the patients they serve. The surveys are designed to answer key questions of interest to health care policy makers, public health professionals, and researchers. They may include the factors that influence the use of health care resources; the quality of health care, including safety; and disparities in health care services provided to population subgroups in the United States. Data from NHCS are organized around the settings in which health care is delivered. Data are accessible via the NCHS website (see http:// www.cdc.gov/nchs/nhcs.htm). The National Health and Nutrition Examination Survey (NHANES) is a nationally representative survey of the civilian noninstitutionalized population in the 50 states and the District of Columbia. The NHANES has been administered in four waves of varying duration since 1971. Beginning in 1999, updates to the NHANES have been released every 2 years. The survey contains a rich source of information on sociodemographic variables, preventive health behaviors, risk factors, clinical conditions, and health status indicators, including the results of lab tests, clinical examinations, and physical functioning tests. Downloads are available for data collected through the 2005-2006 cohort from the NCHS website (see http://www.cdc.gov/nchs/about/major/nhanes/datalink.htm). National Health Expenditure Accounts are compiled annually by the Office of the Actuary at CMS. They provide total national spending across the health system by source of payment (public, private, and out-of-pocket) and ser-

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0 ACCOUNTING fOr HeALTH AND HeALTH CAre vice provider (hospitals, physicians, pharmaceutical firms, etc.). This information is summarized and published on a yearly basis in a “sources and uses” of funds table, available via download from the CMS website (see http://www.cms.hhs. gov/NationalHealthExpendData/) beginning with data from 1960. The National Health Interview Survey (NHIS) is a cross-sectional, nation- wide in-person survey of approximately 40,000 households representing the civilian noninstitutionalized U.S. population. The first survey was administered in 1957 and has been repeated on an annual basis. The NHIS allows the monitoring of trends in illness and disability and the tracking of progress toward achieving national health objectives. Annual updates of the NHIS are available via down - load from the NCHS website (see http://www.cdc.gov/nchs/nhis.htm). The National Health Measurement Study (NHMS), directed by the Uni- versity of Wisconsin School of Medicine and Public Health, is a nationally rep - resentative sample of 3,844 noninstitutionalized adults ages 35-89. The NHMS was designed to compare several common instruments that attempt to assess an individual’s health-related quality of life based on self-reported symptoms and impairments and related questions, which vary across instruments. Fielded in 2005-2006, the data set is available at http://www.disc.wisc.edu/NHMS/index. html. The National Home and Hospice Care Survey (NHHCS) is a continuing series of surveys of home and hospice care agencies in the United States. Infor- mation was collected about agencies that provide home and hospice care and about their current patients and discharges. The NHHCS is based on a probability sample of home health agencies and hospices and includes all agencies licensed or certified by Medicare or Medicaid. The NHHCS was fielded in 1992-1994, 1996, 1998, 2000, and 2007. See http://www.cdc.gov/nchs/nhhcs.htm for more information and updates. The National Hospital Ambulatory Medical Care Survey collects data on the utilization and provision of ambulatory care services in hospital emer- gency and outpatient departments. Findings are based on a national sample of visits to emergency departments and outpatient departments of noninstitutional general and short-stay hospitals, exclusive of federal, military, and Department of Veterans Affairs (VA) hospitals. The survey spans the 50 states and the Dis - trict of Columbia and has been fielded every year since 1992 (the most recent year available is 2007). Data are available at http://www.cdc.gov/nchs/ahcd. htm. The National Hospital Discharge Survey, conducted annually since 1965, provides nationally representative data on inpatients discharged from nonfederal short-stay hospitals in the United States. Only hospitals with an average length of stay of fewer than 30 days for all patients, general hospitals, and children’s gen - eral hospitals are included in the survey. Federal, military, and VA hospitals, as well as hospital units of institutions (such as prison hospitals) and hospitals with fewer than six beds staffed for patient use are excluded. In 2005, approximately

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0 APPeNDIX A 375,000 inpatient records were obtained from 444 hospitals. The most recent data are for 2006, available at http://www.cdc.gov/nchs/nhds.htm. The National Household Survey on Drug Abuse (NHSDA), conducted by the Substance Abuse and Mental Health Services Administration, focuses on the incidence, prevalence, consequences, and patterns of substance use and abuse. In 1997, the NHSDA was expanded from 18,000 to about 25,000 respondents to generate estimates for the nation and for two states (California and Arizona). In 1999, the NHSDA was further expanded to 70,000 respondents to generate estimates for all 50 states. Summary data and annual reports through 2008 can be found at http://www.oas.samhsa.gov/nsduhLatest.htm. The National Medical Expenditure Survey (NMES) was a year-long panel survey of approximately 15,000 households consisting of nearly 36,000 individuals in the civilian, noninstitutionalized population. The survey provides information on the U.S. population’s access to health care, use of health services, expenditures and sources of payment for care, health insurance coverage, health status, risk factors and disease prevalence, demographic characteristics, and employment and economic status. The NMES is publicly available via download from the Inter- university Consortium for Political and Social Research (see http://www.icpsr. umich.edu/). The National Nursing Home Survey (NNHS) is a national survey of nurs- ing homes, their residents, and discharged patients conducted by the NCHS. Surveys were administered in 1973-1974, 1977, 1985, 1995, 1997, 1999, and 2004. The NNHS provides information on the institutionalized population resid - ing in nursing homes regardless of the resident’s insurance status and the primary payer of the nursing home stay. The NNHS data are available via download from the NCHS website at http://www.cdc.gov/nchs/nnhs.htm. The National Survey of Ambulatory Surgery (NSAS) is the only national study of ambulatory surgical care in hospital-based and freestanding ambulatory surgery centers. The NSAS was conducted from 1994 to 1996 but discontinued due to lack of resources. The NSAS was again conducted in 2006, with results released in 2010 at http://www.cdc.gov/nchs/nsas.htm. The National Survey of Family Growth is a periodic survey of women ages 15-44 that began in 1973—men were added to the survey in 2002. The survey gathers information on family life, marriage and divorce, pregnancy, infertility, use of contraception, and men’s and women’s health. The survey results are used by the U.S. Department of Health and Human Services and others to plan health services and health education programs and to determine the need for other sta - tistical studies of families, fertility, and health. Data and latest information are available on the NCHS website (see http://www.cdc.gov/nchs/NSFG.htm). The National Vital Statistics System collects and disseminates information on vital events, which include births, deaths, marriages, divorces, and fetal deaths. Registrars in 57 vital event registration areas collect data from local officials and transmit them to NCHS. NCHS compiles those data and issues public-use data

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0 ACCOUNTING fOr HeALTH AND HeALTH CAre files and analytical reports that have been used in health services research to estimate life expectancy and mortality rates for specific diseases. See http://www. cdc.gov/nchs/nvss.htm for more information. The Surveillance, Epidemiology, and End Results–Continuous Medicare History Sample File (SEER-CMHSF) has annual Medicare spending for 5 percent of the Medicare population and includes data on medical expenses for inpatient hospital stays, outpatient services, skilled nursing facility stays, home health agency charges, and physician services. The linked SEER-CMHSF con - tains all Medicare claims for the cancer patients included in the SEER registries. These data are available from 1976 to 1997 and then 2001 and 2002. These data can be used to determine the cost and health impact of cancer care by service category. The SEER-CMHSF contains roughly 70,000 cancer patients per year and 400,000 noncancer control individuals per year. The Surveillance, Epidemiology, and End Results–Medicare Linked Data- base (SEER-Medicare) reflects the linkage of two large population-based sources of data that provide detailed information about Medicare beneficiaries with cancer. Over a dozen state and regional registries across the United States participate in the SEER program by reporting all newly diagnosed cases of cancer and tracking these individuals until their deaths. Beginning in 1975, data from 9 registries are available, covering approximately 10 percent of the U.S. population. From 2000 onward, 17 registries report data covering 26 percent of the population. The infor- mation collected by the program includes detailed clinical data and the patients’ demographic characteristics. The data provide information on incidence, costs, and health outcomes of cancer patients. The SEER-Medicare database provides a link- age between the SEER cancer registries and Medicare enrollment and claims files. See http://healthservices.cancer.gov/seermedicare/ for more information. The World Health Survey (WHS) was administered in 2002-2003 to moni- tor whether health systems were achieving their desired goals. The WHS was the first major survey program designed to address the issue of cross-population comparability in measuring health. Samples were randomly selected (for ages older than 18 years) and number between 1,000 and 10,000 individuals in each of 70 participating countries. See http://www.who.int/healthinfo/survey/en/index. html for results and analysis.