Toward a National Health Care Survey A Data System for the 21st Century (1992) / Chapter Skim
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Appendix C: Federal Health Data Sources
Appendix C: Federal Health Data Sources
Pages 125-150
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From page 125... ...
The federal statistical system in the United States is decentralized, with authority and responsibility for statistical activities spread among several agencies of the government. There exists an abundance of statistical information related to the health status and the health care industry of this nation.
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From page 126... ...
The survey had two purposes—to promote knowledge of the population's health status and to create jobs for the unemployed. Twenty years later, statisticians inside and outside the government were still relying primarily on the 1935-1936 National Health Survey and a series of supplemental studies carried out in the 1940s and early l950s as the basis for estimating the current level of illness and disability in the United
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From page 127... ...
The Bureau of the Census and the PHS had provided advice to those carrying out these local surveys. It was clear by the early l950s that the federal government's role in health statistics could best be carried out by providing leadership in development of a national health data resource based on the probability sampling of households.
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From page 128... ...
the Health Records Surveys. A year after the passage of the National Health Survey Act, the Household Health Interview Survey (later renamed the National Health Interview Survey)
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From page 129... ...
ambulatory health services by specialties and types of practice of the health professionals providing such services and (2) services of hospitals, extended care facilities, home health agencies, and other institutions; Health care costs and financing, including the trends in health care prices and cost, the sources of payments for health care services, and federal, state, and local governmental expenditures for health care services; and Family formation, growth, and dissolution.
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From page 130... ...
Included in the core are questions on limitation of activity caused by chronic conditions or impairments, hospitalizations, doctor contacts, perceived health status, as well as the social, economic, and demographic characteristics of the interviewed person. Questions on dental visits were also part of the core from 1975 through 1981.
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From page 131... ...
~ . ~ ~ ~ ~ _ ~ TO AT TV National Health and Nutrition Examination Survey The National Health Survey Act authorized special studies in addition to the continuing household interview survey.
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From page 132... ...
Health Records Survey Program Soon after the establishment of the National Health Interview Survey and the Health Examination Survey, it became obvious that information on hospitalized illness and injury, out-of-hospital medically attended illness, long-term institutionalized conditions, and data on the use of providers of services and facilities were either not available on a national basis or were inadequate. As a consequence, by 1960, when the National Health Survey and the National Office of Vital Statistics were combined to form the National Center for Health Statistics, developmental work already had begun for surveys based on records of health facilities and providers of health services.
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From page 133... ...
The original concept of the HRS encompassed records from all types of medical facilities and institutions, including those from such facilities as hospitals, clinics, dispensaries, physicians' and dentists' offices, and nursing homes. In practice, however, the data are limited to that obtained in the four current surveys: National Hospital Discharge Survey, National Ambulatory Medical Care Survey, National Nursing Home Survey, and the National Master Facility Inventory.
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From page 134... ...
The scope of the inventory in its initial stage of development included all hospitals in the United States with 6 or more beds, as well as all resident institutions, except for nursing or personal care homes with less than 3 beds. Institutions included in the NMFI were establishments that were in business to provide medical, nursing, personal, or custodial care to groups of unrelated individuals who have no usual place of residence elsewhere.
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From page 135... ...
, has been expanded to include information about facilities providing health care, including hospitals, skilled nursing and long-term care units of hospitals, nursing and related care homes, facilities that provide some kind of personal care, board and care or domiciliary care (such as residential care homes, group homes, homes for the aged, family care homes, adult foster care homes, personal care homes, adult congregate living facilities, residential community care facilities, domiciliary care homes) , homes for mentally retarded or developmentally disabled people, homes for the mentally ill (such as halfway houses, residential centers for emotionally
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From page 136... ...
Staning in 1985, in addition to manual selection of the sample and transcription of data, NCHS purchased from commercial abstracting services discharge medical abstracts 'and selected samples from these tapes. Until 1987 a two-stage stratified sample design was used and the sample was selected from a frame of short-stay hospitals listed in the National Master Facility Inventory.
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From page 137... ...
. NAMCS, first fielded in 1973, was designed as a continuing national sample survey to meet the needs and demands for statistical information about the provision of ambulatory medical care services in the United States.
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From page 138... ...
During 1973-1985 a multistage probability sample design was used involving samples of PSUs, physician practices within PSUs, and patient visits within physician practices. A modified probability-proportional-to-size sampling procedure using separate sampling frames for metropolitan statistical areas (MSAs)
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From page 139... ...
The need for comprehensive data on a continuing basis became obvious, with the establishment of the Medicaid and Medicare program, increasing use of nursing homes by the elderly population whose numbers were growing, and the overall increasing involvement of the federal government in these and other long-term care issues. In 1973 the National Nursing Home Survey was established in NCHS as a continuing program.
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From page 140... ...
The next survey is scheduled for 1995. The 1985 NNfIS was a sample survey of nursing and related care homes, their residents, discharges, and staff in the conterminous United States that regularly provide nursing or personal care services to residents, regardless of the level of service provision or the certification status of the facility.
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From page 141... ...
The primary purpose of the follow-up study is to provide data on the flow of persons in and out of long-term care facilities and hospitals. The study obtains lon;,itudinal information not readily available in the medical record, such as the resident's health and functional status prior to admission, the reason for admission, and a history of previous nursing home admissions, the resident's current functional status, current living arrangements, and nursing home and hospital use subsequent to the last contact and sources of payment.
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From page 142... ...
This surveillance system provides official state health agencies with the funding, training, and consultation necessary to permit them to routinely collect behalf Oral risk factor information. The data items include weight control, hypertension, physical activity, obesity, mammography, alcohol consumption, seatbelt use, tobacco use, HIV/AIDS, preventive health practices, and routine demographic information such as age, sex, race, and education.
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From page 143... ...
Although these periodic expenditure surveys provide the most comprehensive data on health expenditures and insurance coverage, they are con~ , ~ ducted at infrequent intervals at great cost and are slow to produce accessible data. Medicare Beneficiary Health Status Registry.
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From page 144... ...
Through repeated contacts with the same individuals while they are Medicare beneficiaries, the progression of health and disease can be measured, the relationship between the Medicare program and the health status of its beneficiaries can be examined, and the effectiveness of specific health interventions in influencing the health status of individuals of the group can be evaluated. The primary goals of the registry are to provide information on measuring the relationship of Medicare-reimbursed services to the health status of Medicare beneficiaries; to describe, analyze, and understand health and disease longitudinally in successive cohorts of Medicare beneficiaries; to describe, analyze, and understand the use and costs of services, lor~g-term utilization patterns, and lifetime Medicare costs of individual coh`~;~s: to monitor access to care in special populations; to assess the effectix Bless and impact of specific medical and surgical interventions on the health, quality of life, well- -a.
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From page 145... ...
The sample survey program was initiated in 1969 and today includes ~A~;C`c,;~e tm ~tOtP rn''ntv and private mental hospitals, outpatient psychiatric services, and Veterans Administration psychiatric services. The purpose of these surveys is to obtain data on the sociodemographic, clinical, and treatment characteristics of patients served by these facilities.
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From page 146... ...
For example: The National Hospital Discharge Survey collects information on the mentally ill admitted to short-stay, nonfederal hospitals. The National Ambulatory Medical Care Survey collects information on the mentally ill seen in physicians' offices, including psychiatrists' offices.
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From page 147... ...
Major objectives include the mon~tonng OT patterns and trends of drug abuse, identification of substances associated with drug abuse episodes, and the assessment of drug-related consequences and other health hazards. Health Care Financing Administration The Health Care Financing Administration (HCFA)
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From page 148... ...
The MCBS is focused on health care use and expenditure in the Medicare population and determinants thereof, issues that are of prime importance to HCFA. The core of the MCBS is a series of interviews of a representative sample of the Medicare population to obtain information on their patterns of health service use and cost over time, sources of coverage and payment, assets and income, demographic characteristics, health and functional status, health and work history, and family supports.
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From page 149... ...
Nursing Home Quality Assessment. The Omnibus Reconciliation Act of 1987 requires that each resident of a Medicare or Medicaid certified nursing facility have a periodic standardized, accurate, and reproducible comprehensive assessment of his or her functional capacity using a Residebt Assessment Instrument (RAI)
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From page 150... ...
CONCLUSION The brief descriptions presented above of only some of the national health data systems maintained by the federal government provide a clear illustration of a large number of statistical activities in place and new ones being developed. Despite these various activities, we still lack important statistical information needed for monitoring and evaluating the important changes occurring in the availability, financing, and delivery of health care.
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