Toward a National Health Care Survey A Data System for the 21st Century (1992) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-14
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into what it has chosen to call an integrated National Health Care Survey. Under its plan the National Health Care iThe surveys are the National Hospital Discharge Survey, the National Ambulatory Medical Care Survey, The National Nursing Home Survey, and the National Master Facility Inventory.
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The main features of the NCHS plan are: . To conduct the survey on an annual basis; ~ · To expand the coverage of types of health care providers and health service settings to include hospital emergency and outpatient departments, ambulatory surgery centers, home health agencies, and hospices; · To revise the sample design using a three-stage cluster design in which a subset of the primary sample of the NHIS will be used to select the sample for the independently designed provider-based surveys; and To develop a capability to conduct follow-up studies to examine issues related to outcome and subsequent medical care.
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Collectively such a data system should be flexible enough to adapt to the changes in the health care system as they occur and to meet special needs on an ad hoc basis. NCHS Plan for a National Health Care Survey The panel commends NCHS for taking the first steps in restructuring and expanding the existing health provider surveys to enhance the amount and kind of information available about health care events.
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The cost of care is one of the most, if not the most, important health policy issues confronting the nation today, yet hardly any information is collected by NCHS in the health care provider surveys on payers or health care costs aIld expenditures, including the component paid by insurance. Section 306 of the Public Health Service Act, which provides the statutory mandate for NCHS, lists the specific areas in which statistics are to be collected.
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. NCHS has given considerable thought to the concept of an integrated National Health Care Survey and has presented arguments that its plan implies integration.
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These data will describe the patient population, medical care provided, financing, and provider characteristics." The panel is concerned, however, that, as currently designed, the survey appears to be limited mostly to modest modifications and expansions in coverage and content of the existing health care provider surveys with minimal, if any, true integration of design or data. If the center's objective is to move in the direction of an integrated survey design to provide comprehensive health care data that are urgently needed, especially on the key dimensions of access, expenditures, illness episodes, and outcomes, in the opinion of the panel, it must move beyond the eventbased sampling procedures that are proposed in its plan.
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The panel believes that there is need to develop an integrated data system with linkage capability at the individual level that includes a variety of approaches, including surveys of specific types of health care providers and neaten care settings, follow-up of individuals seen for specific conditions by specific types of providers in specific settings, longitudinal surveys of the household and nursing home populations, and possibly surveys of episodes of illness. In addition, there is need for improved collaboration, coordination, and integration of health care data collected by NCHS and by other agencies of the U.S.
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These respondents with an episode of illness will be followed over a period of time to collect data from both the respondents and their health care providers on the process of health care, the utilization of providers, and costs and expenditures associated with the episode. The panel recognizes that, despite its many potential benefits, adoption of the recommended design framework raises several important issues on various aspects that would require careful examination and resolution as to feasibility and costs prior to making final decisions on the details of the design.
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The panel believes that, if not corrected, this deficiency will impair the ability of NCHS to implement the National Health Care Data System. The panel further notes the fragmented state of the federal health statistics activities and concludes that the Department of Health and Human Services needs to undertake a major review of the vast array of its data collection activities related to health care with the objective of developing a comprehensive and coordinated plan for establishing an efficient and costeffective structure and organization for health care statistics.
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In the final analysis, the commitment and institutional support of the secretary of the Department of Health and Human Services, the Office of Management and Budget, and the Congress are all essential to the successful implementation of a comprehensive integrated health care statistics strategy. RECOMMENDATIONS On the basis of its findings and conclusions the panel provides three categories of recommendations: (1)
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Recommendation 3-4: The panel recommends that the National Health Care Survey include collection of person-based longitudinal information, expanding the data collected to include, but not be limited to, information on the health care received, costs and gross expenditures for health care, and outcomes. Recommendation 3-5: The panel endorses the NCHS decision to use the primary sampling units from the National Health Interview Survey for the National Health Care Survey, to retain their existing definition at this time, and to continue the needed research in this area.
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Recommendation 4-3: The panel recommends that NCHS develop and implement, as a component of the National Health Care Data System, a continuous, longitudinal survey of health care utilization and expenditures, and their health care providers, using cohorts of individuals selected from among National Health Interview Survey respondents. Recommendation 4-4: The panel recommends that NCHS develop and implement a survey capability to obtain longitudinal data for cohorts of residents of nursing homes, while institutionalized, on their use of and expenditures for health care received from providers other than the nursing home itself.
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The panel further urges NCHS to examine the feasibility of collecting health insurance claims files from both private and public insurers for individuals included in the samples from the National Health Interview Survey and the National Nursing Home Survey selected to study health care utilization and costs. Recommendation 4-7: The panel recommends that NCHS take into serious consideration the recommendations in this report relating to the National Health Care Data System before reaching final decisions on the 1995 redesign of the National Health Interview Survey.
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Recommendation 5-3: The panel recommends that the Department of Health and Human Services establish an ad hoc external high-level committee, comprised of persons who have distinguished themselves in the field of health care statistics, survey and sampling methods, and the provision of health services, to undertake a comprehensive review of He health care statistics activities throughout the department and report its findings directly to the secretary. Recommendation 5-4: The panel recommends that the Department of Health and Human Services ensure that sufficient resources for maintaining capability for analysis and dissemination of the data collected be included in the resources allocated for the National Health Care Data System.
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