893
THE NATIONAL CENTER FOR HEALTH STATISTICS AND THE DATA NEEDED FOR NATIONAL HEALTH INSURANCE* DOROTHY P. RICE Director, National Center for Health Statistics Health Resources Administration Public Health Service U.S. Department of Health, Education, and Welfare Hyatsville, Md.
I T is probable that a National Health Insurance (NHI) program will not include benefits for all medical care and will include deductibles and copayments; this requires that we have in place a variety of populationbased data systems that will provide the basis for measurement of costs, of equity in the provision of health services, and of the health status of the population. Program-based data will not be adequate to this need. To cite just one example, a NHI program with deductibles and copayments will not collect information on out-of-pocket expenditures for services which are not covered or even for covered services. I wish to emphasize the importance of maintaining and supporting such population-based data systems. I shall describe briefly the existing data systems of the National Center for Health Statistics (NCHS) and how they can and will be responsive to the needs for data.
HEALTH INTERVIEW SURVEY
The Health Interview Survey (HIS) is the principal source of information on the health of the noninstitutionalized civilian population of the United States. The National Health Survey Act of 1956 provided for this continuing survey and for special studies to secure, on a noncompulsory basis, accurate and current statistical information on the amount, distribution, and effects of illness and disability in the United States and on the services rendered for or because of such conditions. The HIS has been * Presented at the Seminar on Data Needs for Health Planning and National Health Insurance held by the Task Force on the Impact of National Health Insurance of the New York Metropolitan Regional Medical Program at the New York Academy of Medicine May 13, 1976.
Vol. 53, No. 10, December 1977
894
49 8D
RICE D. P. P.
.
RICE~~~~~~~~~~~~~~~~~~~~~~~~~~
collecting health and related information about Americans since July 1957. The data are obtained from the people themselves and, therefore, measure the social and economic dimensions of health-the impact of illness and disability and the resulting uses of health-care services by individuals. The structure that has evolved for the HIS questionnaire includes a relatively stable nucleus of questions, approximately 70% of the questionnaire, complemented by one or more supplements on special topics which change from year to year. Each year's questionnaire contains questions in the following areas: 1) The number of days of restricted activity, including bed-ridden days and days absent from work and school due to illness and injury occurring during the two-week period prior to the week of interview 2) All visits to physicians and dentists occurring during this period 3) The acute and chronic conditions responsible for these days and visits 4) Long-term limitations on activity and mobility and the chronic conditions related to the disability 5) All hospital episodes, including the reason for entering the hospital, length of stay, and whether surgical operation was performed during the past 12 months 6) The interval since the last visit to a doctor or dentist Each year's questionnaire also includes a set of questions designed to obtain estimates of the prevalence of specific chronic conditions and associated disability and of use of health services. Conditions affecting one body system-circulatory, respiratory, and so on-are covered each year; over a six-year period all major body systems are covered. Recent supplements to the annual questionnaires have dealt with such topics as family out-of-pocket health expenses; use of substances such as coffee, tea, sleeping pills, and cigarettes; and public knowledge about and membership in Health Maintenance Organizations and other prepaid group-practice plans. Ten years' experience with the Medicare program that provides protection against the high costs of hospital and medical care for the aged and disabled with deductibles and copayments has proved the need for a continuing household survey to provide timely data on the use of and charges for medical care services covered and not covered under the program. The current Medicare survey interviews panels of persons covered by the program monthly for 15 months beginning in October of each year. It has produced data indicating the number of persons who used Bull. N.Y. Acad. Med.
NATIONAL HEALTH INSURANCE
895
covered services but who did not meet the deductible requirements as well as data concerning the demographic and socioeconomic characteristics of the insured population. It also has collected such data as expenditures for drugs purchased outside of the hospital that are not covered under Medicare. These data cannot be obtained as a byproduct of the reimbursement system-they must be obtained separately by household interviews. Health-insurance coverage of the remainder of the population will require a similar mechanism for the acquisition of data. Such a system already is in place in the HIS and, in fact, it will produce baseline information with which to assess the program. THE HEALTH AND NUTRITION EXAMINATION SURVEY
The first Health and Nutrition Examination Survey (HANES) was initiated in 1970, when the NCHS was assigned an additional specific responsibility: to measure the nutritional status of the United States population and then to monitor changes in that status over time. The Health Examination Survey, which had been initiated a decade earlier, was restructured to combine the new task with its original purpose: the collection and utilization of data which can be obtained only by direct physical examinations, clinical and laboratory tests, and related measurement procedures. This information, which cannot be furnished by the people themselves or by the health professionals who provide their medical care, is of two kinds: 1) prevalence data for specifically defined diseases or conditions of ill health and 2) normative health-related measurement data which show distributions of the total population with respect to particular parameters such as blood pressure, visual acuity, or serum cholesterol level. The surveys use scientific samples of the United States population to provide representative national data which are analyzed and made available in a series of reports. Data collection in the first HANES was completed in 1975; the second program began in 1976. The kinds of information collected in the HANES are so varied and extensive that they are only illustrated here. With respect to the nutrition component, four types of data are included: 1) Dietary intake data, collected through 24-hour recall interviews and food-frequency questionnaires, both administered by an interviewer who is a trained dietitian 2) Hematological and biochemical findings. A sizable battery of such tests has been performed at the mobile examination centers of the survey, Vol. 53, No. 10, December 1977
896
896
D. P. RICE
D.
P.
RICE
where necessary, but for the most part at a central nutrition laboratory established at the Center for Disease Control in Atlanta, Ga. 3) Body-measurements data. The battery used is especially important in connection with infants, children, and youths where growth may be affected by nutritional deficiencies. 4) Findings on various signs indicating a high risk of nutritional deficiency; these are obtained through clinical examination. The health component of the HANES program includes specific defined diseases and conditions for which detailed examinations, tests, questionnaires, etc. are developed to obtain measures of prevalence levels. These vary with the particular program and have included such conditions as chronic rheumatoid arthritis and hypertensive heart disease. Important normative health-related measurements also are obtained. An important element in the health component in the first HANES program was an assessment of unmet health needs through the use of index conditions. Here, for example, our examination established the presence or absence of emphysema or other chronic respiratory disease. At the same time we obtained information from the examined person with respect to his selfperceived health needs in this regard and the actions he has taken with respect to seeking medical care. By interrelating these two kinds of information we hope to have measures of unmet health needs. THE NATIONAL AMBULATORY MEDICAL CARE SURVEY
In May 1973 the NCHS began the National Ambulatory Medical Care Survey (NAMCS) on a continuing basis to gather and disseminate statistical data about ambulatory medical care provided by office-based physicians in the United States. The need for such a system had been recognized many years before, having been pointed out as early as 1953 by the subcommittee on National Morbidity Surveys of the U.S. National Committee on Vital and Health Statistics. NAMCS provides a wide range of baseline data on the characteristics of the users and providers of ambulatory care. These baseline data, together with data on trends obtained as the survey progresses, will provide new insights into ambulatory medical care and stimulate further research on its use, organization, and delivery. The manner in which such care is actually dispensed, as described by the survey, can be related to contemporary arrangements for educating and Bull. N.Y. Acad. Med.
NATIONAL HEALTH INSURANCE
897
training physicians and other health personnel to provide various forms of ambulatory care, especially primary care. Such comparisons will suggest useful new directions and areas of emphasis that can be incorporated into the medical curricula, helping to make medical education more responsive to the shifting requirements and health problems of the population. NAMCS information will be useful to health-planning agencies, managers of health-delivery systems, and others concerned with planning, monitoring, and managing health-care resources; it also will be valuable to those who are developing and evaluating new and modified health-care systems and arrangements. The continuing nature of the survey will permit observation and measurement over time of different methods for managing and treating patients' problems, and it will provide general information on the etiology and epidemiology of selected conditions. It also will provide valuable information about the speed and effectiveness with which certain advances in medical practice are adopted by the basic source of medical care, the office-based physician. VITAL STATISTICs DATA SYSTEMS
Basic vital statistics in the United States are provided through the registration system. These come from records of live births, deaths, fetal deaths, marriages, and divorces or dissolutions of marriages. Registration of these events is a local and state function, but uniform registration practices and the use of these records for national statistics have been established over the years through cooperative agreements between the states and the NCHS or its predecessor agencies. The program is nationwide in scope, covering the entire population of the United States. Vital statistics are used in making estimates and projections of population, in assessing the health of the United States population, in pinpointing health problems, in measuring progress made by national health programs, in epidemiological studies, in marketing research, in demographic, sociological, and economic studies, in studies of the family, and in numerous and varied other aspects of research aimed at understanding our society and its problems and progress. VITAL STATISTICS FOLLOW-BACK SURVEYS
The National Mortality Survey and the National Natality Survey are periodic collections of data based, respectively, on samples of registered Vol. 53, No. 10, December 1977
898 898
D. P. RICE D.
P.
RICE
deaths and births occurring during a calendar year. The NCHS conducted mortality surveys annually from 1961 through 1968 and natality surveys from 1963 through 1969 and again in 1972. A National Infant Mortality Survey also was conducted during 1964 to 1966. Data from the follow-back surveys are in demand by all major users of vital statistics. They help meet the expanding needs for natality and mortality data in public health, medical research, epidemiology, demography, and other related fields. Data provided through the natality surveys are used by agencies and individuals responsible for or studying maternal and child health-care programs, and by researchers and others studying social and demographic issues. They have provided data on such subjects as unwanted pregnancies, prenatal and postpartum care, health status of mother and infant at delivery, and health-insurance coverage for medical bills related to pregnancy. The mortality surveys have provided data on: the duration and costs of hospitalization in the last year of life, the relation between risk of death in infancy and the socioeconomic status of the parents, the relation between rates of infant mortality and the mother's reproductive history, and the smoking habits of decedents. NATIONAL SURVEY OF FAMILY GROWTH
The National Survey of Family Growth is a multipurpose statistical survey; it provides a wide range of information to serve the needs of persons and organizations concerned with the dynamics of population change, family planning, and maternal and child health. This survey is designed primarily to produce data on factors influencing trends and differentials in fertility, family planning practices of the population, sources from which family-planning advice and services are obtained, the effectiveness and acceptability of the various methods of family planning, and those aspects of maternal and child health that are most directly related to fertility and family planning. The survey is based on personal interviews with about 10,000 women in child-bearing ages selected from a nationwide area probability sample of households. It is conducted biennially. HOSPITAL DISCHARGE SURVEY
This annual survey produces information on the characteristics of patients treated in short-stay general hospitals, the lengths of stay, diagBull. N.Y. Acad. Med.
NATIONAL HEALTH INSURANCE
899
nosis and surgical operations, and the patterns of use of care in hospitals of different size and ownership and in various regions of the United States. Information is based on a sample of about 225,000 abstracts of medical records from a national sample of some 400 hospitals. Data have been collected in this survey each year since 1965. NATIONAL NURSING HOME SURVEY SYSTEM
Between 1963 and 1969 the NCHS conducted surveys of nursing homes and their residents on an ad hoc basis. With the increased utilization of nursing homes that followed the implementation of the Medicaid and Medicare programs, those who set standards for, plan, provide, and assess long-term-care services needed comprehensive national data on a continuing basis. To meet their needs, the National Nursing Home Survey System was developed in 1972, with the initial survey in the system conducted in 1973-1974. This system provides data through biennial nationwide sample surveys of nursing homes, their residents, and staffs. The purposes of the surveys are:
1) To collect data on characteristics of the nursing home, its services, residents, and staff 2) To collect data on the cost to the facility of providing care by major components such as labor, fixed, operating, and miscellaneous expenses 3) To collect data on Medicare and Medicaid certification (such as number of beds, their utilization, number of residents receiving program benefits, and charges) so that all data can be presented according to certification status and can be linked to Social Security Administration and Social and Rehabilitation Service data (via the HEW Management Information System) for special studies 4) To provide indicators which can be used to measure a nursing home's capability to provide quality care 5) To interrelate data on cost, facility, staff, and residents to reveal the relations that exist between costs and such pertinent variables as utilization, services offered, staffing, and the physical condition of the residents OTHER DATA SYSTEMS
In addition to these, the NCHS operates several other data systems which primarily provide information related to the availability and utilizaVol. 53, No. 10, December 1977
900
900
D. P. RICE D.
P.
RICE
tion of health resources. These include comprehensive inventories of inpatient health facilities and family-planning clinics in the United States and inventories of licensed personnel in certain health occupations, including dentistry, nursing, optometry, and pharmacy. From time to time ad hoc surveys are undertaken to complement these continuing data systems. Finally, we are directing a major effort to the development of the Cooperative Health Statistics System, as mandated by our enabling legislation, Public Law 93-353. This system will provide comparable and uniform statistics at federal, state, and local levels through the use of common definitions, standards, and methodologies. The basic data components of the system are vital statistics, health manpower, health facilities, hospital care, ambulatory care, long-term care, and healthinterview statistics. For the immediate future our goal is the implementation of the vital statistics, manpower, and facility-data components in each of the 50 states. Data on manpower and facilities for local areas are needed especially by the new health-planning and resources-development programs being established across the nation. However, we must continue to rely upon the national data systems for much of the data required for assessment of the impact of national health insurance. For example, at least until all data components of the cooperative system are implemented in all states, the national data systems will be our means of determining the proportion of the health expenditures of the poor or the elderly that are met by national health insurance or of measuring changes over time in health status. The national systems have a demonstrated capability for responding to national data needs, and we shall continue to improve that capability.
Bull. N.Y. Acad. Med.
THE NATIONAL CENTER FOR HEALTH STATISTICS AND THE DATA NEEDED FOR NATIONAL HEALTH INSURANCE* DOROTHY P. RICE Director, National Center for Health Statistics Health Resources Administration Public Health Service U.S. Department of Health, Education, and Welfare Hyatsville, Md.
I T is probable that a National Health Insurance (NHI) program will not include benefits for all medical care and will include deductibles and copayments; this requires that we have in place a variety of populationbased data systems that will provide the basis for measurement of costs, of equity in the provision of health services, and of the health status of the population. Program-based data will not be adequate to this need. To cite just one example, a NHI program with deductibles and copayments will not collect information on out-of-pocket expenditures for services which are not covered or even for covered services. I wish to emphasize the importance of maintaining and supporting such population-based data systems. I shall describe briefly the existing data systems of the National Center for Health Statistics (NCHS) and how they can and will be responsive to the needs for data.
HEALTH INTERVIEW SURVEY
The Health Interview Survey (HIS) is the principal source of information on the health of the noninstitutionalized civilian population of the United States. The National Health Survey Act of 1956 provided for this continuing survey and for special studies to secure, on a noncompulsory basis, accurate and current statistical information on the amount, distribution, and effects of illness and disability in the United States and on the services rendered for or because of such conditions. The HIS has been * Presented at the Seminar on Data Needs for Health Planning and National Health Insurance held by the Task Force on the Impact of National Health Insurance of the New York Metropolitan Regional Medical Program at the New York Academy of Medicine May 13, 1976.
Vol. 53, No. 10, December 1977
894
49 8D
RICE D. P. P.
.
RICE~~~~~~~~~~~~~~~~~~~~~~~~~~
collecting health and related information about Americans since July 1957. The data are obtained from the people themselves and, therefore, measure the social and economic dimensions of health-the impact of illness and disability and the resulting uses of health-care services by individuals. The structure that has evolved for the HIS questionnaire includes a relatively stable nucleus of questions, approximately 70% of the questionnaire, complemented by one or more supplements on special topics which change from year to year. Each year's questionnaire contains questions in the following areas: 1) The number of days of restricted activity, including bed-ridden days and days absent from work and school due to illness and injury occurring during the two-week period prior to the week of interview 2) All visits to physicians and dentists occurring during this period 3) The acute and chronic conditions responsible for these days and visits 4) Long-term limitations on activity and mobility and the chronic conditions related to the disability 5) All hospital episodes, including the reason for entering the hospital, length of stay, and whether surgical operation was performed during the past 12 months 6) The interval since the last visit to a doctor or dentist Each year's questionnaire also includes a set of questions designed to obtain estimates of the prevalence of specific chronic conditions and associated disability and of use of health services. Conditions affecting one body system-circulatory, respiratory, and so on-are covered each year; over a six-year period all major body systems are covered. Recent supplements to the annual questionnaires have dealt with such topics as family out-of-pocket health expenses; use of substances such as coffee, tea, sleeping pills, and cigarettes; and public knowledge about and membership in Health Maintenance Organizations and other prepaid group-practice plans. Ten years' experience with the Medicare program that provides protection against the high costs of hospital and medical care for the aged and disabled with deductibles and copayments has proved the need for a continuing household survey to provide timely data on the use of and charges for medical care services covered and not covered under the program. The current Medicare survey interviews panels of persons covered by the program monthly for 15 months beginning in October of each year. It has produced data indicating the number of persons who used Bull. N.Y. Acad. Med.
NATIONAL HEALTH INSURANCE
895
covered services but who did not meet the deductible requirements as well as data concerning the demographic and socioeconomic characteristics of the insured population. It also has collected such data as expenditures for drugs purchased outside of the hospital that are not covered under Medicare. These data cannot be obtained as a byproduct of the reimbursement system-they must be obtained separately by household interviews. Health-insurance coverage of the remainder of the population will require a similar mechanism for the acquisition of data. Such a system already is in place in the HIS and, in fact, it will produce baseline information with which to assess the program. THE HEALTH AND NUTRITION EXAMINATION SURVEY
The first Health and Nutrition Examination Survey (HANES) was initiated in 1970, when the NCHS was assigned an additional specific responsibility: to measure the nutritional status of the United States population and then to monitor changes in that status over time. The Health Examination Survey, which had been initiated a decade earlier, was restructured to combine the new task with its original purpose: the collection and utilization of data which can be obtained only by direct physical examinations, clinical and laboratory tests, and related measurement procedures. This information, which cannot be furnished by the people themselves or by the health professionals who provide their medical care, is of two kinds: 1) prevalence data for specifically defined diseases or conditions of ill health and 2) normative health-related measurement data which show distributions of the total population with respect to particular parameters such as blood pressure, visual acuity, or serum cholesterol level. The surveys use scientific samples of the United States population to provide representative national data which are analyzed and made available in a series of reports. Data collection in the first HANES was completed in 1975; the second program began in 1976. The kinds of information collected in the HANES are so varied and extensive that they are only illustrated here. With respect to the nutrition component, four types of data are included: 1) Dietary intake data, collected through 24-hour recall interviews and food-frequency questionnaires, both administered by an interviewer who is a trained dietitian 2) Hematological and biochemical findings. A sizable battery of such tests has been performed at the mobile examination centers of the survey, Vol. 53, No. 10, December 1977
896
896
D. P. RICE
D.
P.
RICE
where necessary, but for the most part at a central nutrition laboratory established at the Center for Disease Control in Atlanta, Ga. 3) Body-measurements data. The battery used is especially important in connection with infants, children, and youths where growth may be affected by nutritional deficiencies. 4) Findings on various signs indicating a high risk of nutritional deficiency; these are obtained through clinical examination. The health component of the HANES program includes specific defined diseases and conditions for which detailed examinations, tests, questionnaires, etc. are developed to obtain measures of prevalence levels. These vary with the particular program and have included such conditions as chronic rheumatoid arthritis and hypertensive heart disease. Important normative health-related measurements also are obtained. An important element in the health component in the first HANES program was an assessment of unmet health needs through the use of index conditions. Here, for example, our examination established the presence or absence of emphysema or other chronic respiratory disease. At the same time we obtained information from the examined person with respect to his selfperceived health needs in this regard and the actions he has taken with respect to seeking medical care. By interrelating these two kinds of information we hope to have measures of unmet health needs. THE NATIONAL AMBULATORY MEDICAL CARE SURVEY
In May 1973 the NCHS began the National Ambulatory Medical Care Survey (NAMCS) on a continuing basis to gather and disseminate statistical data about ambulatory medical care provided by office-based physicians in the United States. The need for such a system had been recognized many years before, having been pointed out as early as 1953 by the subcommittee on National Morbidity Surveys of the U.S. National Committee on Vital and Health Statistics. NAMCS provides a wide range of baseline data on the characteristics of the users and providers of ambulatory care. These baseline data, together with data on trends obtained as the survey progresses, will provide new insights into ambulatory medical care and stimulate further research on its use, organization, and delivery. The manner in which such care is actually dispensed, as described by the survey, can be related to contemporary arrangements for educating and Bull. N.Y. Acad. Med.
NATIONAL HEALTH INSURANCE
897
training physicians and other health personnel to provide various forms of ambulatory care, especially primary care. Such comparisons will suggest useful new directions and areas of emphasis that can be incorporated into the medical curricula, helping to make medical education more responsive to the shifting requirements and health problems of the population. NAMCS information will be useful to health-planning agencies, managers of health-delivery systems, and others concerned with planning, monitoring, and managing health-care resources; it also will be valuable to those who are developing and evaluating new and modified health-care systems and arrangements. The continuing nature of the survey will permit observation and measurement over time of different methods for managing and treating patients' problems, and it will provide general information on the etiology and epidemiology of selected conditions. It also will provide valuable information about the speed and effectiveness with which certain advances in medical practice are adopted by the basic source of medical care, the office-based physician. VITAL STATISTICs DATA SYSTEMS
Basic vital statistics in the United States are provided through the registration system. These come from records of live births, deaths, fetal deaths, marriages, and divorces or dissolutions of marriages. Registration of these events is a local and state function, but uniform registration practices and the use of these records for national statistics have been established over the years through cooperative agreements between the states and the NCHS or its predecessor agencies. The program is nationwide in scope, covering the entire population of the United States. Vital statistics are used in making estimates and projections of population, in assessing the health of the United States population, in pinpointing health problems, in measuring progress made by national health programs, in epidemiological studies, in marketing research, in demographic, sociological, and economic studies, in studies of the family, and in numerous and varied other aspects of research aimed at understanding our society and its problems and progress. VITAL STATISTICS FOLLOW-BACK SURVEYS
The National Mortality Survey and the National Natality Survey are periodic collections of data based, respectively, on samples of registered Vol. 53, No. 10, December 1977
898 898
D. P. RICE D.
P.
RICE
deaths and births occurring during a calendar year. The NCHS conducted mortality surveys annually from 1961 through 1968 and natality surveys from 1963 through 1969 and again in 1972. A National Infant Mortality Survey also was conducted during 1964 to 1966. Data from the follow-back surveys are in demand by all major users of vital statistics. They help meet the expanding needs for natality and mortality data in public health, medical research, epidemiology, demography, and other related fields. Data provided through the natality surveys are used by agencies and individuals responsible for or studying maternal and child health-care programs, and by researchers and others studying social and demographic issues. They have provided data on such subjects as unwanted pregnancies, prenatal and postpartum care, health status of mother and infant at delivery, and health-insurance coverage for medical bills related to pregnancy. The mortality surveys have provided data on: the duration and costs of hospitalization in the last year of life, the relation between risk of death in infancy and the socioeconomic status of the parents, the relation between rates of infant mortality and the mother's reproductive history, and the smoking habits of decedents. NATIONAL SURVEY OF FAMILY GROWTH
The National Survey of Family Growth is a multipurpose statistical survey; it provides a wide range of information to serve the needs of persons and organizations concerned with the dynamics of population change, family planning, and maternal and child health. This survey is designed primarily to produce data on factors influencing trends and differentials in fertility, family planning practices of the population, sources from which family-planning advice and services are obtained, the effectiveness and acceptability of the various methods of family planning, and those aspects of maternal and child health that are most directly related to fertility and family planning. The survey is based on personal interviews with about 10,000 women in child-bearing ages selected from a nationwide area probability sample of households. It is conducted biennially. HOSPITAL DISCHARGE SURVEY
This annual survey produces information on the characteristics of patients treated in short-stay general hospitals, the lengths of stay, diagBull. N.Y. Acad. Med.
NATIONAL HEALTH INSURANCE
899
nosis and surgical operations, and the patterns of use of care in hospitals of different size and ownership and in various regions of the United States. Information is based on a sample of about 225,000 abstracts of medical records from a national sample of some 400 hospitals. Data have been collected in this survey each year since 1965. NATIONAL NURSING HOME SURVEY SYSTEM
Between 1963 and 1969 the NCHS conducted surveys of nursing homes and their residents on an ad hoc basis. With the increased utilization of nursing homes that followed the implementation of the Medicaid and Medicare programs, those who set standards for, plan, provide, and assess long-term-care services needed comprehensive national data on a continuing basis. To meet their needs, the National Nursing Home Survey System was developed in 1972, with the initial survey in the system conducted in 1973-1974. This system provides data through biennial nationwide sample surveys of nursing homes, their residents, and staffs. The purposes of the surveys are:
1) To collect data on characteristics of the nursing home, its services, residents, and staff 2) To collect data on the cost to the facility of providing care by major components such as labor, fixed, operating, and miscellaneous expenses 3) To collect data on Medicare and Medicaid certification (such as number of beds, their utilization, number of residents receiving program benefits, and charges) so that all data can be presented according to certification status and can be linked to Social Security Administration and Social and Rehabilitation Service data (via the HEW Management Information System) for special studies 4) To provide indicators which can be used to measure a nursing home's capability to provide quality care 5) To interrelate data on cost, facility, staff, and residents to reveal the relations that exist between costs and such pertinent variables as utilization, services offered, staffing, and the physical condition of the residents OTHER DATA SYSTEMS
In addition to these, the NCHS operates several other data systems which primarily provide information related to the availability and utilizaVol. 53, No. 10, December 1977
900
900
D. P. RICE D.
P.
RICE
tion of health resources. These include comprehensive inventories of inpatient health facilities and family-planning clinics in the United States and inventories of licensed personnel in certain health occupations, including dentistry, nursing, optometry, and pharmacy. From time to time ad hoc surveys are undertaken to complement these continuing data systems. Finally, we are directing a major effort to the development of the Cooperative Health Statistics System, as mandated by our enabling legislation, Public Law 93-353. This system will provide comparable and uniform statistics at federal, state, and local levels through the use of common definitions, standards, and methodologies. The basic data components of the system are vital statistics, health manpower, health facilities, hospital care, ambulatory care, long-term care, and healthinterview statistics. For the immediate future our goal is the implementation of the vital statistics, manpower, and facility-data components in each of the 50 states. Data on manpower and facilities for local areas are needed especially by the new health-planning and resources-development programs being established across the nation. However, we must continue to rely upon the national data systems for much of the data required for assessment of the impact of national health insurance. For example, at least until all data components of the cooperative system are implemented in all states, the national data systems will be our means of determining the proportion of the health expenditures of the poor or the elderly that are met by national health insurance or of measuring changes over time in health status. The national systems have a demonstrated capability for responding to national data needs, and we shall continue to improve that capability.
Bull. N.Y. Acad. Med.
