Toward a Health Statistics System for the 21st Century Summary of a Workshop (2001) / Chapter Skim
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2. Health Statistics: Past, Present, and Future
2. Health Statistics: Past, Present, and Future
Pages 7-30
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From page 7... ...
Rice, Professor Emeritus Institute for Health arid Aging University of California, Sari Frar~cisco INTRODUCTION The organization, delivery, and financing of health care services in the United States is complex, comprising an interdependence of the private and government sectors of the economy. This pluralistic health care economy, with its pragmatic mix of public and private organizations, has produced a wide range of databases that enable us to monitor the health of the nation.
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Private organizations of health professionals, health service providers, health insurance, and many others have important interests in the collection and use of health data. The federal government needs a variety of data to support its major role in improving health and medical care delivery systems throughout the nation.
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The Public Health Service conducted the first National Health Survey in 1935-1936, funded by the Works Projects Administration (Duncan and Shelton, 19781. In 1953 the National Opinion Research Center began a series of surveys separated by five-year intervals on the consumer's use of medical care, the degree of health insurance protection, and expenditures for care (Andersen and Anderson, 19671.
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Most federal health data systems have traditionally been developed independent of each other. Despite the large amount of money and staff resources devoted to these statistical activities, we lack information necessary to adequately assess the health status of the population, and the determinants of risks to health, and the ability to analytically relate data across these areas.
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NCHS shares the costs incurred by the states in providing vital statistics for national use. Additional programs related to the NVSS include the Linked Birth and Infant Death Data Set, the National Maternal and Infant Survey, the National Mortality Followback Survey, and the National Death Index.
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, a computerized index of death record information beginning with 1979 deaths, has made enormous contributions to more efficient epidemiologic and other health studies in which researchers can go to one source, NCHS, to obtain mortality information on their study participants. Prior to the establishment of the NDI, each state had to be contacted separately for such information on file in the state vital statistics offices.
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This construct raises issues of privacy and confidentiality, rapidly evolving issues that reflect the complex interplay of personal rights, ethical concerns, legal responsibility, and societal interest in the general welfare of the population and public health. Privacy and confidentiality will be discussed further below.
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Currently, approximately 30 states have population-basecl registries, but they may be limited by both uncler-registration ancl selection bias (Stroup ancl Teutsch, 19981. HEALTH STATUS, HEALTH CARE UTILIZATION, AND MEDICAL CARE COSTS Statistics abound on health status ancl use of medical care services at the fecleral, state, ancl local levels.
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MEPS is a subsample of NHIS participants, providing health status and other data for enhanced analytical capacity. Use of NHIS data in concert with the data collected in the 1996 MEPS provides the capacity for longitudinal analysis.
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, nursing homes (National Nursing Home Survey) , ancl health agencies providing home health care services ancl hospice care (National Home ancl Hospice Care Survey)
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The private health sector includes organizations of health service providers, health professionals, health insurance payers, consumers, industry, and private philanthropy. Many national and state data collection activities are conducted by these private organizations, but their quality is variable.
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The needs for health data at the state and local levels, however, have not adequately been met. The Cooperative Health Statistics System, a nationwide cooperative network of public and private agencies linked together
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Longitudinal Data The surveys, surveillance, and vital statistics programs meet many of the current needs for health data. The cross-sectional survey data give a "snapshot" at a point in time of the health status of people at different stages in their lives and allow periodic examinations of changes over time.
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These reports have specifically recommended the need for longitudinal studies, such as the recommendation that NCHS develop and implement a continuous, longitudinal survey of health care utilization and expenditures, and their health care providers, using cohorts of individuals selected from among NHIS survey respondents (National Research Council and Institute of Medicine, 1992) Other I`leniifietl Gaps Testimony to the many other identified gaps in current health statistics and the needs for specific health data is documented in the recent compilation of the conclusions and recommendations regarding health data and data systems in the published reports of the National Research Council and Institute of Medicine since 1985 Jane Durch, personal communication, September 9, 19991.
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From page 21... ...
By moving to this consolidated, annual household data collection effort, the analytical capabilities of these surveys have been significantly expanded and enhanced. The NHIS household interview core questionnaire provides populationbased statistics on health status and health care utilization with sufficient sample size to allow for analyses based on disaggregation of detailed age, race, sex, income, and other sociodemographic characteristics, and allows for the collection of data on a broad range of topics provided by NHIS.
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the Medicare Current Beneficiary Survey should be closely coordinated with MEPS in terms of greater questionnaire coordination ancl analytical linkages; ancl (3) design of a state-level telephone survey to obtain basic health status, access to care, insurance, ancl expenditure clata of importance for national policy analysis, performance evaluation, ancl mocleling.
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Expanded access to the Internet and more powerful computing hardware for management and processing of data have had positive effects on the accuracy of data collected and disseminated as well as on the timeliness of available data. Access to health data via computers has clearly increased, thereby changing and expanding the user pool and thus the uses of the data.
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These reports recognized that diverse groups of researchers, business leaders, and policy makers have developed databases to permit increasingly sophisticated analyses of community health needs, practice patterns, costs, and quality of care. Greatly enhanced electronic capabilities for data management create opportunities for easy linkage of health data files, resulting in concerns about misuse of the information and how well the privacy and confidentiality of personal health information will be guarded.
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The improvement of the quality and reliability of health statistics in the private sector is most urgently needed. Stantlartlization of Data Elements, Uniform Definitions and Coding, Minimum Data Sets Health data are collected by many organizations and at multiple geopolitical levels for a variety of uses.
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It requires the DHHS to adopt national uniform standards for electronic transmission of certain health information. It is understood that the adoption of uniform national standards for electronic processing of insurance claims and related transactions will improve information flow and help generate significant savings, while improving efficiency and enhancing the quality of health care services.
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As former director of one of the federal statistical agencies, I believe that the best way to provide objective high-quality information on the demographic, economic, social, and health characteristics of our population, and trends in those characteristics, is through agencies specifically established for that purpose. These agencies have "no axe to grind," can usually guarantee confidentiality to respondents, and hence are able to produce unbiased quality information acceptable to a wide array of users both within and outside government.
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The demands for health data are greater than our ability to produce them. Budgetary pressures are requiring assessment of current data collection and dissemination procedures.
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Committee on Regional Health Data Networks. Molla S
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1997 For the Record: Protecting Electronic Health Information. Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure.
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