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Summary
Pages 1-16

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From page 1...
... As the population continues to age, the strain that will be put on publicly funded programs such as Medicare will only elevate the debate about how best to meet the nation's health care needs. One factor contributing to the trend of rising expenditures is the ever-expanding and increasingly sophisticated array of life-extending and life-enhancing treatments produced by medical research for the range of conditions and diseases that afflict the population.2 In addition, the body of knowledge about the effect of 1This summary includes mainly top-level recommendations; the body of the report contains addi tional detailed recommendations, particularly with respect to data needs.
From page 2...
... Without this kind of information, it is impossible to credibly assess whether the nation spends too much or too little on medical care relative to, say, public health measures, and, perhaps more importantly, whether we purchase something close to the right mix of medical care goods and services for a given level of resources expended. In order for policy makers to pursue actions that reduce costs sensibly, improve performance, and, in general, enhance the efficiency of the national approach to health and medical care, a more systematic approach to compiling data for the purpose of tracking productivity in the sector is needed.
From page 3...
... Given the wide range of statistical and research measurement needs, creating health data systems that will adequately inform policy requires a multipronged effort. Economic accounting (as practiced by BEA)
From page 4...
... In the broad-concept account, medical care is an input in the production of "health" -- treatments are pursued with the objective of extending or enhancing a patient's years of life. The two projects are complementary; the analytic pieces for which the statistical agencies are responsible -- e.g., medical care expenditure accounts and price indexes -- are intermediate building blocks for a comprehensive health data system.
From page 5...
... For policy purposes, the most pressing need is to measure medical care expenditures and related outputs and outcomes as well as possible. In addition, accurate expenditure and price data on medical care are essential both for devel oping broader health accounts and for improving the medical care component of the NIPAs.
From page 6...
... Clinical Classification Software, which groups the numerous Interna tional Classification of Diseases-Ninth Revision codes into broader categories that are "clinically meaningful." Reallocating the NHEA totals using data from the Medical Expenditure Panel Survey (MEPS) , the research team found that the largest eight expenditure categories (circulatory system, mental disorders, musculoskeletal, injury and poisoning, digestive, neoplasms, respiratory, and nervous system)
From page 7...
... ALLOCATING SPENDING ACROSS TREATMENT-OF-DISEASE CATEGORIES The first major task in developing a national health account -- whether it is BEA's satellite version or the broader health type -- is to devise a method for allocating economy-wide spending on medical care into the treatment-of-disease categories described above. Because they serve as building blocks for many kinds of health data systems, improving the methodology for organizing and tracking health care expenditures is an immediate priority.3 Given the number of different disease classification schemas currently in use in the U.S.
From page 8...
... One is an encounter-based method in which spending is attributed to one or to several diagnoses as reflected by data extracted from patient claims. A second, broader approach involves constructing episodes of treatment -- which may include numerous encounters over a predefined period -- then adding up dollars spent nationally on each of the range of diseases and conditions.
From page 9...
... complete group, such as found in parts of Intermountain Healthcare, the Geisinger Health Care System, or one of the Hawaiian islands before attempting it on a national basis. DEVELOPING PRICE INDEXES FOR MEDICAL CARE INPUTS AND OUTPUTS Much of what is required to develop health and health care accounts has to do with medical care price deflation.
From page 10...
... . If price indexes track industries in a way that segregates by type of service facility, then surgeries taking place in a hospital are sampled to generate one price index, whereas surgeries taking place in clinics are sampled in the estimation of another.
From page 11...
... Information about medical care outcomes and the chang ing quality of treatments is also essential for balanced policy discussions about resource allocation, which have focused nearly exclusively on the cost side while neglecting the changes in value that accrue as a result of the expenditures. As an example, the price of treating heart attack patients has increased dramatically, but so too has the desirability of outcomes.
From page 12...
... Integrating emerging information from the research community is an essential enhancement that can be made to the data infrastructure. Recommendation 6.7: Significant analytic value could be added to Medicare data compiled by the Centers for Medicare & Medicaid Services if more clinical information on outcomes and patient characteristics were included.
From page 13...
... Recommendation 5.1: A committee of members from agencies responsible for collecting population health data (Agency for Healthcare Research and Quality, National Center for Health Statistics, Census Bureau, etc.) should be charged with identifying and putting in place a single standard population health measurement tool (or set of tools)
From page 14...
... Recommendation 5.3: Initially, the national health account should focus on quality-adjusted life expectancy measured in quality-adjusted life years as the best summary measure of health in each year. ATTRIBUTING HEALTH GAINS Throughout this report, we focus on methods for identifying, quantifying, and valuing inputs to health -- beginning with treatments of specific medical conditions -- and for measuring changes in the population's health.
From page 15...
... For constructing a core data set to underlie national health and health care accounts, it is reasonable to use MEPS supplemented by claims information wherever population or disease coverage gaps appear. Survey and claims data
From page 16...
... However, their sample sizes are adequate only for high-prevalence conditions such as cardiovascular disease and risk factors. In contrast, insurance claims data provide a large sample, but at the expense of representativeness -- no single source provides a national sample.


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