Integrating Federal Statistics on Children Report of a Workshop (1995) / Chapter Skim
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Monitoring Changes in Health Care for Children and Families
Monitoring Changes in Health Care for Children and Families
Pages 156-191
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From page 156... ...
Kominski, R., and P.M. Siegel 1993 Measuring education in the Current Population Survey.
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From page 157... ...
EDUCATIONAL ATTAINMENT AND THE TRANSITION TO WORK 155 Mizell, H 1988 A commentary on Ivan Charner and Bryna Shore Fraser's Youth and Work: What We Know, What We Don't Know, What We Need to Know.
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From page 158... ...
Indeed, several states have already moved to implement health care reforms. In addition, powerful economic forces are leading to rapid changes in the organization and delivery of health care.
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From page 159... ...
Health care reforms are likely to bring about profound changes in the manner in which children and their families in this country obtain health care. Universal coverage would give almost 10 million children who are now uninsured health insurance coverage (Snider and Boyce, 1994)
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From page 160... ...
Monitoring and evaluating the changes that accompany health care reforms for children, their families, and the health care system that serves them presents a formidable challenge. Fortunately, the United States possesses a system for collecting and disseminating health statistics that is the envy of most other developed countries.
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From page 161... ...
In the next section, a framework is presented for assessing the types of data needed for monitoring the effects of health care reforms on children and families. DATA NEEDED FOR MONITORING CHANGES IN HEALTH CARE Evaluation of the changing health care system requires data that systematically address concerns about equity, access, quality, and costs of care.
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From page 162... ...
Indirect costs of illness. records Health status Infant and childhood mortality, low birthweight, health and functional status Vital statistics; indicators (including physical, development, behavioral, and emotional)
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From page 163... ...
; types of practitioners records involved in providing services; outcomes of visits Health Health care Work force deployment, by type of professional and type of physician; Systems systems resources primary care resources; specialty care resources; hospitals; ambulatory care surveillance organizations (including HMOs) ; long-term care facilities, laboratories; MONITORING CHANGES IN HEALTH CARE home health services organizations, public health organizations & services, (e.g., school health facilities)
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From page 164... ...
• Information is also needed to track environmental and social characteristics that predispose children and families to illness or interfere with efforts to ameliorate illness. Data collection strategies should be designed to provide baseline information on all of these characteristics and should be organized to monitor changes over time as health care reforms are implemented.
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From page 165... ...
And it is organized according to these types of information sources: • Vital statistics and surveillance systems for obtaining populationbased information concerning health status. • Population surveys to obtain data concerning health status, access to services, use of services, experiences and satisfaction with various aspects of services, and both direct and indirect out-of-pocket costs of dealing with health problems.
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From page 166... ...
and health status National Health Personal Health status; chronic conditions; Interview Survey interviews behavioral problems; learning and on Child and developmental problems; birth Family Health characteristics (NCHS)
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From page 167... ...
births Annual and infant deaths and infant deaths All deaths All deaths Annual occurring among children Nationally Only adolescents Every 2 representative surveyed; years sample of students comparable but in grades 9-12; unlinked survey state-level data data for adults available 50,000 households Approximately Annual; 30,000 children insurance and under 18 years access surveys plus family added in 1993 members One child from 17,000 children Every 7-8 each NHIS (in 1988) under years; planned household 18 years plus for 1996 if linked data on funding other family available members continued on next page
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From page 168... ...
telephone planning and unintended pregnancy; interviews adoption; infertility National Health Personal Physical health; clinical findings; and Nutrition interviews; growth and development Examination physical Survey examinations; laboratory tests National Medical Multiple personal Linked data on access, utilization, Expenditure interviews; health status, and expenditures Survey provider record (AHCPR) checks; insurance policies analysis National Personal interviews Longitudinal tracking of health status Longitudinal Survey of YouthChild Data (DOL and NICHD)
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From page 169... ...
MONITORING CHANGES IN HEALTH CARE 167 Child/Family Planned Overall Sample Sample Periodicity 10,000 live births; 10,000 live births; Every 8 4,000 fetal deaths; 4,000 fetal deaths; years, with 6,000 infant deaths; 6,000 infant deaths longitudinal oversample of follow-up; blacks last conducted in 1988 with 1991 follow-up 8,500 women ages 8,500 women ages Every 5 years 15-44; oversample 15-44; oversample subsequent of blacks of blacks follow-up; last conducted in 1988 with 1990 telephone interviews 30,000 persons ages 14,000 children Periodic; 2 months and older under age 20 currently in 4th examined for year of 6-year NHANES III cycle; continuous examinations to begin in 1996 14,000 households 10,500 children Every 8-10 (in 1987) plus years; last linked data on conducted in other family 1987; planned members for 1996 Children born to Approximately Every 2 years female members 8,500 children of the NLSY A cohort of 23,000 A cohort of 23,000 Will follow kindergarten kindergarten cohort through children children 5th grade; data collection to begin with 1998 1999 school year continued on next page
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From page 170... ...
utilization, and health status Current Population Personal interviews Health insurance coverage; public Survey (Census) program participation National Sample survey of Prevalence of substance abuse Household Survey population age 12 on Drug Abuse and older (ADAMHA)
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From page 171... ...
MONITORING CHANGES IN HEALTH CARE 169 Child/Family Planned Overall Sample Sample Periodicity 32-month 15,000 children A new panel is longitudinal panel under age 18 introduced every survey; 20,000 in 1990 panel 12 months; households beginning 1996, a 48-month panel of 50,000 households is planned 20,000 households Approximately Will follow over from the 1993 SIPP 15,000 children a 10-year period panel if funding available 57,000 households 33,000 children Monthly; health monthly under age 15 insurance and program participation data collected in March surveys 18,000 households Approximately Biennial 5,000 youth ages 12-17 494 hospitals; Approximately Annual 274,000 discharges 60,000 discharge records for children under 18 years 700 facilities; Unknown (to be Annual; to be 180,000 patient implemented in implemented in records 1994) 1994 3,400 physicians Approximately Annual in office-based 7,500 records for practices; 45,000 children patient visits continued on next page
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From page 172... ...
licensing agencies; health agencies; sampling frame for professional provider surveys associations Claims Data Claims submitted Hospitalization; quality of care; variation to private insurance in practice patterns; health care payments; companies for diagnosis and treatments; some data have insured individuals cost sharing and claims submitted to state Medicaid agencies
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MONITORING CHANGES IN HEALTH CARE 171 Child/Family Planned Overall Sample Sample Periodicity 1,500 home health Approximately 700 Annual agencies and records for children hospices; 7,000 under 18 years current patients; 7,000 discharged patients 525 hospitals; Approximately Annual 70,000 patient visits 15,000 records for children under age 15 Stratified national Not applicable Annual; to be sample of implemented in establishments to 1994 include all sizes of businesses, both private and public sector; 100,000 establishments screened to conduct 51,000 interviews Hospital discharge Depends on state Continuous data records from 14 collection effort state data systems funded through 1994 All licensed/certified Not applicable Periodic; facilities in covered recently categories expanded to include additional providers Depends on system Depends on system Depends on system continued on next page
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From page 174... ...
Since the relevance and usefulness of these data sources extend beyond personal health services, they are not separately reviewed in this section. Below, we describe the principal sources of data for monitoring changes in health care.
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For example, when linked with the Area Resource File (a system surveillance dataset) , vital statistics can provide information on the relationship between preventable mortality or morbidity and the level of resources available in the same geographic area.
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Population Surveys Almost all national population-based health surveys focus heavily on health status and utilization of health services. Household surveys commonly obtain information on number of hospitalizations and physician vis
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This was the case with the 1988 National Health Interview Survey on Child Health. Useful questions were asked about physical, emotional, developmental, and learning problems, but different reference or
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From page 178... ...
New surveys sponsored by the National Center for Health Statistics have expanded the range of facilities and services studied to include ambulatory surgery centers, home and hospice care providers, and ambulatory care provided by hospitals. However, since the information obtained typically concerns individual encounters, it is not possible to link hospitalizations or visits made by individuals from one time to another or from one provider to another.
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From page 179... ...
, there are some major problems in using existing administrative record data for health care reforms. One notable problem concerns the identification of the "denominator." Data are available for beneficiaries (i.e., those covered by health plans)
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Responsibility for its delayed adoption is due at least in part to controversies over the importance and necessity of certain data elements, issues concerning the confidentiality of data about individual patients, individual providers, and individual health care plans (which may regard such information as proprietary) , and intensive lobbying by special-interest groups for inclusion of data elements of particular interest to them.
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From page 181... ...
For example, it is now possible to link the Medicare Current Beneficiary Survey with Health Care Financing Administration claims payment files and with the National Death Index, Social Security records, and the Area Resource File (Wunderlich, 1992)
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From page 182... ...
The attributes include comprehensiveness, timeliness, ability to meet descriptive and analytical needs, ability to assess change, ability to measure short-term and long-term effects, provision of adequate geographic detail, capacity to assess effects on vulnerable populations, flexibility to address emerging issues, and capacity to integrate information within and across data bases. Comprehensiveness The framework presented in Table 1 suggests several domains of data needed for a comprehensive assessment of the impact of health care reforms on children and families.
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From page 183... ...
For example, there is a need for family-level identifiers in all household-based health surveys. In some surveys, such as the National Health Interview Survey, it is currently very difficult to identify records for parents of sample children, making familylevel analysis all but impossible.
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From page 184... ...
Information for the tracking system could be derived from a combination of administrative data, public health surveillance data, and telephone survey data. Administrative data would be derived from health plans, claims payment systems and other sources.
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From page 185... ...
Two promising possibilities for panel surveys are now being planned that could be of enormous value in monitoring health care reforms. First, the National Center for Health Statistics is considering conducting a child and family survey as part of the National Health Interview Survey.
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For example, changes in access and utilization of care could be expected to occur soon after implementation of a reform. In contrast, changes in child health status, if they occur, are likely to become apparent only years later.
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From page 187... ...
First, the sample design, particularly the selection of primary sampling units, must be developed in a manner that is consistent with state-level estimation. In the past, major health surveys, such as the National Health Interview Survey, have selected primary sampling units that overlap state boundaries or have excluded some states entirely.
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From page 188... ...
The National Center for Health Statistics, with its long history of cooperating with states on the development of uniform standards for vital statistics, may be well suited to leading this effort. With health care reforms in place, there will be a much greater need for coordinated information at the local, state, and national levels.
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From page 189... ...
At the most basic level, databases should share common definitions and terminology whenever possible; unfortunately, this happens less frequently than is desirable. For example, the National Health Interview Survey, the National Medical Expenditure Survey, the Current Population Survey, and the Survey of Income and Program Participation use different questions for assessing health insurance coverage.
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From page 190... ...
For example, data on utilization and expenditures from Medicare administrative files are linked to population-based survey data in the Medicare Current Beneficiary Survey. Similarly, the National Death Index now permits linkage of death certificates to most of the population surveys sponsored by the National Center for Health Statistics.
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From page 191... ...
As much as possible, the system should rely on existing data bases, modifying them when necessary but keeping in mind their original purposes. Fortunately, the nation already possesses a rich set of health databases that can be used for monitoring health care reforms.
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