HHS data systems cover a broad range of analytic objectives, paralleling the range of research, programmatic, and analytic issues addressed by HHS programs. Analytic objectives include:
• broad monitoring of the population and health system to identify trends, health problems, risk behaviors and conditions, measure the burden of illness, prevalence of conditions, and develop health accounts
• more specific data to support HHS program needs, such as management of the Medicare program, oversight of grants, and coordination of substance abuse/mental health programs
• analytic base for formulating policy, modeling the impact of proposed changes in programs, and evaluating the impact of policies over time
• public data resource for biomedical, epidemiological, and health services researchers to use in conducting independent research or HHS-supported analysis
• measuring, monitoring and evaluating performance of HHS-supported programs, including those proposed for consolidation in performance partnership grants
Health data systems must be broad, balanced, and comprehensive, obtaining information on 1) health status; 2) health risks (e.g., environmental, behavioral, genetic, exposure to infectious agents); 3) the capacity and functioning of the medical care and public health systems; and 4) health care costs, utilization, and associated areas. It is essential to be able to interrelate data from these areas in order to assess interactions and relationships.
In order to obtain information on the full range of issues that are encompassed by concepts of health and health care it is necessary to collect information on many, interrelated levels. It is necessary to obtain information on the characteristics of the population (including diverse subjective and objective measures of health status, functioning, insurance coverage, expenditures, utilization patterns, satisfaction with care), health behaviors, unhealthful exposures, behavioral and medical risk factors, and attitudes about (and knowledge of) health and health care. This information must be linked to information on the medical care and public health system's structure, employer provided health insurance, provider behavior, the distribution of public and private resources, and costs.
The interaction of information on populations and the health care system allows for the evaluation of effectiveness of care and interventions, the interplay of supply and demand leading to over or under supply of key providers, the investigation of how changes in the system will affect supply, total costs, and the shifting of costs to different payors, and adequacy of care. The lack of information in any one area makes it impossible to interpret the data that is collected, reducing its analytic usefulness. For example, it will not be possible to monitor the health of the Nation and to explain significant changes in these trends, to develop accurate projections and forecasts for planning purposes, or to evaluate the health care system and intervene to improve access and quality. As a result, HHS could not meet its primary objective to improve the health of the population.
Information is needed for the population as a whole, as well as for subgroups defined by demographic characteristics (age, race, gender, income) and geographic location, since in many cases HHS programs have particular responsibility for these populations.
To obtain such diverse information, it is imperative that a diverse array of survey mechanisms and approaches be employed. These include:
• personal interviews (e.g., to obtain information on the health and expenditure experience of families, the knowledge, attitudes, and risk behaviors of individuals, and how health conditions are translated into functioning in society);
• interviews or records from employers (e.g., to gauge the extent to which individuals are provided with health insurance, or the extent of occupational health problems and services);
• collection of information from providers of health care and essential public health services, including (e.g., to obtain medical or cost detail unknown to individuals, or to obtain a sufficient sample of rare events such as a surgical procedure or exposure to an infectious agent), or vital registration officials (e.g., to obtain complete coverage and detail on sentinel health events such as birth and death), as well as other data collection approaches to providers in order to determine their organization, distribution, behavior, and preferences; and
• direct physical examination of individuals (e.g., to identify undiagnosed or untreated illnesses, objectively measure and validate health status and disease prevalence, and analyze the relationship between risk factors and disease).
Key customers and constituents of HHS surveys include:
• agencies within HHS that use data for program management, actuarial projections, policy development, and evaluation;
• researchers within HHS that use data in epidemiologic studies, identification of hypotheses for biomedical research, demographic studies, etc.;
• analysts in other Executive and Legislative branch organizations, including OMB, CBO, OTA, and GAO;
• State and local governments involved in public health and health care financing;
• academic researchers working independently and with support from HHS;
• advocacy groups, including advocates for public health, disease-specific medical research, children, the aged, Americans with disabilities, and those advocating particular strategies for health reform; and
• the private sector, including providers, managed care organizations, and associations.