Consensus was reached among the various HHS agencies on key features of a plan for consolidating HHS' survey. Major elements of this plan are summarized below, and detailed in Tab E.
The HHS Plan for Survey Consolidation will result in :
• A more rational, systematic strategy for collection of data on key health issues facing HHS.
• The filling of a critical gap by the production of annual estimates of health care expenditures, insurance coverage, and employer-related insurance costs.
• The continued ability to meet public health data needs now met through ongoing and planned population, provider-based, and infrastructure surveys, within a framework that also allows for expansion to meet unmet public health data needs.
• An enhancement of the analytic capabilities of HHS surveys, allowing multiple HHS data collection efforts to be linked analytically through the use of common core questionnaire, common sampling frames, and common definitions and terms.
• An overall reduction in the burden imposed on survey respondents by HHS, below what would have been required in independent surveys to meet the same data needs.
• Efficiencies in sampling, data collection, questionnaire design, and survey operations, allowing more of HHS' limited data collection resources to be focused on meeting high priority data needs.
This consolidation creates a framework in which nearly all of the major surveys of HHS will be significantly restructured and redesigned.
Key features of this plan include the following:
• Redesigning the core questionnaire and automating the ongoing NHIS, to continue broad-based monitoring of health issues and to establish the capability to use the NHIS as a sampling frame for multiple HHS population surveys.
• Implementation of an ongoing, longitudinal household panel survey on insurance and expenditures - the Medical Expenditures Panel (MEP). Growing out of the NMES design, the MEP will use the NHIS as a sampling frame, with coordinated questionnaires to enhance analytic linkages and reduce respondent burden. Immediate benefits of consolidation will be realized by using the 1995 NHIS as the sampling frame for the 1996 panel. The 1996 MEP would be introduced at a lower sample size than was planned for the 1996 NMES, but would be increased in size to meet precision requirements as the study continues in 1997.
• The MEP would be conducted on a periodic cycle so that insurance and expenditure data will be available annually, but with less detail and at lower cost than would be incurred if a full NMES-type plan were employed. The continuing annual sample size for the MEP would be 8,000 households, increasing to 12,600 households at five year intervals. An extensive provider followup would be conducted at these five year intervals, with more limited information being obtained from providers on the continuing annual sample.
• The MCBS will be closely coordinated with the MEP in terms of 1) greater questionnaire coordination; 2) analytic linkages of the MCBS and MEP samples to increase the power of each survey; and 3) possible offsetting reductions in sample size if analytic goals can be achieved through such linkages. Further steps to consolidate the MEP and MCBS will be evaluated as the MEP reaches a steady annual state in 1998.
• Consolidation of the NEHIS and NMES-HIPS, through a merger of field operations and the adoption of a common questionnaire for all employers. The consolidated NEHIS/HIPS would parallel the sample size cycles of the MEP. A sample of 42,000 employers every five years would coincide with the more extensive MEP, and provide both national and 50-State estimates in that year. The annual sample of 15,000 employers would provide for continuing national estimates.
• Joint field operations and common core questionnaires and forms for major surveys of health care providers, beginning with NCHS' National Health Care Survey components (hospitals, physicians, ER and OPD's, home and hospice care, ambulatory surgery) and the provider followup to the Medical Expenditure Panel. Additional evaluation efforts will address the potential for closer coordination or consolidation with the SAMHSA Drug Abuse Warning Network and the AHCPR Healthcare Cost and Utilization Project.
• Merger of the National Nursing Home Survey and the NMES Nursing Home Expenditure Survey into an integrated, periodic survey of nursing home capacity, services, utilization, and expenditures. Further evaluation will be made of the potential for coordinating the institutional component of the MCBS with this newly consolidated strategy for nursing home data.
• Redesigning the National Health and Nutrition Examination Survey so that it would be conducted using the NHIS as the sampling frame for its next cycle, beginning in 1998. The 1998 NHANES would begin with a more limited 2-year household-examination based survey, followed by continuous three-year cycles involving complete examinations, laboratory tests, and dietary interviews in mobile, field examination centers. In addition to being directly linked to the NHIS, the redesigned NHANES would serve as HHS' primary vehicle for obtaining detailed, objectively measured data on health status, prevalence of conditions, and distribution of medical risk factors in the population.
• Continuing the design of the National Survey of Family Growth as a survey directly linked to the NHIS sampling frame, with greater questionnaire coordination with other components of the consolidated survey plan.
• Development of a conceptual framework for characterizing health care capacity and public health infrastructure, and rationalizing and coordinating HHS' provider inventories, health workforce analyses, and data collection efforts to characterize the public health infrastructure. Building on this framework, HHS would develop the analytic capability to link capacity and infrastructure data more closely with health status, economic, and outcomes measures, and to look at interaction between functioning and costs in (and between) the medical care and public health systems.
• A design framework in which the National Household Survey on Drug Abuse could be consolidated with the NHIS in several respects, ranging from 1) closer coordination between the questionnaires of the two surveys; 2) using the NHIS as the sampling frame for the NHSDA; to 3) conducting the NHSDA as a
supplement to the NHIS. Some of these possibilities require that difficult (and possibly insurmountable) methodological issues be overcome. Tab F outlines these issues.
• Further efforts to integrate disease surveillance and grant reporting systems, which typically are conducted in partnership with State and local public health officials. These efforts will include 1) removing, to the extent possible, Federal requirements for States to maintain distinct, non-integrated data collection mechanisms; 2) support of streamlined, integrated data systems at the State level that can satisfy disease surveillance objectives; and 3) consolidation of categorical grants into performance partnership grants, with streamlined reporting requirements. Efforts to streamline and integrate these multiple, distributed data systems will depend on strong Federal leadership in the development of consensus standards, definitions, and approaches to recording and sharing of data.
• A periodic State-level telephone survey would be designed to obtain basic health status, access to care, insurance, and expenditure data of importance for national policy analysis, performance evaluation, and modeling. By using the available NHIS sample, already distributed widely in States, and using questionnaires from the consolidated national surveys, State level data can be obtained efficiently and be directly comparable to national data. If funding is available, this survey would be conducted at periods when the MEP was off-peak.
• A modular design that will allow surveys to be expanded to meet other critical data needs, such as for subpopulations (e.g., minorities, poor) or for State and local areas. This design will allow States to "buy into" the consolidated HHS survey to obtain data on their States. States may find this to be an efficient option for monitoring performance partnership grants. HHS would also devote efforts to developing modeling techniques that would enhance the value of national surveys for State purposes.
• Improved and more uniform policies regarding privacy, data access, public data release, and sharing among HHS agencies and with outside users, and development of new HHS policies that would assure that any new survey activities considered by HHS agencies would be developed within the consolidated survey framework, to the extent possible.