HHS sponsors or operates a diverse number of surveys and other data collection efforts. Many of these have been conducted as independent efforts for technical reasons (e.g., specific design features, such as anonymity, that are not typical to other surveys), practical reasons (keeping burden on individual respondents to a minimum), funding reasons (e.g., dedicated or set-aside funding streams), and to maximize the flexibility and management control inherent in smaller-scale surveys.
Tab A summarizes the major parameters in designing surveys. Tab B is a matrix that summarizes key attributes and design parameters of selected major HHS surveys. The largest of these surveys, the primary focus of this report, are summarized below:
• The National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics (NCHS), is a continuous household survey of approximately 40,000 households. The NHIS covers a broad range of health status, health insurance, utilization, and risk behavior topics on an annual basis, and numerous specialized supplements are added to the NHIS annually to address topics of current priority. A current example is the Disability Survey, which in 1994 and 1995 is using the NHIS to identify persons with disabilities. These persons are being recontacted for detailed study.
• The National Medical Expenditure Survey (NMES), conducted by the Agency for Health Care Policy and Research (AHCPR), is a study of 14,500 households conducted approximately every 10 years. The NMES collects detailed data on utilization, expenditures, and insurance in addition to related information on health status and disability. Multiple household interviews are augmented by collection of data from insurance plans and medical care providers, and an institutional component obtains data on nursing home expenditures.
• The Medicare Current Beneficiary Survey (MCBS), conducted by the Health Care Financing Administration (HCFA), is an ongoing longitudinal panel survey of approximately 12,000 individuals selected from Medicare administrative files. Household respondents provide data on utilization, expenditures, and insurance coverage, which is supplemented by linkage to Medicare claims information. The MCBS sample includes institutionalized beneficiaries.
• The National Employer Health Insurance Survey (NEHIS), a collaborative effort of NCHS, AHCPR, and HCFA, is a telephone survey of approximately 40,000 establishments to obtain information on the nature and cost of health benefits offered by employers. This survey was first conducted in 1994.
• The National Household Survey on Drug Abuse (NHSDA), conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), focuses on estimating the incidence, prevalence, consequences, and patterns of substance use and abuse. NHSDA surveys 18,000 respondents using special procedures to protect privacy and anonymity.
• The National Health Care Survey (NHCS) is a family of NCHS surveys that inventories providers and measures of the utilization of health services through a series of surveys of providers. Surveys under the NHCS include those of hospitals, physicians, emergency and outpatient departments, nursing homes, home and hospice care providers, and ambulatory surgery centers.
• Surveys of the Public Health Infrastructure. In FY 1996, in collaboration with the public health community, PHS will initiate a strategy for obtaining comprehensive baseline and trend data on the public health infrastructure at national, state, and local levels, to fill gaps in currently available data on the impact of proposed changes in the health care system on the capacity of communities, States, and the nation to carry out essential population-based public health functions or to provide safety-net services, and to evaluate and monitor our investment in public health or the relationship between the capacity and functioning of the public health system to health care costs and the health f the population. This effort will address the provision of "essential services" of public health, persons providing these services, revenue sources and expenditures, and the extent to which population-based public health services cross-subsidize personal health care services and vice versa. The need for this effort, and the general approach, is summarized in Tab C.
• The National Health and Nutrition Examination Survey (NHANES) collects data through direct physical examinations, laboratory analysis, and interviews. In the most recent NHANES, completed in 1994, approximately 30,000 persons were surveyed in standardized mobile examination centers to obtain a wide range of measurements. NHANES already represents a consolidation of HHS' direct physical measurement activities, in that the data needs of more than a dozen individual agencies are met through the NHANES mechanism. Tab D includes examples of the types of information obtained through direct physical examinations.
• The National Survey of Family Growth (NSFG) is an interview survey of women in their reproductive years. The subject matter focus includes family planning, contraceptive use and efficacy, adoption and abortion, and other aspects of reproductive health, family formation, and dissolution. The NSFG is conducted every five years, with intermediate longitudinal followup interviews. The NSFG is already consolidated with the NHIS in that the sample for the NSFG is selected from NHIS respondents.