HHS Plan for Integration of Surveys. Measuring the Health Care and Public Health Infrastructure


The Department now obtains data on the level, characteristics and distribution of the health workforce and the physical capital in the health system through a number of separate inventories and surveys, with several more in the early planning stages. Data are obtained from a variety sources, including direct data collection, collaborative networks with State agencies, purchase of data from professional associations, and gathering of data available from public sources. In addition to data collection activities, the Department supports analytical programs in health resources and health workforce.

HHS programs include:

• National Health Provider Inventory, which focuses on nursing and related care homes;

• National Reporting Program for Mental Health Statistics - (Family of inventories and sample surveys of mental health organizations, and mental health services in prisons and general hospitals);

• Drug and Alcohol Services Information System (Annual inventory of alcohol and substance abuse treatment units and associated client data);

• HRSA's health professions analysis program (Analytical activities involving modeling and projections based largely on secondary data from other agencies and professional associations such as AHA and AMA);

• Area Resource File, a composite data base of county level information on health personnel, health facilities, health expenditures, socioeconomic and demographic data;

• The planned Public Health Infrastructure Data System, which will obtain data on the capacity, functioning, and funding of essential public health services in State and local public health agencies;

• HCFA National Provider Files; and

• HCFA health facility survey and certification activities.

The primary objectives of these activities include needs assessment; workforce planning; program administration; designation of medically underserved areas; descriptive analyses of the health care system; and sampling of providers for utilization surveys. Further, these data are essential to the evaluation and monitoring of our investment in public health and the relationship between the capacity and functioning of the public health system to health care costs and the health of the population.

The health facility and provider surveys have focused on selected providers of care rather than on the broad range of players in the health arena. As a result, there is a lack of systematic, comprehensive information that characterizes the capacity of the personal health care system and the infrastructure of the public health system over time. These efforts do not fully document and reflect the complexity of the underlying system, which is already heterogeneous and rapidly changing.

In the FY 1996 HHS Data Investment Initiative, funds have been earmarked for improvements in this area. The Investment provides for an expansion of the National Health Provider Inventory to additional health providers; development of a new data strategy for the public health infrastructure; new information on managed care settings; expansion of specialized inventories of substance abuse and mental health providers; and expansion of the Area Resource File.

What is needed is a conceptual framework--in effect, a broader systems view--that allows for characterization of the health system as a whole, the analysis of interactions between supply and demand, and the analysis of the relationship between capacity, functioning of the system, and cost. Such information would allow modeling of the impact of change in one aspect of the system on others (e.g., the interaction of the personal and public health systems under various health reform scenarios). It will allow HHS to monitor the capacity and performance of the providers, State and local agencies, and other players that are relied upon to accomplish national objectives.

In addition, regional, State and community level perspectives are essential in resource analysis and planning. Accordingly, a stronger focus on systems-wide or community perspectives would allow for analysis of the overall structure of the system in terms of regionalization, organization, redundancy, etc.

During the next year, HHS will take steps to develop such a conceptual framework, focusing on the characterization of communities and other geographic areas, relating systems capacity to measures of demand obtained through population surveys, and relating capacity measures to utilization surveys.

These steps will include:

• development of a common set of terms and definitions that can be used to characterize the health workforce and health establishments in all data collection systems;

• an HHS-wide approach to identifying commonalities that will allow linkages - such as standards for geocoding information, linkages between data systems obtaining information in the same areas, etc. These efforts can build on HCFA experience in developing national provider identification systems;

• development of approaches to defining and measuring trends in the structure, organization and operations of managed care entities;

• development of conceptual and analytic linkages that can tie separate data collection efforts into a systems-wide "virtual" inventory;

• coordinated approaches to data partnerships with States, as well as coordinated approaches to purchasing of secondary data from associations; and

• development of a strategy to direct HHS health workforce and resources data into accessible analytical data bases.

With such a conceptual framework, HHS can rationalize, consolidate, and coordinate existing and planned activities in this area.