Though the health care system is complex, current sources of information correspond to the three types of data needs previously discussed: health resources and structure, (inputs from facilities, providers, insurer/payer coverage vehicles), indicators of the process of care (utilization of discrete services) and--least commonly--outcomes of care (spending, clinical outcomes). Within each data need category, the information now collected, reflecting the current emphasis in health data, is considerably narrower in scope than current users demand.
As reflected in Table 1, information on health resources and structures is typically divided between health provider and health insurer data. Health provider data are based largely on inventories or files from health care facilities and various types of providers. These files are maintained in federal agencies and in various provider associations. States keep such information on facilities and providers subject to their licensing provisions and sometimes for a broader set of facilities or providers. For the most part, these data relate to discrete entities or individual providers -- information on their characteristics or relationships with one another is limited.
Health agencies or associations have not traditionally been very involved in maintaining data on health insurers and managed care entities. State insurance departments keep such data for insurers or HMOs subject to their licensure requirements. Inventories also are maintained centrally by trade associations and research or consulting firms. Industry data from the Department of Commerce can sometimes provide insight into particular issues of interest.
Information on the process of care is based mainly on discharge/encounter-level data for institutional services (hospital discharges, nursing home stays), with some limited data collection from institutional providers of ambulatory care (outpatient facilities, home health agencies) and--to an even lesser extent--office-based practice. Payers also may have data from claims that can support analysis, though this is much more likely to be the case for public programs (Medicare and, to an extent, Medicaid) than for private insurers. HHS, states, and national provider associations each maintain specific kinds of information. The only information on utilization provided distinctly for individual insurers or payers comes from state filings of utilization and financial information by insurers and HMOs, and from evolving “report card”-type efforts reflected in HEDIS 3.0 reporting.
The latter involves aggregate reporting for plans or other entities rather than the development of patient-level databases. Proprietary data of various types are marketed by consulting firms to meet the operational or other needs of purchasers, providers, or health plans, particularly in the interest of benchmarking. However, proprietary data tend to be expensive and not publicly available.
Information on outcomes of the system are quite limited. For the most part, outcomes are derived analytically from process data. The Health Care Financing Administration (HCFA) maintains national health account information with aggregate spending by provider and payer type. The agency has recently expanded the estimates of provider and payer expenditures to the state level. Personlevel data on discharges and encounters can support some limited outcomes analysis. Provider data collected as an adjunct to the Medical Expenditure Panel Survey can do the same. Vital statistics data also may be used in outcome studies, as may other population data, all of which are outside the scope of inquiry here.
ILLUSTRATIVE CURRENT MAJOR SOURCES OF
SUPPLY-SIDE INFORMATION BY TYPE
|Health Care Resources - Facilities/Providers|
|National Health Provider Inventory||AHA Annual Hospital Survey||Licensure Files|
|National Home & Hospice Care Survey||AMA Physician Masterfile|
|BHP Supply Projections (physicians, nurses)||AAMC Medical Student Data|
|BLS Labor Force Data|
|Health Care Resources - Insurers/Managed Care Entities|
|Department of Commerce Data on Firms||AAHP HMO/PPO Directory||HMOs and Insurers Licensed by State|
|Process and Outcome of Care|
|National Hospital Discharge Survey (being modified)||AMA’s Socioeconomic Monitoring System||State Hospital Discharge Data|
|National Ambulatory Medical Care Survey||Proprietary Benchmarking Systems||Ambulatory Data Sets (where they exist)|
|National Hospital Ambulatory Medical Care Survey||HEDIS 3.0||Insurance Commissioner Filings|
|National Nursing Home Survey||AHA Annual Hospital Survey|
|Medicare and Medicaid Data Systems|
|HCFA Analysis of Mortality by Hospital|
|SAMHSA Program/Facilities Data|
|National Vital Statistics|
|National Linked Births/Deaths|
|National Health Expenditure Accounts|
|Medical Expenditure Panel Survey|