HCFA and others have sponsored work on issues relating the needs for information about health accounts based on expenditures. Haber and Newhouse (1991) reported on an effort to revise the national health expenditure accounts in 1988 as well as efforts proposed in 1990. They also made recommendations for future change that are still relevant today. The paper discusses emerging issues and reviews existing revisions to the accounts to better estimate out-ofpocket spending directly, disaggregate expenses, and reduce errors leading to underestimates and double-counting. It also highlights the growing prevalence of vertical integration and managed care, which creates a need for classifications of expenditures that are more responsive to type of service than type of provider, including a more meaningful definition of “professional services.” Self-insurance is flagged as a potential threat to the quality and completeness of data on private insurers. To support predicting growth in home health spending, the paper also identifies a need to better define and distinguish between the types of home health and personal health services and the use of an expanded provider list to capture information on spending.
In addition to this broad review, there are other, more focused efforts relating to health expenditure data. Genuardi, Stiller, and Trapnell (1996) consider expenditure data for the prescription drug sector, pointing out the importance of changes in retail outlets with new emerging pharmaceutical suppliers and actors; rebates and other payment changes; and other industry changes such as the growth of generic drugs and managed care. The authors compare estimates based on manufacturer sales, consumer purchasers, and retail sales, and they develop new techniques for estimating the effects of rebates. Ginsburg and Pickereign (1996) assess the policy utility and quality of data used to track health care costs. The authors focus on three kinds of data: provider data on revenues or costs, claims data from insurers, and premium data from employees. They emphasize how these compare in terms of quality and utility, what they tell you, and how they influence the conclusions one draws about costs and trends.