Long, Marquis, and Rogers (1995) present insight based on conversations with staff from states on priorities for health expenditure data, including why such information is used, what the concepts and components of health expenditure accounts are, and what issues and priorities exist in enhancing information. The issues include the scope of health expenditures: for example, are expenditures restricted to personal health care or does broader public health spending apply? How are interstate transfers to be assessed? Similarly, what should the categories for measuring spending be and what should the units of measurement (including cost shifting) and sources of data be? The authors believe that priority should be given to developing spending data on hospital, physician, other professional services, and prescription drugs to start, with methods that provide information on the flow of funds from payers to these functional uses. They also recommend that estimates be based on residence, and categories be based on services rather than providers. Intermediate and more long-term priorities include expansion of spending estimates to all health services, substate estimates, subpopulation estimates, capital and research spending accounts, and public health spending.
Gold, Burnbauer, and Chu (1995/1996, 1995) report on a 1994 telephone survey that asked state officials about their perception of data needs and weaknesses. In an analysis of data used to support health care reform, the authors identify major gaps in data on health expenditures (particularly for expenditures in the private sector and outside of institutions) and on health system and health plan performance. The major barriers to improving the data include funding shortages, lack of comparability across datasets, and the unwillingness of providers and insurers to submit needed data. In a related and more general analysis, the authors present information on the low levels of policymakers’ confidence in the ability to address emerging, but priority, health issues with existing data. Also discussed is the shakiness of policymakers’ confidence in specific kinds of public health data and provider data. Particular weaknesses occur in the following areas: the ability to identify alternative sources of care for clinic users, the effects of clinics on outcomes, and the ability to link data across patients, clinics, or jurisdictions. Also, inpatient data was found to be much better than data on ambulatory care, and data on structure (e.g., counts of providers) was more likely than process data to be available.