Report of the fifteenth anniversary conference : review and evaluation of past activities of the Committee with suggestions for future study in demographic, health, and medical-economic statistics.

  • United States. National Committee on Vital and Health Statistics.
Date:
1966
Catalogue details

Licence: Public Domain Mark

Credit: Report of the fifteenth anniversary conference : review and evaluation of past activities of the Committee with suggestions for future study in demographic, health, and medical-economic statistics. Source: Wellcome Collection.

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    bargaining and by politics. In labor agreements, where health benefits in 1952 constituted about 20 percent of the fringe benefit dollar and retirement about 50 percent, health now accounts for about 37 percent of the fringe dollar and retirement about 39 percent. Consequently, the consumer of health statis- tics is asking increasingly more sophisticated questions, such as How effective are prepayment or insurance in meeting episodical costs? Does the benefi- ciary at best merely stand still, or is he receiving increased coverage? A major indus- try wants a closely supervised panel set upto answer these and related questions. What are the impacts of service, supposedly with full payment, as against indemnity on medical costs? Does the one encourage misuse, the other prohibit it? Is there a proper mixture? Do deductibles reduce needed care or unneeded care? What differences, say in admission rates, can be demonstrated as depending on the organization of medical practice, as for example, under or not under group-practice programs? The consumer asks the very frank question, what is good and what is bad care? Accredi- tation does not satisfy him, nor does general reference to the quality of care. He wants to know the criteria according to which care is effective. The market wants better information about work standards—for example, allowable variations for performing an uncomplicated urinalysis. The market wants to know how multiple coverage should be handled. There is greater interest in better measures of disease and in their translation into the need for manpower and facilities. The market knows this is a difficult area, but it is not content with the present, wide variations in practice and planning. What is the matter with getting some health inven- tories taken, although the translation of either a symptom or complaint or a finding into the need for facilities or programs is a matter of judgment? With nursing homes and the like, how can we develop substitute facilities rather than additive facilities? With disadvantaged groups—the aged, the temporarily unemployed, the chronically low- incomed—the buyer recognizes that a lot of the data are averages, the problem might lie in distribution, and that we really don't know as much about it as we think. Mr. McNerney next turned to aconsideration of priorities and roles as between government and the private sector. In his view: The government is in a far better position to answer the incidence and prevalence of need and translation of this into terms of service, this broad descriptive type of information, or again an analysis of the system. The govern- ment ts in a much better situation to comment on the disadvantaged as they exist as a nationwide problem. Correspondingly, you probably get further on the more sensitive areas of effective use and work standards by having the format laid down perhaps nationally for the sake of some consistency, with implementation through the private sector. Mr. McNerney recommended that the Committee take an overview and draw some guidelines to avoid undesirable duplication and get certain agencies out of a posture ofindecision, especially foundations and national associations, The time is ripe for better methods of data collection; for making use of more explanatory variables, including use of multivariate analysis; for separating the effects of rising costs from the effects of rising utilization, interms of education, family size, and age. We need better definitions of specialist, nursing home, and nursing and better measures of comparative costs of types of care. In conclusion: