This section presents statistics on health expenditures and insurance coverage, including medicare and medicaid, medical personnel, hospitals, nursing homes and other care facilities, injuries, diseases, disability status, nutritional intake of the population, and food consumption. Summary statistics showing recent trends on health care and discussions of selected health issues are published annually by the U.S. National Center for Health Statistics (NCHS) in Health, United States. Dataon national health expenditures, medical costs, and insurance coverage are compiled by the U.S. Centers for Medicare & Medicaid Services (CMS) (formerly Health Care Financing Administration), and appear on the CMS Web site at <http://www.cms.hhs.gov/statistics/nhe>and in the annual Medicare and Medicaid Statistical Supplement to the Health Care Financing Review. Statistics on health insurance are also collected by NCHS and are published in Series 10 of Vital and Health Statistics. U.S. Census Bureau also publishes data on utilization of insurance coverage. Statistics on hospitals are published annually by the Health Forum, L.L.C., an American Hospital Association Company, in Hospital Statistics. Primarysources for data on nutrition is the annual Food Consumption, Prices, and Expenditures, issued by the U.S. Department of Agriculture. NCHS also conducts periodic surveys of nutrient levels in the population, including estimates of food and nutrient intake, overweight and obesity, hypercholesterolemia, hypertension, an clinical signs of malnutrition.
National health expenditures-CMScompiles estimates of national health expenditures (NHE) to measure spending for health care in the United States. The NHE accounts are structured to show spending by type of expenditure (i.e., hospital care, physician and clinical care, dental care, and other professional care; home health care; retail sales of prescription drugs; other medical nondurables; vision products and other medical durables; nursing home care and other personal health expenditures; plus nonpersonal health expenditures for such items as public health, research, construction of medical facilities, administration, and the net cost of private health insurance) and by source of funding (e.g., private health insurance, out-of-pocket payments, and a range of public programs including medicare, medicaid, and those operated by the Department of Veterans Affairs (VA)).
Data used to estimate health expenditures come from existing sources, which are tabulated for other purposes. The type of expenditure estimates rely upon statistics produced by such groups as the American Hospital Association, the Census Bureau, and the Department of Health and Human Services (HHS). Source of funding estimates are constructed using administrative and statistical records from the medicare and medicaid programs, the Department of Defense and VA medical programs, the Social Security Administration, Census Bureau’s GovernmentalFinances, state and local governments, other HHS agencies, and other nongovernment sources. More information and detailed descriptions of sources and methods are available on the CMS home page at <http://www.cms.gov/home/rsds.asp>.
Medicare and medicaid-Since July 1966, the federal medicare program has provided two coordinated plans for nearly all people age 65 and over: (1) A hospital insurance plan, which covers hospital and related services and (2) a voluntary supplementary medical insurance plan, financed partially by monthly premiums paid by participants, which partly covers physicians’ and related medical services. Such insurance also applies, since July1973, to disabled beneficiaries of any ageafter 24 months of entitlement to cash benefits under the social security or railroad retirement programs and to persons with end stage renal disease.
Medicaid is a health insurance program for certain low-income people. These include: certain low-income families with children; aged, blind, or disabled people on supplemental security income; certain low-income pregnant women and children; and people who have very high medical bills. Medicaid is funded and administered through a state-federal partnership. Although there are broad federal requirements for medicaid, states have a wide degree of flexibility to design their program. States have authority to establish eligibility standards, determine what benefits and services to cover, and set payment rates. All states, however, must cover these basic services: inpatient and outpatient hospital services, laboratory and X-ray services, skilled nursing and home health services, doctor’s services, family planning, and periodic health checkups, diagnosis and treatment for children.
Health resources-Hospital statistics based on data from the American Hospital Association’s yearly survey are published annually in Hospital Statistics and coverall hospitals accepted for registration by the Association. To be accepted for registration, a hospital must meet certain requirements relating to number of beds, construction, equipment, medical and nursing staff, patient care, clinical records, surgical and obstetrical facilities, diagnostic and treatment facilities, laboratory services, etc. Data obtained from NCHS cover all U.S. hospitals that meet certain criteria for inclusion. The criteria are published in Vital and Health Statistics reports, Series 13. NCHS defines a hospital as a nonfederal short-term general or special facility with six or more inpatient beds with an average stay of less than 60 days.
Statistics on the demographic characteristics of persons employed in the health occupations are compiled by the U.S. Bureau of Labor Statistics and reported in Employment and Earnings (monthly) (see Table 615, Section 12, Labor Force, Employment, and Earnings). Data based on surveys of health personnel and utilization of health facilities providing longterm care, ambulatory care, and hospital care are presented in NCHS Series 13, Data on Health Resources Utilization and Advance Data from Vital and Health Statistics. Statistics on patient visits to health care providers, as reported in health interviews, appear in NCHS Series 10, NationalHealth Interview Survey Data.
The CMS’s Health Care Financing Review and its annual Medicare and Medicaid Statistical Supplement present data for hospitals and nursing homes as well as extended care facilities and home health agencies. These data are based on records of the medicare program and differ from those of other sources because they are limited to facilities meeting federal eligibility standards for participation in medicare.
Disability and illness-General health statistics, including morbidity, disability, injuries, preventive care, and findings from physiological testing are collected by NCHS in its National Health Interview Survey and its National Health and Nutrition Examination Surveys and appear in Vital and Health Statistics, Series 10 and 11, respectively. The Department of Labor compiles statistics on occupational injuries (see Section 12, Labor Force, Employment, and Wealth). Annual incidence data on notifiable diseases are compiled by the Public Health Service (PHS) at its Centers for Disease Control and Prevention in Atlanta, Georgia, and are published as a supplement to its Morbidity and Mortality Weekly Report. The list of diseases is revised annually and includes those which, by mutual agreement of the states and PHS, are communicable diseases of national importance.
Nutrition-Statistics on annual per capita consumption of food and its nutrient value are estimated by the U.S. Department of Agriculture and published quarterly in National Food Review. Historical data can be found in FoodConsumption, Prices, and Expenditures, and online at <http://www.ers.usda.gov/data/foodconsumption>. Statistics on food insufficiency and food and nutrient intake are collected by NCHS to estimate the diet of the nation’s population. NCHS also collects physical examination data to assess the population’s nutritional status, including growth, overweight/obesity, nutritional deficiencies, and prevalence of nutrition-related conditions, such as hypertension, hypercholesterolemia, and diabetes.
Statistical reliability-For discussion of statistical collection, estimation, and sampling procedures and measures of reliability applicable to data from NCHS and CMS, see Appendix III.