Informing American Health Care Policy

Informing American Health Care Policy provides a critical perspective on the National Medical ExpAnditure Surveys (NMES) and how these surveys have responded to the sometimes conflicting challenges of policy and research. Sponsored by the Agency for Health Care Policy and Research and written by a stellar panel of interdisciplinary experts including contributions from nationally known economists, sociologists, and survey researchers, this essential resource is filled with lessons learned and emerging strategies for the future. Foreword.

Preface and Acknowledgments.

The Editors.

The Contributors.

Introduction (A. Monheit & R. Wilson).

PAST CHALLLENGES AND CURRENT ISSUES.

National Medical ExpAnditure Surveys: Genesis and Rationale (R.Andersen & O. Anderson).

Modeling Consumer and Provider Behavior: The First NationalExpenditure Study (G. Wilensky).

The Provider System and the Changing Locus of Expenditure Data:Survey Strategies from Fee-for-Service to Managed Care (J. Cohen& A. Taylor).

SOURCES OF PAYMENT AND THE STRUCTURE OF HEALTH INSURANCE.

Examining Health Insurance Differences: Issues of Public Equity andCost Efficiency (P. Short).

Health Insurance, Employment, and the Labor Market (A.Monheit).

VULNERABLE POPULATIONS: HEALTH CARE AND MEASURES OF ACCESS.

The National ExpAnditure Surveys and Studies of Access to Care byVulnerable Populations (M. Berk).

Evaluating Medicare and Medicaid: The Yield in Information from theNational Medical Expenditure Surveys (J. Kasper).

SURVEY METHODS, BUDGET CONSTRAINTS, AND OPERATIONAL ISSUES.

Better Estimates of Populations at Risk and More EfficientSampling: Changing Survey Design Strategies over Time (S.Cohen).

Continuity Versus Change: Challenges in Designing a SuccessorSurvey (D. Walden).

Survey Integration and End-of-Century Constraints (R.Arnett).

THE ROLE OF NATIONAL DATA IN POLICY FORMULATION.

Health System Reform Debates and Medical Expenditure Surveys (L.Nichols).

Name Index.

Subject Index. "... Informing American Health Care Policy is a useful, evenentertaining book for anyone who uses health data or who wants tounderstand the history and evolution of expAnditure surveys."(Health Affairs May/June 2000)

"In this important book, the lead researchers associated with NMESdescribe the development of this rich data source and, in a seriesof well-crafted papers, illustrate the use of these data ininforming major areas of health policy. It is a must-read foranyone interested in American health policy-especially for youngerprofessionals entering this growing field." (Uwe E. Reinhardt,James Madison Professor of Political Economy, PrincetonUniversity)

"National health expenditure surveys have provided policymakerswith the information they need to make informed decisions. Thisvolume tells us about the evolution and contributions of thefederal government's most ambitious health care survey. I recommAndit for those interested in improving the quality of data availableto those who formulate policy." (John K. Iglehart, founding editor,Health Affairs)

"I enjoyed reading this book. Thanks to the major investment inhealth expAnditure and insurance surveys and the increasinglysophisticated analytic capacity described in this volume, policyofficials now have a much more precise and up-to-date understandingof the implications of policy choices." (Karen Davis, president,The Commonwealth Fund; developed President Carter's 1977 nationalhealth reform proposal)

"Thoughtful and informed reflections on the lessons learned byNMES. Provides sound guidance and procedures required to addressthe Anduring policy questions of Who's covered? Who pays?, and Howmuch? in the emerging U.S. health care environment of the future."(Lu Ann Aday, professor of behavioral sciences and management andpolicy sciences, the University of Texas School of Public Health;and author, Designing and Conducting Health Surveys, FourthEdition) ALAN C. MONHEIT, Ph.D. is the director of the division of social and economic research in the Center for Cost and Financing Studies at the Agency for Health Care Policy and Research. Monheit has served as a member of the President Health Care Reform Task Force, as a technical advisor to the Robert Wood Johnson Foundation, the Kaiser Family Foundation, and the Health Insurance Association of America. In 1993 he received the first AHCPR Administrator's Award for health services research. RENATE WILSON is adjunct associate professor of public health in the Johns Hopkins University School of Hygiene and Public Health and a consultant to the Center for Cost and Financing Studies at the Agency for Health Care Policy and Research. ROSS A. ARNETT is the director of the Center for Cost and Financing Studies at the Agency for Health Care Policy and Research. In 1977 the average American spent $755 per year on health care, most physicians functioned as indepAndent practitioners, and only 5.6 million people under the age of 65 were enrolled in HMOs. Twenty years later, per capita expAnditures had more than tripled, most physicians practiced within a managed care environment, and HMO enrollment stood at 62 million. Keeping pace with these and other changes in the U.S. health system has been the job of the National Medical ExpAnditure Surveys (NMES). Since they were first started in the 1970s, these federal government surveys have defined our basic understanding of how individuals and families use and pay for America's health care systems and have directly influenced national policy changes, health care reform, and cost-control strategies.Informing American Health Care Policy is the definitive resource that analyzes the overall effect of the National Medical ExpAnditure Surveys. This important edited collection is written by an outstanding panel of experts from a variety of disciplines and includes contributions from nationally known economists, sociologists, and survey researchers. Rich in insights and lessons learned, Informing American Health Care Policy? Offers a critical assessment and a discerning overview of NMES' outcomes? Describes how the design strategies and methods evolved over the past two decades? Provides a detailed discussion about the collection of a wide range of data on health insurance and employment status? Addresses troublesome issues in defining and measuring access in vulnerable populations? Summarizes the multiple and complex issues of survey design, population sampling, and analytical method? Demonstrates the indispensability of NMES data in the health reform debatesThe contributors examine how the current health care environment reflects the successes and failures of previous research and makes recommAndations on how to adapt survey research to be more effective in the In 1977 the average American spent $755 per year on health care, most physicians functioned as independent practitioners, and only 5.6 million people under the age of 65 were enrolled in HMOs. Twenty years later, per capita expenditures had more than tripled, most physicians practiced within a managed care environment, and HMO enrollment stood at 62 million. Keeping pace with these and other changes in the U.S. health system has been the job of the National Medical Expenditure Surveys (NMES). Since they were first started in the 1970s, these federal government surveys have defined our basic understanding of how individuals and families use and pay for America's health care systems and have directly influenced national policy changes, health care reform, and cost-control strategies.

Informing American Health Care Policy is the definitive resource that analyzes the overall effect of the National Medical Expenditure Surveys. This important edited collection is written by an outstanding panel of experts from a variety of disciplines and includes contributions from nationally known economists, sociologists, and survey researchers. Rich in insights and lessons learned, Informing American Health Care Policy

• Offers a critical assessment and a discerning overview of NMES' outcomes
  
• Describes how the design strategies and methods evolved over the past two decades
  
• Provides a detailed discussion about the collection of a wide range of data on health insurance and employment status
  
• Addresses troublesome issues in defining and measuring access in vulnerable populations
  
• Summarizes the multiple and complex issues of survey design, population sampling, and analytical method
  
• Demonstrates the indispensability of NMES data in the health reform debates

The contributors examine how the current health care environment reflects the successes and failures of previous research and makes recommendations on how to adapt survey research to be more effective in the future.

The Important Lessons Learned from the National Medical Expenditure Surveys

Informing American Health Care Policy provides a critical perspective on the National Medical Expenditure Surveys (NMES) and how these surveys have responded to the sometimes conflicting challenges of policy and research. Sponsored by the Agency for Health Care Policy and Research and written by a stellar panel of interdisciplinary experts including contributions from nationally known economists, sociologists, and survey researchers, this essential resource is filled with lessons learned and emerging strategies for the future.

"I enjoyed reading this book. Thanks to the major investment in health expenditure and insurance surveys and the increasingly sophisticated analytic capacity described in this volume, policy officials now have a much more precise and up-to-date understanding of the implications of policy choices."—Karen Davis, president, The Commonwealth Fund; developed President Carter's 1977 national health reform proposal

"In this important book, the lead researchers associated with NMES describe the development of this rich data source and, in a series of well-crafted papers, illustrate the use of these data in informing major areas of health policy. It is a must read for anyone interested in American health policy-especially for younger professionals entering this growing field."—Uwe E. Reinhardt, James Madison Professor of Political Economy, Princeton University

"National health expenditure surveys have provided policymakers with the information they need to make informed decisions. This volume tells us about the evolution and contributions of the federal government's most ambitious health care survey. I recommend it for those interested in improving the quality of data available to those who formulate policy."—John K. Iglehart, founding editor, Health Affairs

"Thoughtful and informed reflections on the lessons learned by NMES. Provides sound guidance and procedures required to address the enduring policy questions of Who's covered? Who pays?, and How much? in the emerging U.S. health care environment of the future."—Lu Ann Aday, professor of behavioral sciences and management and policy sciences, the University of Texas School of Public Health; and author, Designing and Conducting Health Surveys, Fourth Edition