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system includes the following components: vital statistics, health manpower, health facilities, hospital care, ambulatory care, and long-term care.
urged that the PHS take more forceful steps than it has to date to assure that the focal role becomes an actuality.
As an initial step to achieve this goal, DHEW has transferred NCHS from HRA to a more central location, in the Office of the Assistant Secretary for Health. NCHS previous placement limited its focal role, and was not consistent with the requirement of Public Law 93-353 that the NCHS Director be supervised by the Department's principal adviser for health programs.
This reorganization, however, only resolves a part of the focal role problem. The creation of the Health Care Financing Administration, and the emergence within HCFA of a large research/statistical center which has overlapping responsibilities with NCHS may, for the present, lead to a continuation of the confusion about the appropriate division of responsibility for health care statistics.
PHS' Office of Health Policy, Research and Statistics (OHPRS)
This office, the major policy and planning arm of the Office of the Assistant Secretary for Health, is the departmental focal point for the development and coordination of health data and statistical policy. In this role, this office is responsible for assuring health data standardization, providing policy oversight for clearance of public-use reports, identifying immediate and long-range health data needs, and for the development of data policy objectives.
While this office has made significant accomplishments in some of these areas, it is the pursuit of the latter two responsibilities which has been most obviously lacking, and to a great degree this parallels the failings of the Health Data Policy Committee. The reorganization of the policy and statistics functions of the PHS should, over the course of the next few years, lead to a greater concentration on the policy analysis, planning and evaluation requirements for health care delivery.
The system currently operates under conditions which permit separate components contracts within a State. CHSS is moving toward the concept of single State contracts for all funded components. This notion should be fully pursued as it would, among other things, allow for flexibility within the system and result in better integration of data collected through the system. Furthermore, the most appropriate focus for CHSS activities within a State would appear to be a State supported health statistics center.
Although State supported health statistics centers may not be the primary collectors of data associated with each of the components, they are, for a number of reasons, the preferred contractor. The most compelling argument for this arrangement is that it allows for a statistical capability to be established or fostered within the States. The ability of States and substate units to collect and analyze data for their own management, evaluation, and resource allocation needs is vital. Assuring that this capacity exists, and can be relied upon, should be a principal thrust of the cooperative program. Although the establishment of a State statistical capacity is important, it must be undertaken with a view towards insuring that the Federal Government obtains the data it requires.
Consequently, both the indirect/long-term benefits, and the direct/immediate benefits of the cooperative arrangement to the Federal Government should be recognized as precepts of the system. It should also be recognized that as a result of the fostering and ultimate development of State health statistics centers, the Federal Government will not be committed to ever-increasing financial support in this area.
Another issue relating to single State contracts is that although these contracts will generally be developed with State health agencies, such agencies do not necessarily control all State health data activities. Many States, for example, have separate mental health agencies. The Federal Government should secure a commitment from each state organization with which it contracts to obtain all the information it needs. Such an arrangement will preclude the need for separate cooperative systems in the health area.
Because the initial CHSS components were identified some time ago, and in light of the evolving nature of the health care system, a complete
NCHS' Cooperative Health Statistics System
The Cooperative Health Statistics System (CHSS) sponsored by NCHS was identified in DHEW's statistics plan as a major element of statistical coordination for the Public Health Service in the future. The CHSS, which is mandated by Public Law 93-353, is designed as a uniform, coordinated data system to guide Federal, State, and local decisionmakers in assessing health needs, improving health planning, and identifying health programs and services. The
office it is designed to advise. In the future, a communication loop should be developed and formalized to permit the committee to become more responsive to the statistical issues of concern to the Secretary and the Assistant Secretary for Health, DHEW, and to permit guidance to flow from these offices to the committee.
requirements analysis of Federal and State health statistics should be undertaken by DHEW as a priority task. Such an analysis will either support the continuation of the cooperative system with its present set of components, or will identify data needs not being met by the present system, possibly necessitating the addition of new and/or the elimination of present components. This analysis should examine the general issues of State data needs (e.g., office-based physician ambulatory care data) and Federal data needs (e.g., marriage and divorce statistics), as well as the need for specific data to be collected through the present cooperative mechanism.
It is hoped that over the next few years the advice and counsel of this committee and other advisory committees will increasingly be relied upon.
In addition, an audit of the system should be undertaken to assess the current state of data collection activities within CHSS States. Such an audit would determine whether or not minimum data sets are being employed as required, whether differing formats for data set elements affect the quality and comparability of data collected, whether time variations in data collection is a problem, whether response rates are adequate, and so forth.
The establishment of the cooperative system has wide implications for data collection activities sponsored by such agencies as the Health Care Financing Administration, the Bureau of Health Manpower, the Bureau of Health Planning and Resource Development, and ADAMHA. It is expected that these organizations will rely on the CHSS to supply many of their data needs. The data sets currently being employed through the cooperative system may need to be further modified in order to be acceptable to these agencies.
DHEW's Health Data Policy Committee
The Health Data Policy Committee (HDPC) of the Public Health Service was established to assist in policy guidance and coordination of health data requirements of the Department of Health, Education, and Welfare. The committee generally limited itself to reacting to specific statistical issues brought to its attention, rather than a policymaking rate.
With the organization of HCFA as a separate entity, reporting directly to the Office of the Secretary of HEW, the major coordinative function of the Committee has ceased to exist. The Department is presently planning to replace this Committee with a Departmental Health Data Advisory Committee, whose function will be to coordinate statistical activities within the Department and to advise the Secretary of HEW on crosscutting issues in health and health related statistics. A Health Statistics Coordinating Committee has also been established, within PHS, to assist the Assistant Secretary for Health in technical and operational coordination among the PHS agencies.
To function meaningfully, any health data policy group must represent and consider all major health data interests and issues within the Department. For this to occur, and for the recommendations of the committee to result in appropriate actions, the committee should report to the official who is an appropriate focus for the policy, organizational, and coordination issues which it will be addressing.
In terms of operational strategy, the committee could function in a more productive fashion were it to concentrate its activities in the following areas: long-range planning, general coordination activities, and promulgation of statistical standards. Such activities first require a systematic identification of policy issues which have implications for health data activities.
In addition to improving on prior performance in the coordination and standard setting roles, the committee should attempt to move from an essentially
The major external advisory group which deals with health data is the U.S. National Committee on Vital and Health Statistics. While this committee has closely inspected the programs of the National Center for Health Statistics, it has not, in the recent past, become as involved with other important health data collection activities and programs. It is recommended that in the future this committee take a broader look at health data collection activities within DHEW and broaden its range of interest to focus on the variety of matters which are of concern to the Department. Clearly this committee could play a greater role in the development of statistical policy in the health area than it has recently. The ability of the committee to participate more actively in policy development has been impeded by the lack of direction and feedback it should receive from the
Future iterations of the plan should devote more space to priority setting and action programs. In addition, future plans would be expected to rely heavily on such specific subject-area plans as have been suggested for development in this chapter (e.g. manpower, environment, and health planning).
reactive posture to more of an anticipatory, problemoriented position.
As a major function, the Health Data Advisory Committee should thoroughly examine the fragmented health data collection activities within DHEW and propose alternative mechanisms which would not only eliminate unnecessary and duplicative activities, but which would also result in a more coordinated, planned approach for collecting information in major areas of interest.
The initial health statistics plan for the Public Health Service was coordinated by the Health Data Policy Committee and developed in the Office of Policy Development and Planning of the Assistant Secretary for Health. As a first effort the document was a major accomplishment. Although it recognized important deficiencies in the health statistics area, remedial action programs were not proposed in the first plan, nor was any general long-range strategy proposed for attacking existing or anticipated problems. The second effort, while moving in this direction, was not as forceful as it could have been.
Improvement in the Quality of Data Collected
Improvements in coordination, the development of standards and data comparability, and so forth, should have a positive effect upon the quality of health data collected by Federal agencies. A special problem exists, however, for health data which are collected as single-time efforts for program specific purposes. It is strongly recommended that the Health Statistics Coordinating Committee consider the broad issue of the quality of data collected within the Public Health Service and that the Office of the Assistant Secretary for Health encourage the establishment of quality surveillance and control procedures by each agency involved in health data collection activities.
Chapter 9. HOUSING AND COMMUNITY DEVELOPMENT STATISTICS
of new units in multifamily structures and the survey
of completion of single and multifamily units as well Housing and community development statistics
as the survey of sales of new one-family homes have many interrelationships with other functional
indicate the characteristics of conventional housing areas, notably with demographic, construction,
units coming on the market and the rate at which finance, and price statistics. While it is not possible to
units are absorbed. The recently introduced mobile discuss housing without reference to such other areas,
home placement survey attempts to fill the same attention in this chapter will be concentrated on ad
function for new mobile homes. The mobile home dressing those aspects which have peculiar
survey is expected to play a key role in ensuring that significance for housing.
this significant source of new residential units is
covered adequately in the sampling frames for the Responsible Agencies and Core Programs
Census surveys. Data produced by the Bureau of the
and alterations and repairs are also relevant to the Collection Agencies
functioning of the housing market. These programs Housing inventory comprises a large component of
are described in the chapter on construction statistics. the Nation's physical wealth. The Housing Division
The Bureau of Labor Statistics (BLS) is also a of the Bureau of the Census oversees the collection of
source of basic data concerning the housing the most important body of data regarding this vital
inventory. The information is provided as part of the national resource. The major programs administered BLS Consumer Price Index and the Consumer by the Housing Division are the housing portion of
Expenditure programs. The price index program sup the Decennial Census of Population including a
plies separate monthly estimates for owners and follow-on Survey of Residential Finance and a
renters of trends in the components of housing costs separate sample of the components of inventory
for the Nation, 4 regions, and 25 cities. The change, the Annual Housing Survey, the Quarterly
Consumer Expenditure program includes data every Housing Vacancy Survey, and the Quarterly Survey 10 years on actual consumer expenditures for housing of the Market Absorption of New Apartments. summarized by size of city and region. Plans for the The most basic of the data programs are the
Consumer Price Index and the Consumer censuses of population and housing which provide
Expenditure Survey are discussed in the chapter on detailed data on salient characteristics of housing and
price statistics. its occupants for all localities in the Nation. The
The Bureau of Economic Analyses (BEA) provides periodic census data are supplemented on a current
measures of the current value of housing services basis by the Annual Housing Survey (AHS) which
(value added) as part of the national economic acprovides updates primarily on a national basis. The
counts. Summary data are published quarterly and AHS is structured so as to show the components of detailed components are prepared annually. In adinventory change (e.g., additions, losses, and
dition, BEA prepares annual series on farm and mergers) as well as the changes in the characteristics nonfarm mortgage debt. of households occupying a panel of the same housing units over time. The AHS includes 3 rotating panels of 20 metropolitan areas each year for a total of 60 Analytical Agencies areas over a 3-year cycle.
The chief analytical agency in the housing field is The Bureau of the Census provides current data on the Department of Housing and Urban Development the functioning of the housing market on a national (HUD). Within HUD the Office of the Assistant and regional level. The survey of vacancy rates for Secretary for Policy Development and Research units for sale or rent, the survey of market absorption contains the largest emphasis on analytical efforts.
The Assistant Secretary for Housing and the Agriculture are concerned with the analysis of rural
The Veterans Administration provides data on the
characteristics of mortgage loans guaranteed under of 11 monthly surveys which provide detailed data on
the VA Loan Guarantee program for the veteran gross flows of mortage credit including loan
population. originations, purchases and sales of long-term mortgage loans and originations of construction and
The final group of agencies includes the federally land development loans. The surveys are conducted
sponsored financial agencies which in one way or by private trade associations as well as by Federal another have a significant bearing on mortgage credit agencies and the Bureau of the Census.
market developments. These agencies include the PD&R is currently strengthening its capability to
Federal Home Loan Bank Board, the Federal Home analyze the microdata tapes made available from the
Loan Mortgage Corportion (FHLMC), the Federal AHS. This should improve the Department's ability
National Mortgage Association (FNMA), and the to monitor housing quality and the general
Government National Mortgage Association performance of the market. The largest analytical
(GNMA). Each of these agencies is vitally concerned
with financial transactions in its area of responsibility effort handled by PD&R is the Housing Allowance Experiment involving demand, supply, and
and provides considerable detailed information on administrative components. This complex
the nature of current financial transactions relating to undertaking in the housing field is roughly analogous
housing. In addition, the Federal Reserve Board to the income maintenance experiments.
maintains detailed statistics on mortgage debt
outstanding in support of its general responsibility The Office of the Assistant Secretary for Housing for monetary policy. provides a continuing series on the characteristics of insured mortgage transactions. For various reasons, the Federal Housing Administration (FHA) insured
User and Policy Groups share of the housing market has declined significantly. Data based on these transactions,
Statistics on the progress of housing and comhowever, provide some of the most important munity development are of concern to the housing insights concerning the characteristics of the current
subcommittees of the Congress, to whom the market. The office also provides detail on the
Department of Housing and Urban Development characteristics of families moving into low rent public
(HUD) is required to report each year on progress in housing and other subsidized housing units and
achieving the Nation's housing goal. Among other families re-examined for continued occupancy. things the Department is required to “...compare the The Office of the Assistant Secretary for Com
results achieved during the preceding fiscal year munity Planning and Development (CPD) oversees
...with the objectives established for such year under the distribution of planning funds, a portion of which
the plan... and indicate necessary revisions in are used by State and local governments for gathering
objectives (Housing and Community Development statistics of housing used for local planning. In ad
Act of 1968). The housing goal initially specified the dition, CPD is responsible for oversight of the
elimination of substandard housing over the ten-year distribution of Community Development Block
period ending in 1978. At the present time HUD is Grant (CDBG) funds under the Housing and Com
reviewing the methods used to estimate housing need munity Development Act of 1974. These funds are al as part of a broader assessment of future production located to recipients on the basis of a legislatively
and rehabilitation targets. mandated formula.
There are at least three additional broad policy
areas for which statistics of housing and community The Farmer's Home Administration and the Rural development are of concern to government and Development Service of the Department of private groups: