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
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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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    We know very little about the flow of funds in relation to private practitioners—our dentists, pharmacists, physicians—although perhaps 90 through our private practice structure. We know nothing about the investments private practitioners have made in setting up and amortizing their practices. Hence, we cannot indicate how the private, the institutional, and the governmental sectors are intertwined economically. Organizationally, we have inherited a health services system geared largely to acute condi- tions, with the hospital and the physician as the central core. But we are now creating many services for long-term illnesses which are on the periphery of that main core. We are extremely deficient in our knowledge of the flow from the central core to the periphery, and we do not know adequately what is entailed in this type of Situation. In nursing homes, for example, the health services system shades off into nonprofessional services. The system also ramifies into families, with home helps, and into the society itself. We need to know how the professional health services structure interrelates with the nonprofessional helps of one kind or another.'' This means that we must move more and more into a considera- tion of the human factors in the functioning of a unique system like our health services. Humanly speaking, waiting periods in out- patient departments often are unconscionable, and the outpatient department is too often a bleak place. Our statistics should record such facts. We should examine the concept of convenience. We can figure out the tolerance points, the workload of physicians, the tolerance points of patients, and so forth. We see ranges of use patterns that differ in different contexts—in a group-practice con- text, in a fee-for-service Blue Shield context, and so on—but we don't know why. With respect to measuring quality, we are still in the methodological stage. We can indicate whether or not surgery is performed by doctors with board certification. We could report more on what takes place in what kinds ofinstitutions. 12 Discussion A conferee suggested that it was high time for a group with wide recognition to develop ''some kind of document that sets forth the different points of view from which you can look at quality.'' This would not mean that the group would decide whether someone performing an operation was or was not qualified because he possessed or did not possess some accepted trait. Another discussant indicated that health serv- ices were too rigidly categorized as are health personnel, Nursing homes contain a substantial percentage of persons not really belonging there, who have no other place to go. They could be taken into day-care centers while the family is working during daylight hours. '’The nursing home could keep standards but then the housing | elements wouldn't have to be under those stand- ards.'' Also the housing unit could be associated with community activities in a community center. The Committee might well formulate patterns relevant to problems of this kind. During the course of the discussion Dr. Anderson reiterated his conviction that the Federal Government ''should go more and more into routine reporting of use and expenditure data [in the health area], particularly from households.' It was noted that other countries are looking to the United States to develop standards in these areas of health manpower and health facilities. PRESENTATION BY MR. McNERNEY Mr. McNerney observed that health adminis- tration is feeling the need for more facts and better information because it is moving from preoccupation with technical questions and good human relations: to more basic matters of policy formulation and the concept of responsibility to a constituency. The shift is being hastened by the very rapid rise in health costs, which is highly visible to the consumer. The consumer also is noting great variations in admission rates, inuse rates of facilities in hospitals, inuse byrace, and so on. Concern is accentuated by collective