N C H S - N H C S

The National Health Care Survey (NHCS) was initially built upon the following four National Center for Health Statistics (NCHS) surveys: the National Hospital Discharge Survey, the National Ambulatory Medical Care Survey, the National Nursing Home Survey, and the National Health Provider Inventory (formerly the National Master Facility Inventory). Later NHCS surveys include the National Survey of Ambulatory Surgery, the National Hospital Ambulatory Medical Care Survey, and the National Home and Hospice Care Survey. The National Employer Health Insurance Survey is also a component of NHCS.

The National Hospital Discharge Survey (NHDS), initiated in 1965, was one of the first facility-based surveys conducted by the National Center for Health Statistics. Data for this national probability sample survey are obtained from about 500 hospitals and 270,000 patient records annually. Sampled hospitals include those with average length of stays for all patients of fewer than 30 days, general hospitals, and children’s general hospitals. Exceptions include Federal, military, and VA hospitals; hospital units of institutions; and hospitals with fewer than six beds for patients. Because of this Survey’s continuous operation since its onset, it provides a rich data source for monitoring national trends in inpatient hospitalizations over a 35-year period. Reportable items include patient demographics, medical diagnoses and procedures, expected sources of payment, length of stay, and discharge information. Some information about the characteristics of the hospital facilities are also available from this data set. For other information about this survey, visit the Web site: National Hospital Discharge Survey.

The National Ambulatory Medical Care Survey (NAMCS) began in 1973 and except for the years 1982-84 and 1986-88, has been conducted annually since its inception. The sample frame is made up of visits to nonfederally employed office-based physicians providing (primarily) patient care, excluding three specialties--radiology, pathology, and anesthesiology. Data collected about sampled visits include patient demographics, patient's reason for visit, physician diagnosis, surgical procedures performed, injury-related facts, and diagnostic/screening and therapeutic/preventive services ordered or provided, including medications. Other details about the visit, such as types of health care providers seen, primary expected payment source, and time spent with physician are also collected. These records-based data provide basic national estimates on both the use and the provision of ambulatory medical care services and complement other ambulatory care patient information obtained from several different NCHS surveys. For other information about this survey, visit the Web site: National Ambulatory Medical Care Survey.

The National Nursing Home Survey (NNHS) first conducted in 1973-74 and periodically thereafter--most recently in 1999-- provides demographic and health-related information about the resident and discharged nursing home population and information about staff providing the care as well as other characteristics of those facilities. The survey sample consists of about 1,500 facilities plus a sample of 6 current residents and 6 discharges from each facility. Facility data include: size, ownership, Medicare/Medicaid certification, occupancy rate, and types of services provided. Resident information addresses four primary topic areas: demographic characteristics, health status measures, charge and payment information, and services received. This survey is currently undergoing a major redesign and will be fielded again in 2003. For other information about this survey, visit the Web site: National Nursing Home Survey.

The National Hospital Ambulatory Medical Care Survey (NHAMCS) was first fielded in 1992 and has been conducted annually since that time, thereby supplying for 10 consecutive years key information about patient visits to hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS uses a four-stage probability design with samples of geographically defined areas, hospitals within these areas, clinics within hospitals, and patient visits within clinics. Items obtained about hospital outpatient department visits mirror data collected about office-based physician visits from the NAMCS. Specifically, they include patient demographics, patient's reason for visit, physician diagnosis, surgical procedures performed, injury-related facts, and diagnostic/screening and therapeutic/preventive services ordered or provided, including medications. Other details about the visit, such as types of health care providers seen, primary expected payment source, and time spent with physician are also collected. Many of these same items also appear on the Patient Record form used for emergency department visits. However, response categories for some data items vary for the ED component. For example, mammography is listed under diagnostic/screening services ordered or provided for OPD visits but it is not listed under diagnostic/screening services for ED visits. Additional items obtained (since 1997) only for ED visits include mode of arrival, time interval in which patient should be seen, and presenting pain level. Some characteristics about the hospital facility, such as type of ownership, are also collected. For other information about this survey, visit the Web site: National Hospital Ambulatory Medical Care Survey.

The National Survey of Ambulatory Surgery (NSAS) was introduced in 1994 and stayed in operation through 1996. This survey was designed to provide national estimates about the use of ambulatory surgery services. During this 3-year period, about 120,000 visits from 500 facilities were sampled annually. Sampled facilities included those places where surgical and nonsurgical procedures are performed on an outpatient basis, including hospital or freestanding center’s general operating rooms, dedicated ambulatory surgery rooms, and other specialized rooms such as, endoscopy units and cardiac catheterization labs. In addition to diagnosis, surgical, and diagnostic procedures information, the database includes total cost and expected source of payment, pre-operative, post-operative, and surgery times, patient disposition, and patient demographic items. Given the ever-increasing volume and expanding scope of outpatient surgeries performed in this country, it is important that needed resources be dedicated to re-activate this important survey. For other information about this survey, visit the Web site: National Survey of Ambulatory Surgery.

The National Home and Hospice Care Survey (NHHCS), a national probability sample survey of home health and hospice care agencies, was first conducted by NHCS in 1992 and repeated in 1993 and 1994. The survey was fielded again in 1996, 1998, and most recently in 2000. The NHHCS was implemented as a result of changing trends in alternative sources of care for individuals and families facing long-term and end-of-life health care needs. In 2000, the sample consisted of about 1,800 home health and hospice agencies and a sample of 6 current patient records and 6 discharged patient records from those agencies. The survey includes all types of agencies that provided home health and hospice care regardless of whether they were Medicare or Medicaid. Data collected depict both the characteristics of these health care providers and the people they serve. Agency and patient items include for example, type of ownership and affiliation; Medicare and Medicaid certification; patient demographics and functional status; diagnoses; services received; types of service providers; patient living arrangements and caregiver; expected sources of payment; and reason for discharge. Data are obtained through personal interviews with agency administrators and staff primarily responsible for the sampled patients care. Respondents also refer to patient medical and other records, as necessary. For other information about this survey, visit the Web site: National Home and Hospice Care Survey.

The National Employer Health Insurance Survey (NEHIS), conducted in 1994 by NHCS, was the first federally-sponsored survey designed to produce State estimates of employer-sponsored health insurance. The NEHIS surveyed a probability sample of all U.S. employers in each State in the private and public sectors. Altogether, about 39,000 public and private employers and self-employed individuals were interviewed via telephone using a computer-assisted telephone interviewing (CATI) methodology. The sample frame for private sector employers was the October 1993 Dun’s Market Identifiers (DMI) file. The 1993 National Health Interview Survey (Quarters 3 and 4) was the sampling frame for self-employed individuals. The sample frame for local governments in most cases was the U.S. Bureau of the Census 1992 Census of Governments file. Federal and State governments were included with certainty. The NEHIS sample design also included subsampling of health insurance plans in order to reduce response burden of respondents in business establishments offering employees more than five health insurance plans. The major objectives of NEHIS were to measure State and national levels of health insurance spending by employers; to provide baseline data at the State and national levels for monitoring trends in the employment-based health insurance system; and to provide data for prospective policy analysis of the effects of health care reform. For other information about this survey, visit the Web site: National Employer Health Insurance Survey.

The National Health Provider Inventory (NHPI) conducted in 1991, contains a comprehensive national listing of health care facilities, including nursing homes, home health agencies, hospices, and licensed residential care facilities. [Its predecessor was the National Master Facility Inventory (NMFI), which produced 10 inventories between 1963 and 1986.] Also, the 1991 inventory was the first to include home health and hospice care agencies and facilities. NHPI collected data from over 84,000 facilities primarily via mail questionnaires and telephone followup, if necessary. Data in the inventory include information on the services, location, staff, and other characteristics of the facilities. In addition to providing basic national statistics on nursing homes, residential-care facilities, home health agencies, and hospices, the NHPI provides a sampling frame of facilities for other health care provider surveys. For other information about this inventory, visit the Web site: National Health Provider Inventory. At the present time, NHCS is working on developing other frames, including a frame for long-term care residential places. This major undertaking is currently in the developmental stage.