In July's ONLINE installment, CADUCEUS focused on locating health care statistics in a selection of medical subject specialty databases. This month the focus shifts to nonmedical files as sources for health-related numeric data. Most government-sponsored survey reports are readily accessible in ASI (American Statistics Index) and NTIS. First, knowing the titles of surveys available and who is responsible for data collection and publication is an important preliminary step in successful statistical problem-solving online.
KEY ORGANIZATIONS AND THEIR HARDCOPY PUBLICATIONS
Just as no one agency or organization in the United States is responsible for health care delivery or funding, no single source collects all types of medical statistics. Decentralization is a hallmark, as is paucity of retrospective data. In a discussion of difficulties to anticipate in searching for statistical information, one leading authority cites several somewhat startling facts to bear in mind. (1) A nation wide birth and death registration program was not established in the United States until 1933. (2) It was not until 1925 that notifiable diseases were systematically reported by all states to a centralized authority. (3) No one agency is responsible to this day for collection of incidence data on all diseases.  Despite these drawbacks, a surprising amount of data is, indeed, collected by three key U.S. government agencies: the National Center for Health Statistics (NCHS), the Centers for Disease Control (CDC), and the Health Care Financing Administration (HCFA).
NCHS, organized in 1960, is the agency responsible for vital statistics registration at the national level. These are published each year (1937- ) in Vital Statistics of the United States, issued in three parts: (1) natality, (2) mortal ity, (3) marriage and divorce. Local and state data are included, but all information is about five years out of date at time of publication. For interim data based on samples rather than whole populations in given geographic areas, Monthly Vital Statistics can be consulted. The lag time between compilation and publication is about three months.
NCHS also conducts ongoing surveys on factors other than births, deaths, marriages, and divorce. Better known survey titles and scope notes are listed in Figure 1. Advance Data, an NCHS newsletter issued irregularly, is devoted to early release of survey findings. Each issue features a single topic, such as "utilization of analgesic drugs in office-based ambulatory care" or 'use of contraception in the U. S."
CDC data collection has traditionally concentrated on communicable (notifiable) diseases and recorded deaths from all causes, published in MMWR: Morbidity and Mortality Weekly Report. CDC surveillance programs have expanded in recent years to include other major health concerns, such as abortion, diabetes, lead-base paint poisoning, congenital malformations, etc. Data from these programs are published quarterly and summarized annually.
HCFA, responsible for Medicare and Medicaid administration, collects and publishes data on Federal health care expenditures and on health care providers (manpower, facilities, and resources). For example, HCFA has surveyed physicians' practice costs and income, hospital wages, and end-stage renal disease facilities (certified providers of renal dialysis or transplantation). Its Annual Medicare Program Statistics summarizes data on enrollment, reimbursement, and utilization. The journals Health Care Financing Trends and Health Care Financing Review are HCFA publications offering a wealth of much-requested numeric data, issued quarterly.
Other government agencies are involved in data collection of potential interest to health care planners and providers, as well as to businesses affected by medical practice and consumer health preference/behavior trends. For example, the Bureau of Labor Statistics reports incidence rates and estimates of the number of job-related injuries and illnesses of employees by industry in annual surveys published for each state. …