Satellite National Health Accounts - Methods, Results, and Programs

The National Health Expenditure Accounts (NHEA) have been produced annually by the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) and its precursor organizations, since 1960. They track medical expenditure by source of payment (private, public, out-of-pocket) and type of expenditure (hospital, physician, etc.).  Information is summarized and data tables are available to the public via download from the Centers for Medicare and Medicaid Services (CMS) website at http://www.cms.hhs.gov/NationalHealthExpendData.

The NHEAs contribute substantially to our understanding of medical spending.  However, because they focus only on spending, the NHEAs provide no information on the value of health care spending, as they do not track the desired output of investment in health care – improved health.  Further, the data are not necessarily at the right level of aggregation to measure value.  To make these productivity calculations, one needs to understand spending at the same level as health outcomes, which are most naturally measured by disease.  Thus, a central issue in expanding the NHEA and our purpose is adding the more disaggregated (or micro) data needed to estimate prevalence of disease and costs.

Source:

Centers for Medicare & Medicaid Services (CMS)

Data & Supporting:

• Chapter 1: Data Sources
• Chapter 2: Types of Variables
• Chapter 3: Disease classification
• Chapter 4: Within Imputation Processes
• Chapter 5: HMO Weight Adjustment
• Chapter 6: Reconciliation of expenditures to NHEA: Survey spending adjustment
• Chapter 7: Calibration processes: for community dwelling population
• Chapter 8: Calibration processes: for institutionalized population
• Chapter 9: Estimation of Calibrated disease prevalence (1999-2012)
• Chapter 10: Cost Attribution by Calibrated Conditions (1999-2012) : Propensity Score Method (1999-2012)
• Chapter 11: Actual and Counterfactual Attributed Cost
• Chapter 12: Mortality Attribution Using Propensity Score Methods

Programs for Data Creation

• Programs underlying results for our Satellite NHA paper are given at http://doi.org/10.3886/E143521V1
• Data README (.pdf)
• Chapter 1: Data Sources (.pdf)
• Chapter 2: Types of Variables (.pdf)
• Chapter 3: Disease classification (.pdf)
• Chapter 4: Within Imputation Processes (.pdf)
• Chapter 5: HMO Weight Adjustment (.pdf)
• Chapter 6: Reconciliation of expenditures to NHEA: Survey spending adjustment(.sas)
• Chapter 7: Calibration processes: for community dwelling population(.pdf)
• Chapter 8: Calibration processes: for institutionalized population(.pdf)

Note: Questions can be directed to Susan Stewart at stewart@nber.org

Tables of Quality-Adjusted Life Expectancy at all ages, 1987, 1994, and 2000-2008

• Black_females (.xls)
• Black_males (.xls)
• White_females (.xls)
• White_males (.xls)
• Description of methods for QALE calculation (Appendix to 2013 AJPH paper)(.xls)
• Coming Soon: Health-Related Quality of Life (HRQoL) scores calculated per respondent in Medical Expenditure Panel Survey, 2000-2015 and SAS code for calculation of these HRQoL scores