Need for Core Modules

Attachment 2d - Summary of the need for each topic area of the NHIS Core Module
Conditions
The NHIS is the major source of information on chronic conditions in the U.S. population. Since risk
factors for many chronic diseases are well known and modifiable, information on their prevalence is
needed routinely to evaluate the impact of prevention programs.
Injuries
Injuries are a leading cause of disability and premature mortality in the United States. The NHIS has
long been a major source of data on the incidence of nonfatal injuries. However, more detailed
population-based data on the causes and circumstances of non-fatal injuries, which are vital for
designing and evaluating injury prevention programs, have been lacking. The National Committee on
Injury Prevention and Control has pointed out the need to build upon and improve existing injury
surveillance data collection systems such as the NHIS. To support these needs, the NHIS expanded
injury questions in 1997 to increase the level of detail on the circumstances of nonfatal injuries.
Limitation of Activities
Limitations in physical functioning and in the ability to perform key activities have long been
recognized as major health issues, and assessment of activity limitation has been done in previous
NHIS questionnaires. With an aging and increasingly diverse population, the need to better understand
activity limitation is imperative since it is higher among elderly, minority, and economically
disadvantaged persons. The 1990 passage of the Americans with Disabilities Act (ADA) also
underscored the need for clear and objective data on activity limitation. Finally, functional assessment
measures are widely used to determine eligibility for numerous federal assistance programs. NHIS data
on functional limitations can help measure the impact of changes in these programs.
Health Behaviors
Many risk factors for a number of important chronic conditions are related to lifestyle choices (such as
smoking and diet). Many of the national health objectives for the Year 2020 are related to health
promotion and risk reduction, and the NHIS has been identified as the major data source to track
progress toward achieving many of these objectives. Most of the items included in this section have
been included in previously fielded supplements to the NHIS. Because of their relevance to many
national health promotion efforts, key health behavior items are incorporated into the NHIS Core
Module.
Access to Health Care
Recent changes to the U.S. health care delivery system have focused attention on the need for data to
assess the types and sources of health care being utilized as well as barriers to obtaining needed health
care.
Health Care Utilization
The NHIS Core questionnaire has always included questions on the utilization of hospital and
outpatient care services. This information is important to those making decisions about allocation of
health care resources and for evaluating the impact of proposed changes in financing of health care
services.

Health Insurance
Since 1990, the NHIS has collected extensive health insurance information on an annual basis. These
data are particularly needed by policy analysts to evaluate the impact of changes to health care
delivery and financing.
Demographic and Socio-Economic Characteristics
As in the past, the NHIS Core Module will collect information on socio-economic and demographic
characteristics of survey participants. One of the well-recognized and longstanding strengths of the
NHIS is its ability to allow examination of health measures by a number of demographic and economic
variables.
Recontact and Matching Information
The NHIS continues to collect, on a confidential basis, data needed to recontact respondents for
additional information and to match respondents to administrative records such as the National Death
Index. The ability to track respondents and match to other records greatly expands the usefulness of
the data at very low cost while mitigating public burden. Collecting data on computer usage and
respondents’ email addresses provides insight into the best means for recontact. This information can
also be used to design follow-back surveys and other special projects aimed at informing changes to
the NHIS.