Need for Core Modules in Re-Designed Questionnaire

Attachment 3d - Summary of the need for each Core Module topic area in the Redesigned
NHIS Questionnaire
Health status
The NHIS is the major source of information on the health status of the U.S. population. This
includes chronic conditions, injuries, and disability and functional limitations.
Chronic diseases are an important public health problem, which can result in morbidity,
mortality, disability, and decreased quality of life. Chronic diseases represented seven of the
top 10 causes of death in the United States in 2014. These data can help to describe the burden
of chronic disease and risk factors, as well as identify research gaps, monitor population
trends, and guide program evaluation.
Limitations in physical and cognitive functioning have long been recognized as major
health issues. With an aging and increasingly diverse population, the need to better understand
functioning and disability 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 disabilities in the population.
The Washington Group questions on functioning and disability assess whether the respondent
has a disability based on their responses to questions that assess difficulties with universal basic
activities rather than by asking them to identify as having a disability. This approach is
consistent with that of the international Sustainable Development Goals, which outline major
goals for policy formulation and program planning.
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, and will
continue to do so once the injury content is developed for inclusion on the redesigned
questionnaire beginning in 2019.
Health Care Services
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. The NHIS Core questionnaire has historically included and will continue to
cover questions on the utilization of hospital and outpatient care services. The data collected
can be used to monitor progress towards goals in preventive care utilization, and to examine
disparities in utilization by socioeconomic characteristics. This information is important to those
making decisions about allocation of health care resources and for evaluating the impact of
changes to health care delivery and financing.
Health Behaviors
Key concepts in health behavior are incorporated into the Sample Adult and Sample Child
annual and rotating core modules. Some behaviors are monitored annual (e.g. cigarette
smoking) to provide data to monitor DHHS Agency Priority Goals. Others are monitored
periodically (e.g. alcohol use, physical activity, sleep) to allow for the study of relationships
between these behaviors and chronic disease outcomes. These data may also be used to
evaluate the impact of programs impacting aimed at changing these behaviors.

Health Care Coverage
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.
Socio-Demographics
As in the past, the NHIS will collect information on socio-economic and demographic
characteristics of adult and child 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.