DECREASES

A. Savings in mechanical tabulation and associated costs resulting from the installation of a computer (11 positions) __

Total net change requested---

EXPLANATION OF CHANGES

$126, 700 755, 000

Procurement of records and processing of data for the health records survey, $184,800

The requested increase would provide funds for the procurement of hospital discharge records, allow several field pretests of the program, provide three statisticians in the Health Records Survey Branch, and four other positions in the National Health Survey Division which are needed to code records and prepare data for computer processing.

Health examination survey increases, $135,400

An increase in the health examination survey activities is required in 1963 if the data now being collected in the mobile health examination trailers is to be processed and analyzed. Aside from the four new positions requested for the Health Examination Survey Branch (three staticians and a medical officer) it will be necessary to recruit six additional staff members to provide editorial typing, computer programing, and supporting administrative services.

Increased scope of registration methods activities, $41,000

The improvement of the quality of the vital records and the coordination of Federal and State efforts is the responsibility the Registration Methods Branch. The increase requested for 1963 would enable the center to provide the States with more adequate information and advice.

Full staffing of the offices of the director and health statistics analysis, $52,500

Two positions are needed in the Office of the Director to assist in carrying forward the international aspects of the center's work. In the Office of Health Statistics Analysis current plans call for a total of 10 positions in 1963. The four new positions being requested will bring this Office to its proposed strength and will equip it to analyze and interpret a wide variety of health data in depth.

Full-year operation of electronic data processing equipment, $122,800

The requested increase for 1963 is to cover the increased rental costs reflecting the installation of an IBM 1410 computer system, a full-year's rental cost on a 1401 computer which will serve in an auxiliary capacity to the 1410, and the salary costs necessary to operate the computer complex for a full year. Health interview survey and other national health survey programs, $168,600 In 1963 the health interview survey will require additional funds to reinstitute quality controls on the basic contract with the Bureau of the Census. Supplemental studies on blindness, deafness, and the cost of medical care require increased financial support, as does a study to evaluate the general validity of the health interview survey program. Five new positions are needed, including a chief of the Developmental and Evaluations Branch, several statisticians, a digital computer programer, and a secretary.

Augmentation of special studies, $80,500

Each of the professional subject matter branches in the National Vital Statistics Division requires additional support to fulfill their responsibility to analyze vital data and to publish special studies on a timely basis. The Surveys and Actuarial Branch requires six additional positions to expand its life table work and to begin a program of sample surveys on births and deaths, and the Natality Statistics Branch requires an additional statistician to carry forward its work on special studies. The new activities of the professional branches will require the support of five positions in the Statistical Operations Branch. Because of the installation of electronic equipment, some employees who have been displaced from work on the regular vital data will be assigned to work on special studies.

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Increase in sample size and reliability of marriage and divorce data, $57,000

A small increase is requested in 1963 to bring the Marriage and Divorce Statistics Branch to full strength. Additional funds will also be needed to procure an increased sample of the marriage and divorce data from the State and local governments, and to process the larger sample. It is estimated that 11 additional processing employees will be required.

Decrease for savings resulting from the installation of a computer, $126,700

The Statistical Operations Branch will be able to effect substantial savings in its regular vital data processing activities in 1963 as a result of the installation of the center's computer. The 11 positions shown as savings are scheduled to augment the special studies program and to process the requested increase in sample size of marriage and divorce records.

The increases requested for the full-year operation of the computer will make possible a reduction in the number of positions needed for the routine processing of vital records in the Statistical Operations Branch. Employees occupying relinquished positions will be utilized in positions associated with electronic data processing and in new positions requested for the Vital Statistics Division.

PREPARED STATEMENT

Senator HILL. We will now hear from the national health statistics group.

Dr. Linder, we are glad to have you with us, sir. We will be glad to have you proceed in your own way.

Dr. LINDER. Mr. Chairman, I have a statement to submit for the record, and a very short summary.

Senator HILL. Very well. Your statement will be placed into the record at this point.

(The statement referred to follows:)

STATEMENT BY DIRECTOR, NATIONAL CENTER FOR HEALTH STATISTICS, ON

NATIONAL HEALTH STATISTICS

Mr. Chairman and members of the committee, when I appeared before you a year ago, I outlined at some length the reasoning leading to the decision to establish the National Center for Health Statistics and I described the continuing responsibilities of the center. An undertaking of the scope reflected in that outline cannot be accomplished in a short period or without encountering major problems.

I am pleased, however, to report that we have moved much nearer our goals during the past year. Substantial progress has been made in reorganizing, reinvigorating, and to some extent in redirecting the programs of the center. Progress has been made too in dealing with numerous problems, including space, personnel, and other administrative matters though more remain to be dealt with. It is fair to say, however, that the outlines of the new organization are now drawn, its targets are fixed and a clear path to its future is visible.

One of the problems with which we have contended during the year centers on the budget itself and traces to the timing of the organization's creation. You will recall that the National Center for Health Statistics was established by the Surgeon General in August of 1960. At that time, planning for the 1962 budget was well underway and it was impossible in the time then available to give full consideration to the budgetary structure of the new organization in any overall sense. Such consideration would probably have been impossible in any case in the early months of our existence because our organizational structure and related financial needs did not emerge immediately but required long and careful planning.

The 1963 budget for the National Center for Health Statistics reflects such planning. It represents the first real effort to evaluate the total needs of the center as a coordinated organizational unit. These estimates reflect certain program deficiencies under which the center will operate in 1962 as well as full staffing of the center's offices. More important they include the minimum resources to equip the center to undertake the responsibilities now assigned to it. In total, the 1963 estimates indicate an increase of $755,000 over funds available for the current year. While the detail justification of this amount is already before you in printed form I should like to devote a few moments to discussion of its major components.

OFFICE OF HEALTH STATISTICS ANALYSIS

The concept of the Office of Health Statistics Analysis is, I believe, an important advance in health statistics research and deserves some attention. The two major operating divisions of the center produce a wide range of significant health data and these are published with detailed technical or expository analyses. However, there have been numerous suggestions that the Public Health Service has a responsibility to give its data a more profound and a more general type of analysis—revealing its significance in relation to major public health problems. This will be the function of the Office of Health Statistics Analysis. The Office will consist of a small group of analytical specialists-isolated from the day-to-day problems of data collection and processing-who will develop a more long-range interpretation of health trends and relations. This extension of the analysis will greatly increase the value of the existing data to the research scientist, the public health administrator, and the legislator.

Naturally, results cannot be expected from this research-type activity overnight, but in the short time in which this Office has existed several very significant studies have been started. One of these is a comparative analysis of recent trends in the death rate. This study is being carried on as a cooperative project between our Office and medical statisticians in three or four other countries. This study should result in a much cleared idea of current mortality problems in the United States as compared to those in other countries.

In view of the great importance of the mission of this Office, it is essential that recruitment proceed with extreme care to insure that the best qualified professional staff is obtained. For this reason, it was decided to extend the staffing of this Office over a 2-year period, thus limiting its growth in the current fiscal year. Recruiting has now progressed satisfactorily enough to warrant confidence that we can complete staffing in 1963 to the level now foreseen for this Office.

OFFICE OF ELECTRONIC SYSTEMS

With regard to the Office of Electronic Systems, I am glad to report a most satisfactory and concrete item of progress. When I spoke to this committee last year, our intention to acquire a modern electronic computer for the center was a plan only. Now it is a reality. Since last year we have developed a detailed schedule for the conversion of all center procedures to electronic processing: we have constructed an efficient computer site; the computer has now been installed and is in productive use.

The acquisition of this electronic computer facility has given strong impetus to the modernization effort of the whole center. The first stage of the computer acquisition was completed in December of 1961 with installation of an IBM model 1401 computer. This system has been productive almost from the date of delivery and the advantages of electronic processing are already established. This relatively small configuration, however, is intended only for short-range needs and is not adequate to the ultimate needs of the center. We plan in July of 1962 to expand the system to include a more sophisticated 1410 system.

A careful plan for conversion from current data processing techniques to the computer has been prepared. The plan calls for the processing of all statistical data of the center on its computer facility by 1964. This schedule will require a real effort in training, programing, and coordination of the various phases of data procurement and processing, but on the basis of performance to date we regard it as realistic. The plan involves the use of both 1401 and 1410 installations with increasing emphasis on the latter because of its greater speed and higher storage capacity. The 1401 will remain an essential part of the final configuration because it is the most efficient and economical medium for such purposes as card-to-tape conversion, and print-out of results.

Once facilities have been acquired and the problems of conversion to the electronic system have been overcome we will devote increasing attention to our responsibility for serving as a focus for data processing expertise and for encouraging the use of technological advances throughout the Public Health Service. Indeed, some such activity is already underway and computer time has already been made available to some other elements of the Public Health Service. We will continue a policy of making our equipment available to others to the fullest extent possible, consistent with the principle that the primary purpose of our computer facility is to expedite the processing and analysis of statistical data relating to public health.

NATIONAL HEALTH SURVEY DIVISION

The series of health surveys which were established by the National Health Survey Act of 1956 have now achieved a recognized and authoritative status as a major supplier of up-to-date information on many aspects of the health of the American people.

The health interview survey, which was the first survey to be started, has now published more than 42 major reports on a wide range of topics including health insurance coverage, proportion of hospital bill covered by insurance, rate and duration of hospitalization, days lost from work or school because of illness, and many other topics. The facts are not given just as totals, but are presented in relation to important demographic, social, and economic factors such as degrees of urbanization, income, education, age, and usual economic activity. In fiscal 1963, this survey will continue its basic program. Its budgetary requirements are predictable within relatively narrow limits and the 1963 budget shows only a small increase required for certain quality control measures and for certain supplemental studies which are necessary for the basic rotation system of items covered in the interview questionnaire.

The health examination survey, which is the first effort anywhere in the world to apply the technique of physical and clinical examination to a national sample of the population, is perhaps one of the most difficult and complex statistical studies of health ever undertaken. There have been numerous problems of survey design, logistics, response rate, and analysis to solve.

However, by the end of January of this year we had completed more than 4,200 examinations throughout 19 States and the whole series of 6,000 examinations in the first survey cycle will be completed in the fall of 1962. We will then be in a position to start publishing a type of basic clinical and physical data descriptive of the American population which has never been available before.

The budget request for 1963 provides for the completion of this first cycle of examinations and analytical work involved with the compilation and publication of the collected data. In addition it will be necessary in 1963 to undertake developmental studies in preparation for the second cycle of the health examination survey which will focus on the examination of children and will require a different approach from that used in the first cycle.

The newest of the three major activities of the Health Survey Division is the health records survey, designed to utilize existing medical records in the files of hospitals and other institutions. The first major study undertaken by this survey will be a detailed factfinding survey of resident places providing nursing and personal care. This will give for the first time a more complete understanding of the characteristics of the population of older people served by these institutions.

The program for 1963 includes reporting on the above survey, which was initiated in 1962, as well as sample selection and pretesting for a general institutional survey and for a continuing collection of a sample of general hospital discharge records.

NATIONAL VITAL STATISTICS DIVISION

One of the major initial objectives of the National Center for Health Statistics was a review and a redirection of its program in the field of vital statistics. Federal responsibilities in this field go back as far as 1904 when the Federal Government first began cooperation with the States for the improvement of civil registration and for national tabulations of recorded vital events. Although of long standing, the program requires constant revision and improvement to keep apace with changing public health needs.