Balancing needs with available resources is very often overlooked. Too often we tend to focus our attention on one aspect of the operation and neglect other, equally important areas. Doing so may cause significant problems and result in data which vary greatly in reliability. I recall one incidence where all the eggs were put into one basket resulting in great chagrin.

A number of years ago I was research director for a publication which served the nursing home and extended care industry. The editorial board of the publication asked me to develop an annual survey of the market which could be used as the major feature in every December issue. Because delivery of this issue coincided with the holidays it had always had a lower readership than other issues. The board believed the information from an industry-wide survey would be of considerable interest to subscribers and thus increase December readership.

The industry served by the publication ranged from senior citizen residential type apartment complexes to skilled nursing care facilities. At that time definitions and national standards had not been established. The industry was in a period of explosive growth, and while there was great interest in our establishing some type of norms, no agreements as to terminology could be reached prior to the date of our first mailing.

The budget available for the study was limited. In addition, we had very tight time constraints. The data had to be available to the editors six weeks prior to publication in order to prepare the tables and accompanying editorial comments.

At the time of publication we provided full disclosure. Known flaws in the data were pointed out. In one specific area - cost estimates - we took great care to inform the readers that standards for costing had not been established within the industry and we had had to rely on each respondent's interpretation of the question. Thus, some respondents provided only out-of-pocket operating cost data while others showed operating costs, plus depreciation, cost of capital, and other similar items.

The project was successful in increasing magazine readership. Because of this achievement, the survey was included in the editorial plans for the following years and improvements were made in the survey instrument and the methodology. The cost estimates continued to be a problem but readers asked us to continue to include them. We did so reluctantly and always noted, with the published results, a warning that no standards had been established and the data should be used with great care.

Approximately four years after we had begun this study, I was contacted by a federal government official who asked a few perfunctory questions about the study. After I had provided the answers, this person inquired about the possible availibility of the data prior to publication. When I requested the reason for the government's need for this information I was told it was being used as the basis for estimating costs for nursing care.

The reason for requesting this information ahead of publication was that the government agency had previously been using the data which was almost one year old. Obtaining the data earlier would improve the reliability of its projections, the agency believed.

I was dismayed. I suggested that we had rejected the idea of projecting the data because of the inconsistencies in reporting and stated our concerns in the methodology which accompanied the data. Why would this agency ignore this warning?

The answer I received was distressing. It seems the agency had been able to fund previous projects. Funds for new projects and programs were available. Thus, the agency could continue to spend upwards of one million dollars or more annually studying certain aspects of the health care market but no money was available at that time for the fastest growing segment of the market.

All of this was going on while Congress was making basic decisions on Medicare programs. The agency involved was using the above mentioned data as the basis for health care related expenditures in the U.S. It is no wonder that officials have never been able to get a proper handle on what the government should be providing and what it is going to cost. If a proper balance of resources for research expenditures had been made the legislation might have been significantly different and more cost effective.