cific measures of medical care economic risk and burden. The panel has endeavored to provide as much guidance as possible for needed research and implementation, acknowledging that there are many issues that can be resolved only on the basis of empirical work.

Regarding available survey data, the panel notes that the CPS ASEC, which is the basis for the official poverty measure and the SPM and the most feasible source for producing timely measures of medical care financial burden and risk, excludes institutionalized populations, most members of the armed forces, and the homeless. (This is true of most major federal household surveys.) This limitation places constraints on measuring medical care economic risk for two reasons: (1) the definition of the survey universe excludes respondents who are institutionalized residents at the time of the survey; and (2) the cross-sectional design does not capture transitions into or out of nursing homes and similar long-term care facilities.

To fully capture nursing home transitions and associated costs, one would need a longitudinal survey design that included both the institutionalized and noninstitutionalized components of the population, with a mortality follow-back instrument to fill in the information lost due to participant nonresponse after the time of death. With such data, prospective measures could be developed for the component of the population that was noninstitutionalized at the start of, say, a 1-year follow-up period, to capture an array of medical care and long-term care costs that are currently unmeasured. The downside of a longitudinal design is the time delay in getting a measure needed to monitor the implementation of a policy or program.

In one sense, it does not matter that data on transitions are lacking, because the official poverty measure and the SPM both exclude the institutionalized, so that people who move into nursing homes move out of the universe for poverty measurement. However, this is a particularly significant limitation for the measurement of prospective risk, in that the biggest health-related economic risk for many elderly must be excluded.


The panel used three criteria to guide the development of the report and its recommendations. First, the subject areas examined must be relevant to and within the scope and purview of the panel’s contract charge. Second, the evidence and analysis should be sufficient to support and justify the panel’s findings, conclusions, and recommendations. Third, recommendations should be clearly stated and attainable at reasonable cost.

The report is organized in a manner responsive to the contract charge. Part I contains the panel’s review, conclusions, and recommendations. Parts II and III contain the resources obtained and used by the panel to assist

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