Providing National Statistics on Health and Social Welfare Programs in an Era of Change

Summary of a Workshop

Constance F. Citro, Charles F. Manski, and John Pepper, Editors

Committee on National Statistics

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.
1998



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--> Providing National Statistics on Health and Social Welfare Programs in an Era of Change Summary of a Workshop Constance F. Citro, Charles F. Manski, and John Pepper, Editors Committee on National Statistics National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1998

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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council. The project that is the subject of this report is supported by funds provided by the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-06040-0 Additional copies of this report are available from: National Academy Press, 2101 Constitution Avenue N.W., Washington, D.C. 20418. Call 800-624-6242 or 202-334-3313 (in the Washington Metropolitan Area). This report is also available online at http://www.nap.edu Copyright 1998 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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--> COMMITTEE ON NATIONAL STATISTICS 1996-1997 NORMAN M. BRADBURN (Chair), National Opinion Research Center, University of Chicago JULIE DAVANZO, RAND, Santa Monica, California WILLIAM F. EDDY, Department of Statistics, Carnegie Mellon University JOHN F. GEWEKE, Department of Economics, University of Minnesota, Minneapolis JOEL B. GREENHOUSE, Department of Statistics, Carnegie Mellon University ERIC A. HANUSHEK, W. Allen Wallis Institute of Political Economy, Department of Economics, University of Rochester RODERICK J.A. LITTLE, Department of Biostatistics, University of Michigan CHARLES F. MANSKI, Department of Economics, Northwestern University WILLIAM NORDHAUS, Department of Economics, Yale University JANET L. NORWOOD, The Urban Institute, Washington, D.C. EDWARD B. PERRIN, School of Public Health and Community Medicine, University of Washington PAUL ROSENBAUM, Department of Statistics, Wharton School, University of Pennsylvania KEITH F. RUST, Westat, Inc., Rockville, Maryland FRANCISCO J. SAMANIEGO, Division of Statistics, University of California, Davis MIRON L. STRAF, Director ANDREW WHITE, Deputy Director

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--> Acknowledgments The Committee on National Statistics (CNSTAT) thanks the many people who participated in the workshop on national statistics on health and social welfare programs, including those who prepared papers for presentation, those who served as formal discussants for the papers, and the many others who contributed to the lively and informative discussions at the workshop. We especially thank committee member Charles Manski of Northwestern University for serving as chair. We also gratefully acknowledge the commitment and support of those who worked collaboratively to organize the workshop and prepare this report. Constance Citro of the CNSTAT staff took the major responsibility for organizing the workshop, working with Charles Manski and CNSTAT director Miron Straf and consulting with Joan Turek and James Scanlon of the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Karen Huie made all of the logistical arrangements for the workshop. John Pepper of the Department of Economics, University of Virginia, prepared a first draft of the workshop summary, and all three editors—Constance Citro, Charles Manski, and John Pepper—contributed to the final version of the report. Eugenia Grohman of the staff of the Commission on Behavioral and Social Sciences and Education edited the report, and Agnes Gaskin of the CNSTAT staff prepared it for publication. NORMAN BRADBURN, CHAIR COMMITTEE ON NATIONAL STATISTICS

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--> Contents     Overview   1     What is Changing in Health and Social Welfare Programs?   4     Temporary Assistance for Needy Families Block Grant   4     Supplemental Security Income   5     Food Stamp Program   5     Benefits for Immigrants   6     Medicaid Program and Health Care   6     What Information is Needed?   8     Survey Measures of Program Eligibility, Participation, and Benefits   8     Outcome Measures in Surveys   11     Program Rules   12     Administrative Data on Program Recipients   12     Implications for Data Collectors   15     Coordination   15     Questionnaire Design and Administration   18     Data Validation   18     Flexibility   19     Sample Design   19     Research Issues for Behavioral Analysis   21     References   23 Appendix A:   Workshop Agenda and List of Participants   25 Appendix B:   Comparison of Prior Law and the Personal Responsibility and Work Opportunity Reconciliation Act   31 Appendix C:   Major Survey Sources, Health and Social Welfare Programs   47

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