The Social Security Administration's Disability Decision Process: A Framework for Research

Second Interim Report

Gooloo S. Wunderlich and Dorothy P. Rice, Editors

Committee to Review the Social Security Administration's Disability Decision Process Research

Dorothy Rice, Chair

Division of Health Care Services

INSTITUTE OF MEDICINE

Committee on National Statistics

Commission on Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL

NATIONAL ACADEMY PRESS
Washington, D.C.
1998



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The Social Security Administration's Disability Decision Process: A Framework for Research, Second Interim Report The Social Security Administration's Disability Decision Process: A Framework for Research Second Interim Report Gooloo S. Wunderlich and Dorothy P. Rice, Editors Committee to Review the Social Security Administration's Disability Decision Process Research Dorothy Rice, Chair Division of Health Care Services INSTITUTE OF MEDICINE Committee on National Statistics Commission on Behavioral and Social Sciences and Education NATIONAL RESEARCH COUNCIL NATIONAL ACADEMY PRESS Washington, D.C. 1998

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The Social Security Administration's Disability Decision Process: A Framework for Research, Second Interim Report National Academy of Sciences 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. 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 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 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 Contract No. 600-96-27893 between the National Academy of Sciences and the Social Security Administration. 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 agency that provided support for this project. International Standard Book Number 0-309-06140-7 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's home page at http://www.nap.edu. This report is also available via the Internet at http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at http://www2.nas.edu/iom. For more information about the Committee on National Statistics, visit the CNSTAT home page at http://www2.nas.edu/cnstat. Copyright 1998 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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The Social Security Administration's Disability Decision Process: A Framework for Research, Second Interim Report COMMITTEE TO REVIEW THE SOCIAL SECURITY ADMINISTRATION'S DISABILITY DECISION PROCESS RESEARCH DOROTHY P. RICE* Chair, Professor Emeritus, Department of Social and Behavioral Sciences, Institute for Health and Aging, University of California at San Francisco MONROE BERKOWITZ, Professor of Economics, Emeritus, and Director, Disability and Health Economics Research, Rutgers University, New Brunswick, New Jersey RONALD S. BROOKMEYER, Professor of Biostatistics, The Johns Hopkins University School of Hygiene and Public Health GERBEN DEJONG, Director, National Rehabilitation Hospital Research Center, and Professor of Family Medicine and Adjunct Professor, Georgetown University Institute of Public Policy, Washington, D.C. MARSHAL F. FOLSTEIN, Chairman and Professor of Psychiatry, Tufts University School of Medicine; and Psychiatrist-in-Chief, New England Medical Center, Boston DAVID B. GRAY,† Professor and Associate Director for Research, Program in Occupational Therapy, Washington University School of Medicine ROBERT M. GROVES, Director of the Joint Program on Survey Methodology at the University of Maryland at College Park; and Professor and Program Director, Survey Research Center of the University of Michigan at Ann Arbor WILLIAM D. KALSBEEK, Professor of Biostatistics and Director, Survey Research Unit, University of North Carolina at Chapel Hill JERRY L. MASHAW, Sterling Professor of Law and Management and Professor, Institute for Social and Policy Studies, Yale University CATHARINE C. MASLOW, Director, Initiative on Alzheimer's and Managed Care, Alzheimer's Association, Washington, D.C. DONALD L. PATRICK,* Professor of Health Services, University of Washington School of Public Health and Community Medicine HAROLD ALAN PINCUS, Deputy Medical Director and Director, Office of Research, American Psychiatric Association, Washington, D.C. JOHN A. SWETS,‡ Chief Scientist, Information Sciences, BBN Technologies, Cambridge, Massachusetts EDWARD H. YELIN, Professor of Medicine and Health Policy, Department of Medicine and Institute for Health Policy Studies, University of California at San Francisco Study Staff GOOLOO S. WUNDERLICH, Study Director KRISTEN N. ROBINSON, Program Officer MARGO L. CULLEN, Administrative Assistant *   Member, Institute of Medicine. †   Served until February 1998. ‡   Member, National Academy of Sciences.

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The Social Security Administration's Disability Decision Process: A Framework for Research, Second Interim Report BOARD ON HEALTH CARE SERVICES INSTITUTE OF MEDICINE DON E. DETMER Chair, Senior Vice President, The University of Virginia BARBARA J. McNEIL, Vice Chair, Ridley Watts Professor, Department of Health Care Policy, Harvard Medical School STUART H. ALTMAN, Sol C. Chaikin Professor of National Health Policy, The Florence Heller Graduate School for Social Policy, Brandeis University PAUL D. CLAYTON, Chair, Department of Medical Informatics, Columbia-Presbyterian Medical Center NANCY W. DICKEY, Private Practice, College Station, Texas B. KEN GRAY, Corporate Medical Director, Metroplex Emergency Physician Associates, P.A., Dallas, Texas PAUL F. GRINER, Vice President and Director, Center for the Assessment and Management of Change in Academic Medicine, Association of American Medical Colleges, Washington, D.C. RUBY P. HEARN, Senior Vice President. Robert Wood Johnson Foundation, Princeton, New Jersey PETER BARTON HUTT, Covington and Burling, Washington, D.C. BRENT C. JAMES, Executive Director, Institute for Health Care Delivery Research, and Vice President, Medical Research and Continuing Medical Education, Intermountain Health Care, Salt Lake City, Utah JACQUELINE KOSECOFF, President and Co-Chief Executive Officer, Value Health Sciences, Inc., Santa Monica, California SHEILA T. LEATHERMAN, Executive Vice President, Center for Health Care Policy and Evaluation, United Health Care Corporation, Minneapolis, Minnesota JOHN LUDDEN, Senior Vice President for Medical Affairs, Harvard Pilgrim Health Care, Brookline, Massachusetts RUSSELL L. MILLER, Consultant, Washington, D.C. MILDRED MITCHELL-BATEMAN, Clinical Director, Huntington Hospital, Huntington, West Virginia MARY MUNDINGER, Dean and Centennial Professor in Health Policy, Columbia University UWE E. REINHARDT, James Madison Professor of Political Economy and Professor of Economics and Public Affairs, Princeton University MARY LEE SEIBERT, Acting Provost, Ithaca College GAIL L. WARDEN, President and Chief Executive Officer, Henry Ford Health System, Detroit, Michigan CLYDE J. BEHNEY, Deputy Executive Officer and Acting Director, Board on Health Care Services, IOM

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The Social Security Administration's Disability Decision Process: A Framework for Research, Second Interim Report COMMITTEE ON NATIONAL STATISTICS NATIONAL RESEARCH COUNCIL 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 ERIC A. HANUSHEK, W. Allen Wallis Institute of Political Economy and Department of Economics, University of Rochester RODERICK J.A. LITTLE, School of Public Health, University of Michigan THOMAS A. LOUIS, Division of Biostatistics, University of Minnesota CHARLES F. MANSKI, Department of Economics, Northwestern University WILLIAM D. NORDHAUS, Department of Economics, Yale University JANET L. NORWOOD, The Urban Institute, Washington, D.C. EDWARD B. PERRIN, Department of Health Services, University of Washington PAUL R. ROSENBAUM, Department of Statistics, The Wharton School, University of Pennsylvania KEITH F. RUST, Statistical Group, Westat, Inc., Rockville, Maryland FRANCISCO J. SAMANIEGO, Division of Statistics, University of California at Davis MIRON L. STRAF, Director ANDREW WHITE, Deputy Director

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The Social Security Administration's Disability Decision Process: A Framework for Research, Second Interim Report Acknowledgment of Reviewers This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the authors and the National Academy of Sciences in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The contents of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. The Committee to Review the Social Security Administration's Disability Decision Process Research wishes to thank the following individuals for their participation in the review of this report: JACOB FELDMAN, Chevy Chase, Maryland (Retired Associate Director for Analysis, Epidemiology and Health Promotion, National Center for Health Statistics) JOAN LEON, Executive Vice President, World Institute on Disability LAWRENCE LEWIN, Chief Executive Officer, The Lewin Group, Fairfax, Virginia JANET L. NORWOOD, Senior Fellow, Urban Institute EDWARD B. PERRIN, Department of Health Services, University of Washington While the individuals listed above have provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the authoring committee and the National Academy of Sciences.

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The Social Security Administration's Disability Decision Process: A Framework for Research, Second Interim Report Contents 1   INTRODUCTION   1 2   BACKGROUND   3     Need for a Redesigned Process for Program Eligibility   3     Disability Determination—Structure and Process   5     Commissioner's Conclusions   9 3   A FRAMEWORK FOR RESEARCH IN THE DISABILITY DECISION PROCESS   11     What Is the Nature and Extent of the Problem with the Disability Decision Process?   13     What Alternative Solutions Might Address These Problems?   13     Will a Proposed Decision Process Be Workable and Will It Alleviate the Problems?   14 4   SSA'S RESEARCH PLAN FOR A REDESIGNED DISABILITY DECISION PROCESS   15     SSA's Research Plan   16     Progress Toward the Framework for the Decision Process Research   17 5   CONCLUDING COMMENTS   35     Recommendations   37     REFERENCES   38     APPENDIX: Review of the Social Security Administration's Disability Decision Process Research: Study Mandate   40     ACRONYMS AND ABBREVIATIONS   41

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