The Dynamics of Disability Measuring and Monitoring Disability for Social Security Programs (2002) / Chapter Skim
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5. A Work Disability Monitoring System
5. A Work Disability Monitoring System
Pages 88-112
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From page 88... ...
Effective management of SSA's disability programs requires sufficient information to understand and predict changes in the size, characteristics, and distribution of the pool of persons eligible for disability benefits (applicants and beneficiaries) , as well as to understand the factors that affect application volume and answer many policy questions.
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From page 89... ...
The working age population has grown dramatically and its composition has undergone fundamental change since the inception of the SSDI and SSI programs. This working age population eligible for disability benefits is projected to increase in the coming years as the baby boom generation ages and reaches the ages at which chronic diseases and disabilities are more likely to occur.
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From page 90... ...
Health conditions differ in the degree to which they cause functional limitations and disabilities that may result in work disability. One of the committee tasks was to examine SSA's research into functional assessment instruments for its redesign efforts and to provide advice for adopting or developing instruments for the redesigned decision process and the National Study on Health and Activity.
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From page 91... ...
The committee believes that the NSHA should be considered the first important part of a long-term commitment by the SSA to produce reliable national data on the demand for and quality of its disability benefits programs. However, NSHA will be of limited utility in directly measuring longterm temporal market changes and demographic changes.
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From page 92... ...
SSA should make the investment in resources to expand its infrastructure to develop a permanent infonnation-gathenug system to monitor the disability-reZated needs of those it serves and the impact of disability benefits programs it is regui'7777ed to maintain. Recommendation 5-1: The committee recommends that the Social Security Administration develop an ongoing disability monitoring system from the experience with the National Study of Health and Activity.
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From page 93... ...
It must know how many Americans may need their benefits, who has been applying for them and why, how satisfied those receiving them are win the administrative apparatus Hat has been installed to deliver benefits, and why those eligible but not receiving benefits have not applied. A disability monitoring system would begin with a comprehensive measurement such as the NSHA, from which a reduced set of indicators of the size and characteristics of the "pool" of applicants for disability benefits would be identified.
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From page 94... ...
Therefore, one of the challenges in thinking about the design of a disability monitoring system is to understand how shifts in the nature of work over the past 40 years and into He future affect the meaning of disability, and to make this operational in household surveys and administrative databases. As stated earlier, of interest in the disability monitoring system is not simply the measurement of prevalence and the socioeconomic and demographic conditions linked to disability, but also understanding changes in both the individual and the environmental factors that lead to changes in appliiMuch of the information in this section is drawn from the background paper "Survey Design Options for the Measurement of Work Disabilities," commissioned from Nancy Mathiowetz for use by the committee.
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From page 95... ...
Among the options with respect to household data are stand-alone surveys that permit rich and deep national data on the size of the disabled population (e.g., similar to the NSHA) , survey modules administered as part of preexisting data collection efforts (e.g., a supplement to the Current Population Survey or the Survey of Income and Program Participation)
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From page 96... ...
If proxy responses are accepted, what impact does this design choice have on the measurement error properties of the reporting of disability? As is evident from the alternative design components discussed above, each choice impacts the error structure of the estimates of disability and the analytic capabilities that can be addressed with the resulting data.
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From page 97... ...
1. Reporting from Reduced Sets of Measures in the Intervening Years The NSHA should yield a complex and large set of measures that are used to identify alternative estimates of the number, distribution, and characteristics of the working age population in the United States potentially eligible for benefits under the Social Security disability programs.
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From page 98... ...
Such simulations should provide the effective sample sizes required for all subpopulations of policy relevance, in order to inform the policy and budget functions of SSA. Some of the issues for consideration in the sample design simulations will be the needed frequency of national estimates and the desired sensitivity of the monitoring efforts to changes over time in the size of the pool of the eligible population.
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From page 99... ...
Several federal statistical agencies currently include some measurement of disability in one or more of their household data collection efforts; several other statistical agencies are currently developing such measures for inclusion in Weir studies. The candidate surveys for ongoing monitoring include the American Com
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From page 100... ...
(More detailed descriptions of these surveys and their athibutes can be found in Ma~iowetz, 2001, in Part II.) TABLE 5-1 Federal Data Collection Efforts Sponsor/ Survey Contractor Topic Sample Design Sample American Census Demographics, housing, Rolling sample 3 milk Community social and economic of addresses Survey characteristics American Census Housing, household Fixed sample Natior Housing Survey characteristics, income, of addresses 55,000 recent movers selected in 1985, plus new Metro housing units 230,001 Behavioral Risk CDC/state health Preventive health factors Varies by state; Adults Factor departments and and risk behaviors probability Surveillance contractors in linked to chronic samples of Sample System U.S.
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From page 101... ...
Some candidate surveys do not meet all three criteria but are included for consideration because of some unique design feature of the study. For example, the annual samples for the National Health and Nutrition Exami Jesign Sample Size Frequency Mode sample 3 million households annually Monthly Self-administered; sses mail delivery mple National sample: National: Face to face sses 55,000 housing units semiannual In 1985, v Metro sample: Metro: 1/4 of the units 230,000 housing units sample each year y state; Adults, ages 18 and older Monthly data collection; Telephone ity annual estimation of Sample size varies by ids with state by year res ; panel 59,000 households; Monthly Face to face and sses 94,000 persons telephone ages 16 and older DUS, Sing 6,000 households, 15,000 persons per panel; panels can be pooled to produce calendar-year estimates based estimates on 12,000 households and 30,000-35,000 persons Panels interviewed Face to face; five times over telephone 24 months; annual 50,000 households; Biannual; Face to face; Is 100,000 persons annual estimation telephone ages 12 and older 5 continued
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From page 102... ...
nation Survey (NHANES) and the Medical Expenditure Panel Survey (MEPS)
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From page 103... ...
What evidence is Were about coverage, nonresponse, and measurement error properties of key statistics?
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From page 104... ...
With the obligation of many federal household surveys to provide indicators of disability, can SSA expertise in work disability be viewed as a desirable complement to the skills of the survey sponsor's staff skills?
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From page 105... ...
For example, one might follow all those currently on disability rolls, half of those with disabilities but not covered, a small fraction of those not reporting disabilities but with some health problems, and a still smaller fraction of the remainder of the population. What this means is that a combination of periodic large national survey with screening, and efficiently designed follow-up mostly by telephone, could continue the research on the disability policy questions, and the effectiveness of the process for determining eligibility for disability benefits.
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From page 106... ...
and the frequency of data collection. In addition to the questions outlined above describing a periodic rich data collection effort supplemented by monitoring of the population through an abbreviated set of measures, the development of an ongoing, continuous panel design would have to address: the size of the sample needed to achieve analytic capabilities for a single calendar year versus pooled estimation across contingent years; the life of a single panel, that is, the number of years individuals will be followed through time; Idle periodicity of the data collection; the acceptability of mixed modes for data collection and its effect on the measurement and nonresponse properties of the resulting estimates; the use of a panel design requiring consistent response from the same respondents versus a mix of self and proxy response over time; and the ramifications of the decision on the error properties of the estimators.
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From page 107... ...
When a person applies for disability benefits from either program, a medical determination is required. Medical decisions are made by the Disability Determination Services, reported to SSA's Office of Disability (OD)
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From page 108... ...
SSA should explore the experience of other agencies in conducting such surveys. The National Center for Health Statistics had conducted a survey of employers and He Medical Expenditures Panel Survey also surveys employers.
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From page 109... ...
The general goal of the monitoring system would be to continuously monitor the number of Americans who are eligible to receive SSA disability benefits (i.e., the size and characteristics of the popui
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From page 110... ...
Besides serving as a supplementary source of disability data, integration with the design features of these surveys might prove beneficial both to SSA's monitoring system and to the other surveys. This level of design integration has already been successfully accomplished between the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality and the National Health Interview Survey conducted by the National Center for Health Statistics (Cohen, 1999~.
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From page 111... ...
These steps are shown below in Box 5-1. The committee recognizes that despite its many benefits, developing and implementing the recommended disability monitoring system raises several important issues that would require careful examination and resolution during a three-year planning period before final decisions can be made on the details of He design.
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From page 112... ...
In conclusion, the committee emphasizes that developing and implementing a work disability monitoring system as recommended in this chapter will contribute toward a significantly improved and efficient system of measuring and monitoring work disability and effective fiscal management of the programs.
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