National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

THE DYNAMICS OF DISABILITY

MEASURING AND MONITORING DISABILITY FOR SOCIAL SECURITY PROGRAMS

Gooloo S. Wunderlich, Dorothy P. Rice, and Nicole L. Amado, Editors

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

Board on Health Care Services

INSTITUTE OF MEDICINE and

Committee on National Statistics

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL

NATIONAL ACADEMY PRESS
Washington, D.C.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, DC 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.

Support for this project was provided by Contract No. 600-96-27893 between the National Academy of Sciences and the Social Security Administration. Support of the work of the Committee on National Statistics is provided by a consortium of federal agencies through a grant between the National Academy of Sciences and the National Science Foundation (Grant No. SBR-9709489). The views presented in this report are those of the Committee to Review the Social Security Administration’s Disability Decision Process Research and are not necessarily those of the funding agency.

Library of Congress Cataloging-in-Publication Data

The dynamics of disability : measuring and monitoring disability for Social Security programs / Gooloo S. Wunderlich, Dorothy P. Rice, and Nicole L. Amado, editors ; Committee to Review the Social Security Administration's Disability Review Process Research, Division of Health Care Services, Institute of Medicine and Committee on National Statistics, Division on Behavioral and Social Sciences and Education, National Research Council.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-309-08419-9 (hardcover)

1. Disability evaluation--United States. 2. Social security--United States.

[DNLM: 1. Disability Evaluation--United States. 2. Eligibility Determination--methods--United States. 3. Social Security--United States. W 900 D997 2002] I. Wunderlich, Gooloo S. II. Rice, Dorothy P. III. Amado, Nicole L. IV. Institute of Medicine (U.S.). Committee to Review the Social Security Administration's Disability Decision Process Research. V. National Research Council (U.S.). Committee on National Statistics.

RA1055.5 .D964 2002

2002009395

Additional copies of this report are available for sale from the
National Academy Press,
2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. For more information about the Committee on National Statistics, visit the CNSTAT home page at www2.nas.edu/cnstat.

Copyright 2002 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

THE NATIONAL ACADEMIES

National Academy of Sciences

National Academy of Engineering

Institute of Medicine

National Research Council

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. Wm. 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. Harvey V. Fineberg 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. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

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

RONALD S. BROOKMEYER, Professor of Biostatistics,

The Johns Hopkins University School of Hygiene and Public Health

GERBEN DEJONG (until 3/9/00), Director,

National Rehabilitation Hospital Research Center, and

Professor of Family Medicine and Adjunct Professor,

Georgetown University Institute of Public Policy

MARSHAL F. FOLSTEIN, Chairman and Professor of Psychiatry,

Tufts University School of Medicine; and

Psychiatrist-in-Chief,

New England Medical Center, Boston, Massachusetts

DAVID B. GRAY (until 4/22/98), Professor and Associate Director for Research,

Program in Occupational Therapy, Washington University School of Medicine

ROBERT M. GROVES, Director,

Survey Research Center of the University of Michigan at Ann Arbor and

Senior Research Scientist,

Joint Program in Survey Methodology, University of Maryland

ALAN M. JETTE, Professor and Dean,

Sargent College of Health and Rehabilitation Sciences, Boston University

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,

Initiatives on Managed Care and Acute Care, Alzheimer’s Association, Washington, D.C.

DONALD L. PATRICK, Professor of Health Services and Director,

Social and Behavioral Sciences Program, University of Washington School of Public Health and Community Medicine

HAROLD A. PINCUS, Executive Vice Chairman,

Department of Psychiatry, University of Pittsburgh School of Medicine and

Senior Scientist,

RAND, Pittsburgh, Pennsylvania

JOHN A. SWETS (until 10/4/99), Chief Scientist,

Information Sciences, BBN Technologies, Cambridge, Massachusetts

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

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

NICOLE AMADO, Research Associate

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

BOARD ON HEALTH CARE SERVICES INSTITUTE OF MEDICINE

DON E. DETMER (Chair), Dennis Gillings Professor of Health Management,

The Judge Institute of Management Studies, University of Cambridge

BARBARA J. McNEIL (Vice Chair), Ridley Watts Professor,

Department of Health Care Policy, Harvard Medical School

LINDA AIKEN, The Claire M. Fagin Leadership Professor of Nursing and Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research,

University of Pennsylvania

HARRIS BERMAN, Chief Executive Officer,

Tufts Health Plan, Waltham, Massachusetts

BRIAN BILES, Professor,

Department of Health Services Management and Policy, School of Public Health and Health Services, The George Washington University, Washington, DC

J. LYLE BOOTMAN, Dean and Professor,

College of Pharmacy and

Executive Director,

Center for Health Outcomes and PharmacoEconomics (HOPE) Research, Arizona Health Sciences Center, University of Arizona

CHRISTINE CASSEL, Dean,

School of Medicine and

Vice President for Medical Affairs,

Oregon Health Sciences University, Portland, Oregon

PAUL D. CLAYTON, Medical Informaticist,

Intermountain Health Care, Salt Lake City, Utah

JACK C. EBELER, President and CEO,

Alliance of Community Health Plans, Washington, DC

DOUGLAS A. HASTINGS, President,

American Health Lawyers Association, Washington, DC

RUBY P. HEARN, Senior Vice President Emerita,

Robert Wood Johnson Foundation, Princeton, New Jersey

ROBERT L. JOHNSON, Professor of Pediatrics and Clinical Psychiatry and Director of Adolescent and Young Adult Medicine,

University of Medicine and Dentistry of New Jersey, New Jersey Medical School

SHEILA T. LEATHERMAN, Founder,

The Center for Health Care Policy and Evaluation and

Executive Vice President,

UnitedHealth Group, Minneapolis, Minnesota

SHOSHANNA SOFAER, Robert P. Luciano Professor of Health Care Policy,

School of Public Affairs, Baruch College, New York, New York

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

DONALD STEINWACHS, Professor and Chair,

Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

PAUL C. TANG, Medical Director,

Clinical Informatics, Palo Alto Medical Foundation, Palo Alto, California

JANET M. CORRIGAN, Director,

Board on Health Care Services, IOM

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

COMMITTEE ON NATIONAL STATISTICS NATIONAL RESEARCH COUNCIL

JOHN E. ROLPH (Chair),

Marshall School of Business, University of Southern California

JOSEPH G. ALTONJI,

Department of Economics, Northwestern University

ROBERT BELL,

AT&T Laboratories, Florham Park, NJ

LAWRENCE D. BROWN,

Department of Statistics, University of Pennsylvania

ROBERT M. GROVES,

Survey Research Center, University of Michigan

HERMANN HABERMANN,

United Nations Statistics Division, New York, NY

JOEL L. HOROWITZ,

Department of Economics, Northwestern University

WILLIAM D. KALSBEEK,

Survey Research Unit, Department of Biostatistics, University of North Carolina

ARLEEN LEIBOWITZ,

Department of Policy Studies, University of California—Los Angeles School of Public Policy

RODERICK J. A. LITTLE,

School of Public Health, University of Michigan

THOMAS A. LOUIS,

The RAND Corporation, Arlington, VA

DARYL PREGIBON,

AT&T Laboratories-Research, Florham Park, NJ

NORA CATE SCHAEFFER,

Department of Sociology, University of Wisconsin—Madison

MATTHEW D. SHAPIRO,

Department of Economics, University of Michigan

ANDREW WHITE, Director

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

Acknowledgments

The Committee to Review the Social Security’s Disability Decision Process Research gratefully acknowledges the contributions of the many individuals and organizations over the course of six years, not all of whom can be individually listed here, who participated and gave generously of their time and knowledge to this study.

Support for this study was provided by the Social Security Administration (SSA). Staff of SSA was helpful in providing information about the research projects undertaken relating to the disability decision process and the planning, development, and statistical design of the National Study of Health and Activity, the two principal study areas of the contract. We particularly wish to thank Scott Muller, Senior Economist, Office of Research Evaluation, and Statistics, who served as the SSA project officer throughout the duration of the study. We also acknowledge David Barnes and Rosanne Hanratty who served as co-project officers with Dr. Muller in the early years of the study. In addition we acknowledge the many federal and nonfederal government officials and those from the research and disability communities who gave expert presentations to the committee at its meetings and those who participated in the two large workshops organized by the committee. They are listed in Appendix A and B of this report.

We are grateful to Elizabeth Badley, Alan Jette, Cille Kennedy, Nancy Mathiowetz, Laura Trupin, and Edward Yelin, the authors of the commissioned papers prepared for the study. These papers were used exten-

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

sively by staff and committee in drafting the report. These papers are included in Part II of the report.

We acknowledge with gratitude the contributions of our consultant, Nancy Mathiowetz, Associate Professor at the University of Maryland’s Joint Program on Survey Methodology. Dr. Mathiowetz provided assistance and technical expertise to staff and the committee in organizing the workshop on Survey Measurement of Work Disability, co-editing the summary report of the workshop, and advising on dissemination of the report. She also authored two of the commissioned papers on statistical issues associated with survey measurement of disability and the various possible methods of obtaining continuing information on disability issues confronting SSA.

We acknowledge the contributions of the IOM study staff to whom an important debt of gratitude is owed. The committee is especially grateful for the guidance and efforts of our study director, Gooloo S. Wunderlich, for the enormous contribution she made to the study. She had primary responsibility for organizing the deliberations of the committee and preparing the drafts of the study reports, tasks that she accomplished with considerable skill and tact. Gooloo’s professionalism, knowledge, and extraordinary commitment and perseverance were critical to resolving many policy and technical issues and completing the study. Nicole Amado served ably as a senior project assistant, research assistant, and more recently as research associate—at times simultaneously handling the functions of all three positions. Her excellent support and attention to detail were critical to the success of the final report. She independently developed all of the components required in IOM reports and reviewed and edited the various drafts of the report for accuracy and style under very tight deadlines. She researched and developed all the tables and figures in the report and reformatted all the tables in Part II of the report. The committee acknowledges the several other staff who assisted the committee at various times and in varying capacities over the six years of the study.

Other IOM staff provided support and assistance to the study committee. The IOM Financial Associates helped keep our budget in order. The Staff of the Office of Reports and Communication handled the logistics of the reports review process and shepherded the reports through the editing and production process. Sally Stanfield at the National Academy Press was supportive and helpful as always for each of the six reports issued by the committee.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

Finally, I would like to thank all the members of the committee for their generous contribution of time and expert knowledge to the deliberations and the preparation of the committee reports including this final report.

Dorothy P. Rice, Chair

Committee to Review the Social Security Disability Decision Process Research

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
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Reviewers

The report has been reviewed in draft form 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 institution in making its 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 review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Henry Aaron, Senior Fellow, Brookings Institution, Washington, D.C.

Richard G. Frank, Professor, Harvard Medical School, Boston, Massachusetts

David Gray, Researcher Professor, Washington University School of Medicine, St. Louis, Missouri

Robert Haveman, Professor, University of Wisconsin—Madison

Lisa Iezzoni, Professor of Medicine, Harvard Medical School, Boston, Massachusetts

Corinne Kirchner, Director, Policy Research and Program Evaluation, American Foundation for the Blind, New York, New York

James Morgan, Professor and Research Scientist Emeritus, University of Michigan

Janet L. Norwood, Consultant, Chevy Chase, Maryland

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Edward B. Perrin, Professor Emeritus, University of Washington and Senior Scientist, VA Puget Sound Health Care System, appointed by the Institute of Medicine, and Joseph P. Newhouse, Professor, Harvard Medical School, appointed by the National Research Council’s Report Review Committee. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
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Tables and Figures

TABLES

2-1

 

Disabled Workers: Number of SSDI Applications, Awards, Ratio of Awards to Applications, and Applications per 1,000 Insured Workers for Selected Years, 1960–2000,

 

36

2-2

 

Disabled Workers: Number of SSDI Beneficiaries and Terminations and Termination Rate per 1,000 Beneficiaries, 1960–2000,

 

39

2-3

 

Disabled Workers: Number of SSDI Beneficiaries, Workers Insured in Event of Disability, and Beneficiaries per 1,000 Insured, 1960–2000,

 

42

2-4

 

Percentage of Disabled Workers Awarded SSDI Benefits, by Gender, 1960–2000,

 

46

2-5

 

Labor Force Participation Rates (percent) of Persons with and Without Disabilities, by Gender, United States, 1983–1999,

 

50

5-1

 

Federal Data Collection Efforts,

 

100

6-1

 

Issues and Methods to Be Addressed in a Framework for a Research Plan for a New Disability Decision Process,

 

121

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
×

FIGURES

1-1

 

The Social Security Administration’s current and proposed disability claims process,

 

23

2-1

 

Number of SSDI applications, awards, beneficiaries, and terminations, aged 18–64 years, 1960–2000,

 

36

2-2

 

Number of SSI applications, awards, recipients, and terminations, aged 18–64 years, 1974–2000,

 

38

2-3

 

Average age of persons awarded SSDI benefits, by gender, 1960–2000,

 

45

2-4

 

Percentage distribution of SSDI awards for adults aged 18–64, by diagnostic groups, 1981 and 2000,

 

47

6-1

 

The Social Security Administration’s current and proposed redesigned disability decision process,

 

118

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2002. The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press. doi: 10.17226/10411.
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The Society Security disability program faces urgent challenges: more people receiving benefits than ever before, the prospect of even more claimants as baby boomers age, changing attitudes culminating in the Americans With Disabilities Act. Disability is now understood as a dynamic process, and Social Security must comprehend that process to plan adequately for the times ahead. The Dynamics of Disability provides expert analysis and recommendations in key areas:

  • Understanding the current social, economic, and physical environmental factors in determining eligibility for disability benefits.
  • Developing and implementing a monitoring system to measure and track trends in work disability.
  • Improving the process for making decisions on disability claims.
  • Building Social Security’s capacity for conducting needed research.

This book provides a wealth of detail on the workings of the Social Security disability program, recent and emerging disability trends, issues and previous experience in researching disability, and more. It will be of primary interest to federal policy makers, the Congress, and researchers—and it will be useful to state disability officials, medical and rehabilitation professionals, and the disability community.

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