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11 Department of Health, Education, and Welfare: Welfare Agencies Welfare is the third-largest social knowledge production and applica- tion policy area in the Department of Health, Education, and Welfare. Almost 20 percent, or $136 million, of HEW'S social knowledge produc- tion and application obligations in fiscal 1977 was made by welfare agencies. In contrast to the terms "health" and "education," "wel- fare" is a more awkward and misleading descriptor. While categorized under "welfare," the four agencies described in this section are primar- ily concerned with social service and income security. Due to the in- tertwining of health issues with social service and income security, all four of the agencies described in this section also support research and other activities in health. The placement of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the welfare section was made because poverty and income security issues account for the largest portion of ASPE'S obligations. ASPE, however, is a crosscutting agency with activities spanning the entire range of HEW programs. ASPE supports activities in the health and education policy areas as well as on income security and social services. While their location is imper- fect, the following agencies are discussed under the heading "wel- fare": The Assistant Secretary for Planning and Evaluation is a policy office that supports research and evaluation activities on issues of con- cern to the secretary of HEW. 243
244 SURVEY OF FEDERAL AGENCIES The Office of Human Development Services supports research and related activities on certain groups of "vulnerable" Americans with special needs: children and youth, the aged, the physically and men- tally handicapped, the developmentally disabled, and Native Ameri- cans. The Social and Rehabilitation Service administers the federal and state welfare programs of case assistance for families with dependent children, medical assistance, and social services.1 The Social Security Administration administers the Social Security program. Medicare, and the Supplemental Security Income Program. These agencies and their components are listed in Table 11-1. Table 11-1 demonstrates the diversity of HEW'S "welfare" agencies. While the four agencies are predominantly operating agencies, their goals and audiences are mixed. ASPE is primarily concerned with the TABLE 11-1 Welfare Agencies that Support Social Knowledge Production and Application: Profile (fiscal 1977, $millions) Organizational Predominant Location of Total Social Social Social Knowledge Knowledge Knowledge Production and Production and Production and Application Application Application Primary Goal Agency Obligations Activity Activity or Audience" Office of Human 65.2 Research Operating Mixed Development Services agency Assistant Secretary 34.5 Policy formulation Policy-making Improvement for Planning and demonstrations office of federal Evaluation policies Social Security 27.7 Research Operating Improvement Administration agency of federal programs Social and Rehabili- 9.4 Mixed Operating Knowledge tation Service* agency for third TOTAL 136.9 parties Numbers may not total due to rounding. °See Chapter 2 for a more detailed discussion. The Social and Rehabilitation Service was abolished in March 1977. 'The Social and Rehabilitation Service (SRS) was abolished in March 1977. The reorgani- zation of HEW and SRS is discussed in the SRS section.
HEW: Welfare Agencies 245 improvement of federal policy. The Social Security Administration is concerned with the improvement of the federal program of social secu- rity. The Social and Rehabilitation Service and the Office of Human Development Services are primarily concerned with providing knowl- edge for third partiesâfor example, improving the delivery of social services at the state and local level. ASSISTANT SECRETARY FOR PLANNING AND EVALUATION Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search on st rations ation Statistics Total onstrations Materials ination Total TOTAL 1975 7.274 19.940 2.588 29.802 41 161 202 30.004 1976 11.086 17.889 5.075 34.050 34.050 1977 10.975 18.200 5.375 34.550 34.550 The Office of the Assistant Secretary for Planning and Evaluation (ASPE) serves as the principal adviser to the secretary of HEW on eco- nomic, social, and program analysis matters. A major responsibility of ASPE has been the development of short- and long-range policy objec- tives and program evaluations to assist in the analysis of alternative strategies in health, education, social services, and human develop- ment. ASPE concentrates on policy issues that cut across programmatic lines and are related to major policy initiatives of the department. In 1973, many of the poverty-related research and demonstration programs that had been supported by the Office of Economic Opportu- nity (OEO) were transferred to ASPE. The research projects that were transferred to HEW, along with the HEW income maintenance experi- ments, have made ASPE the lead agency concerned with poverty re- search in the federal government. Research and Program Evaluation ASPE supports both research and program evaluation activities. The research activities are funded by congressional appropriation under the original OEO research authority. The program evaluation activities are funded through evaluation "set asides." These "set aside" funds are
246 SURVEY OF FEDERAL AGENCIES provided to ASPE from other HEW agencies. Both activities, research and evaluation, cover the same policy areas and are discussed to- gether. ASPE'S research and evaluation activities are: (1) income main- tenance and employment; (2) health; (3) other human services (social service, education, etc.); and (4) basic research and statistical data. INCOME MAINTENANCE AND EMPLOYMENT RCSCaTCh JH thlS aTCa is de- signed to provide a better understanding of the causes of low earnings from employment; to ascertain the impact of existing or proposed in- come maintenance and employment-related assistance programs; and to suggest new initiatives to increase self-sufficiency and reduce de- pendency among low-income families and individuals. Examples of research projects include the following. Research on Disability Insurance Applications This project was an econometric analysis of the determinants of disability insurance appli- cations. Analysis attempted to explain the causes of the recent growth in applications and to predict future growth. Research on Labor Economics This project focused on race dif- ferences in earnings, female wage rates, and labor supply. The study examined the factors that affect labor force participation of special groups, including discrimination, lack of education, and irregular em- ployment histories. Possible remedial policies were examined. Poverty, Dependency, and Family Structure This project critically reviewed recent research on the causes of marital separation and di- vorce, marriage, and remarriage among women with children born out of wedlock. Research focused on the possible effects of federal welfare policy on these changes in family structure. Other recent studies have been on policy options for welfare reform initiatives; research on social insurance programs; the use of time by the unemployed; cash equivalence of in-kind income; and unemploy- ment, inflation, and the poor. HEALTH Research in this area focuses on significant policy questions concerning the availability and use of health services among low- income populations. In addition to the health insurance experiment (which is discussed under policy formulation demonstrations), nonex- perimental studies have been supported concerning health insurance. These nonexperimental studies have focused on establishing prelimi- nary estimates of price and income elasticities; the demand for and costs of health services; and the responsiveness of the supply of physi- cians to the demand for medical services.
HEW: Welfare Agencies 247 Other health research studies have focused on the organization and delivery of health care, a study of the effectiveness of the private health insurance markets, and studies dealing with Medicaid reimbursements and physician billing practices for low-income patients. OTHER HUMAN SERVICES Research in this area is intended to provide information on a variety of education programs and explore ways to improve the quality and delivery of human services to the disadvan- taged. Specific areas of inquiry are described below. Education Research is designed to obtain a better understanding of the effects of existing or proposed educational programs and services to the poor; to analyze the relationship of various economic and social conditions on the availability of quality educational services; and to suggest program modifications or new initiatives that will contribute to the policy objectives of equal educational opportunity and the removal of financial barriers. Social Services Research has been funded on the development of information bases about institutionalization of persons who suffer from chronic or mental illness. Research has examined major questions con- cerning the availability and appropriate use of long-term care facilities and associated social services for disabled and elderly populations. Other studies have examined single-parent families and aspects of day care policy and regulations. BASIC RESEARCH AND STATISTICAL DATA Research in this area is di- rected at increasing fundamental understanding of the nature and causes of poverty and inequality. In addition, the program provides for improved collection, analysis, and use of statistical data on policy- relevant economic, social, health, and demographic phenomena. This program area supports the Institute for Research on Poverty at the University of Wisconsin, which has focused on poverty and the size distribution of income and wealth; income transfer and income mainte- nance systems; poverty, household decision making, and demographic behavior; segregation, discrimination, and poverty; legal, political, and administrative systems affecting the poor; and education and the pov- erty problem. This program area has supported the longitudinal study of income dynamics at the University of Michigan's Institute for Social Research. Since 1968, a national probability sample consisting of 5,000 families has been interviewed yearly. The study has focused on economic vari- ables (such as work hours, earnings, total income, and expenditures) and social variables to determine reasons for changes in family income
248 SURVEY OF FEDERAL AGENCIES and welfare. The study has focused on employment, income, and fam- ily structure patterns of low-income families. ASPE has also supported two simulation models: the Transfer Income Simulation Model (TRIM) and the Dynamic Microsimulation Model (Dynasim). TRIM is the basic microsimulation model used by HEW to estimate the costs and caseloads of alternative income maintenance programs. Dynasim is a simulation of future demographic changes. In addition, a major Survey of Income and Education (SIE) has been sup- ported through an interagency transfer to the Bureau of the Census. Policy Formulation Demonstrations ASPE has supported social experiments on income maintenance and health. In addition, ASPE gives demonstration grants to state and local governments. Each is discussed below (fiscal 1977 estimated obliga- tions are in parentheses). INCOME MAINTENANCE EXPERIMENTS ($10.5 million) These are the largest social experiments in ASPE. Two experiments are currently under way, and two experiments are completed and are now being analyzed. Each has been a carefully controlled experiment designed to yield statistically reliable results on the major behavioral and societal effects of alternative income maintenance policies, with particular em- phasis on the labor supply or work incentive effects of such policies. The income maintenance experiments have provided the only hard data available on the likely response of individuals to changes in the income maintenance system. The experiments have also focused on obtaining information on ways to improve the administration of income maintenance systems. Projects currently under way are listed below. Seattle and Denver Income Maintenance Experiments These two experiments are the most comprehensive of the income maintenance experiments. The experiments have a larger sample size than all the other experiments combined. The experiments are testing the interac- tive effects of income maintenance (a negative income tax plan) and participation in a manpower program. The income transfer program is supplemented by one or more manpower programs, including either job training, counseling, and vocational guidance services or day care services for working mothers. Analysis of Gary Income Maintenance Experiment This experi- ment tested the effects of cash assistance programs, combined with day care and social services, on black urban families. Analysts are cur- rently examining the behavioral and societal effects of alternative in-
HEW: Welfare Agencies 249 come maintenance policies, with particular emphasis on the effect of work incentives on such policies. A public use file of the Gary, Ind., experiment is being prepared so that others may make use of the lon- gitudinal data set. Analysis of the Rural Graduated Work Incentive Experiment This experiment was initiated by OEO as a counterpart to the now completed New Jersey (Urban) Experiment. It was designed to measure the be- havioral response of rural working poor families to income-conditioned cash transfers along a number of social and economic dimensions, with emphasis on labor supply and mobility. HEALTH CARE EXPERi ME NT ($5.2 million) The experiment is a multisite (Dayton, Ohio; Seattle, Washington; Charleston, South Carolina; and Fitchburg, Massachusetts) experiment designed to measure the effect of a wide range of cost-sharing insurance plans on the demand for health care and the effects of health status over time. The experi- ment will consider various questions relevant to the design and opera- tion of a national health insurance system, such as: o estimating the responsiveness of demand for health services to insurance provisions, such as deductibles and rates; o determining how responsiveness to insurance provisions differs with such factors as family income and types of illness; o assessing the effect of various insurance plans on health status; o learning how the choice of provider and quality of medical care is affected, if at all, by various insurance plans; and o the administrative costs and difficulties involved in administering different types of income-related insurance plans. STATE AND LOCAL CAPACITY BUILDING ($2.2 million) This program is intended to support and stimulate activities to design, develop, or test innovative systems and technologies that will improve the delivery of human resource services by state and local governments. Innovative demonstrations include new management and delivery systems technology, planning systems, evaluation methodology, and service integration techniques. Emphasis is placed on improved comprehen- sive planning and delivery of human resource programs. Projects in- clude the following. State of Wisconsin received a grant to develop and test a new service delivery design through pilot installation of four community human service center programs in different community settings. The objective is to establish a single community-based organization to coordinate a
250 SURVEY OF FEDERAL AGENCIES variety of now-separate social and health service programs, staffs, and agencies. Texas Municipal League received a grant to assist city governments in planning, coordinating, and managing social service programs by assisting them in staff selection and training, needs assessment, and technical assistance. State of Florida received a grant to provide top management staff in the state Department of Health and Rehabilitative Services with infor- mation derived from systematic "needs assessment" studies. The re- sults of the studies are used in the planning and budgeting process. For Further Information See Policy Research Digest, Fiscal 1976 and Transitional Quarter, and Policy Research, a report to Congress on policy research activities, fiscal 1976âboth publications of ASPE, or write Office of the Assistant Secretary for Planning and Evaluation, Department of Health, Education, and Welfare, Room 422 A, Hubert Humphrey Building, 200 Inde- pendence Avenue, S.W., Washington, D.C. 20201. OFFICE OF HUMAN DEVELOPMENT SERVICES Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 26.117 14.567 2.643 1.240 44.567 10.409 1.970 5.883 18.262 62.829 vm 30.494 15.838 6.561 2.420 55.313 11.804 1.966 6.866 20.636 75.949 vm 30.746 9.192 8.508 1.900 50.346 4.180 1.368 9.297 14.845 65.191 The Office of Human Development (OHD) was established in 1973 to reach certain groups of "vulnerable" Americans with special needs: children and young people, the aged, the physically and mentally handicapped, the developmentally disabled. Native Americans, and people living in rural areas. Programs serving these groups, formerly scattered throughout HEW, were placed in OHD. In July 1977, OHD was reorganized and renamed the Office of Human Development Services (OHDS). The reorganization consolidated eigh- teen program offices and six staff offices into five major program units and four staff offices. The consolidation was designed to bring about more efficient and effective operations and more responsive delivery of services.
HEW: Welfare Agencies 251 OHD was the ninth-largest agency funder of social knowledge pro- duction and application in the federal government during fiscal 1977. Table 11-2 lists the offices in OHD that fund knowledge production and application activities. As can be seen, the Office of Child Development is the largest OHD funder of social knowledge production and applica- tion, supporting nearly 60 percent of the agency total. While OCD is classified as having the improvement of federal programs as its goal, TABLE 11-2 Office of Human Development Services Agencies that Support Social Knowledge Production and Application: Profile (fiscal 1977, Smillions) Organizational Predominant Location of Agency after Total Social Social Social Reorganizalion Knowledge Knowledge Knowledge (Components Production Production Production prior to and and and Consolidation in Application Application Application Primary Goal Parentheses) Obligations Activity Activity" or Audience" Administration for Handi- 14.5 Research Operating Knowledge capped Individuals agency for third (Rehabilitation Serv- 11.7 parties ices Administration) (Developmental Dis- 2.8 abilities Office) Administration for 39.5 Research Operating Improvement Children, Youth agency of federal and Families programs (Office of Child 38.3 Development) (Office of Youth 1.1 Development) Administration for 1.0 Research Operating Knowledge Nalive Americans agency for third (formerly the parties Office of Native American Programs) Administration on Aging in..1 Research Operating Knowledge agency Administration for Pub- lic Services' TOTAL 65.2 for third parties Numbers may not total due to rounding. 'See Chapter 2 for a more detailed discussion. 'Not surveyed.
252 SURVEY OF FEDERAL AGENCIES four of the other five offices are classified as having knowledge for third parties as their goals.2 These four, and parts of OCD, are primarily concerned with assisting states and localities who have the primary responsibility for administering social services to special population groups. Again, the "third-party" nature of social knowledge produc- tion and application is clearly seen in the Office of Human Develop- ment. For Further Information Write Office of Human Development Services, Department of Health, Education, and Welfare, Room 309, Hubert Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. ADMINISTRATION ON AGING Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 4.000 4.700 350 9.050 5.500 5.500 14.550 1976 5.500 4.774 2.200 12.474 6.726 6.726 19.200 1977 6.500 500 3.200 10.200 10.200 The Administration on Aging (AOA) was established in 1965 to provide a focal point in the federal government for addressing the concerns and needs of older persons and coordinating federal programs and policies that affect them. AOA is responsible for administering three grant pro- grams: o support to state and area agencies for establishing comprehensive coordinated service systems for older persons at the community level; o a national nutrition program, designed to provide low-cost, nutri- tious meals to low-income persons aged 60 and over; and o a research, demonstration, and manpower program that seeks to identify effective methods of helping older persons. AOA was not affected by the July 1977 OHDS reorganization. 'in « was a difficult agency to categorize. Because it operates several programs, its primary goal was classified as "improving federal programs" even though many of its knowledge production and application activities are aimed at providing knowledge for third parties in the social service community.
HEW: Welfare Agencies 253 Research The agency's research program is focused around the following four areas. AGING PROCESS (EXCLUSIVE OF BIOLOGICAL PROCESSES) This program area attempts to identify the changes and conditions experienced by the elderly that are associated with the social and psychological proc- ess of aging. It is geared to creating knowledge to enable service agen- cies to be responsive to the problems of old age. DEMOGRAPHIC DESCRIPTIONS OF THE OLDER AMERICAN POPULATION This program area is devoted to the identification, description, and enumeration of the current elderly population and subpopulations. This area also makes projections of population size, mobility, and demo- graphic and distribution characteristics. Knowledge about the attitudes and behavior of older persons is also sought. SOCIAL AND ENVIRONMENTAL CONDITIONS AFFECTING THE ELDERLY This program area attempts to identify, assess, and interpret those social, economic, and environmental conditions that affect the elderly, particularly the low-income and minority elderly. Specific studies focus on national policies that create problems for the elderly; economic and social forces that enhance or diminish their social or economic capital; and the responses of the elderly to social and en- vironmental conditions that inhibit their freedom and independence. INTERVENTION MECHANISMS (SUCH AS SERVICE DELIVERY) This prO- gram area attempts to identify and assess those activities, policies, or programs designed to improve the conditions of the elderly. These studies are geared to providing the understanding necessary for the development, organization, and delivery of social services to them. Demonstrations Prior to fiscal 1977, AOA funded a demonstration program entitled "Model Projects on Aging." (No funds were requested for this program in fiscal 1977.) Both policy formulation demonstrations and policy implementation demonstrations were funded; while these dem- onstrations were categorized separately to obtain the dollar figures presented above, they are discussed jointly. The Model Projects pro- gram sought to test and demonstrate how new programs, systems, or approaches could be used effectively to assist the elderly. Projects that
254 SURVEY OF FEDERAL AGENCIES showed promise for aiding this population group were supported on the following four topics. HOUSING Projects were supported to meet the special housing needs of older persons, such as independent living arrangements through reno- vation or other innovations. CONTINUING EDUCATION Projects were funded that provided continu- ing education for older persons through innovative programs. RETIREMENT EDUCATION AND SERVICES ThCSC prOJCCtS provided cation and information on retirement as well as other relevant services. NEEDS OF THE PHYSICALLY AND MENTALLY IMPAIRED TllCSC provided for better services in meeting the particular needs of physi- cally and mentally impaired older persons. Program Evaluation AOA has an office of planning and evaluation that supports program evaluations of various AOA activities. A major evaluation examined the agency's nutrition program, attempting to measure the effect of the program in terms of the health status, nutritional status, isolation, life satisfaction, longevity, and institutionalization of participants. Another evaluation examined the area planning and service programs funded by AOA by measuring changes in those organizations in their delivery of services to older persons. Another evaluation studied the outreach capacity of the nutrition program to serve those most in need. For Further Information Write Administration on Aging, Department of Health, Education, and Welfare, Room 4670. HEW North, 330 Independence Avenue, S.W., Washington. D.C. 20201. ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES The July 1977 reorganization of OHD created the Administration for Children, Youth and Families (ACYF). The new office consolidated several programs for children and youth administered by OHD. The new administration is responsible for the development of a broader, more comprehensive focus for children and youth. The consolidation of programs also provides an increased focus for supporting the family as the primary resource in meeting the needs of children and youth.
HEW: Welfare Agencies 255 TABLE 11-3 Administration for Children, Youth and Families (fiscal 1977, Smillions) Social Knowledge Production and Application Agency Obligations Office of Child Development Office of Youth Development TOTAL 38.3 1.0 39.4 Numbers may nol total due to rounding. Table 11-3 presents the major agencies consolidated into ACYF and their fiscal 1977 social knowledge production and application obliga- tions. For Further Information For a description of R&D funded by other government agencies pertaining to children and adolescents, see Toward Interagency Coordination, FY '77 Federal Research and Development Activities Pertaining to Adolescence, Fifth Annual Report of the Inter- agency Panel for Research and Development on Adolescence, and Toward Interagency Coordination, FY '77 Federal Research and Development Activities Pertaining to Early Childhood, Seventh Annual Report of the Interagency Panel on Early Childhood Re- search and Development; both volumes are compiled and published by the Social Re- search Group of George Washington University, 2401 Virginia Avenue, N.W., Suite 400. Washington, D.C. 20037. To obtain other information on ACYF, write Administration for Children, Youth and Families, Office of Human Development Services, Department of Health, Education, and Welfare, 5030 Donohoe Building, 400 Sixth Street, S.W., Washington, D.C. 20201. Office of Child Development Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Implemen- Formula- Program General Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 14.501 7.546 1.399 1.240 24.686 4.610 1.158 5.113 10.881 35.567 1976 15.485 7.833 2.871 2.420 28.609 4.784 1.394 5.963 12.141 40.750 1977 14.101 6.682 2.697 1.900 25.380 4.080 1.020 7.857 12.957 38,337
256 SURVEY OF FEDERAL AGENCIES The Office of Child Development (OCD), which is now consolidated in the Administration for Children, Youth and Families, is responsible for serving all children, from conception through early adolescence, with emphasis on the formative first five years of life and on children who are "at risk" because of special problems. The office carries out its mission by fulfilling the following functions: o operating federally funded programs for children, the most notable being Project Head Start; o developing innovative programs for children and their families; o serving as a coordinating point for all federal programs for children and their families; o administering the National Center for Child Abuse and Neglect; o acting as an advocate for the children of the nation, by bringing their needs to the attention of the government and the American people; and o developing national policies and programs that significantly affect the well-being of children and families. In addition to these activities, the office serves as the principal adviser to the secretary of HEW and the assistant secretary for human devel- opment services on all matters pertaining to the care and development of children. Another major activity of OCD is funding research and demonstration projects concerning children. Each of OCD'S major programsâthe Child Welfare Research and Demonstration Program, Project Head Start, and the National Center on Child Abuse and Neglectâhas its own research authority. Each of these three programs and their knowl- edge production and application activities will be discussed separately. CHILD WELFARE RESEARCH AND DEMONSTRATION PROGRAM This prO- gram is focused on day care; child welfare studies, emphasizing chil- dren at risk; and child and family development. Day Care Research and demonstration projects are aimed at iden- tifying alternative programs that result in maximum development and growth of children receiving day care and developing and perfecting administrative support systems for the delivery of day care services to ensure that such services are provided in the most cost-effective way. Examples of day care research include: o Day Care Cost-Effectiveness Study, which was designed to de- termine relationships between variation in day care center cost levels and effect on child and parent;
HEW: Welfare Agencies 257 o Parent Preference Survey, which was designed to identify the na- ture and extent of day care needed for representative communities; and o Effects of Day Care on Psychological Development, which com- pares the cognitive, social, and affective growth of children partici- pating in an experimental day care enrichment program with the growth of matched groups of children who are being reared at home. The goal of day care demonstration projects is to develop alternative delivery systems and innovative programs. An example is the bilingual/bicultural early childhood development project, which is demonstrating comprehensive early child development services in Spanish and English. The services provide an environment of the pri- mary language and culture of the Spanish child, while acquainting him or her with the second language and culture. Child Welfare Studies This program is aimed at the population of children who are at risk as a result of being separated from their families or enduring long separation from families and family life. Re- search projects are funded in the following areas: o Adoption and Foster Care studies, which include an examination of independent adoptions and informal adoptions among black families. o Deinstitutionalization projects, which include a study of the com- munity resources available for the deinstitutionalized child and. a study to assess the effect of deinstitutionalization on children. o Research on Institutions includes an analysis of the effect of in- stitutional placement on the development of adolescents. Another project analyzed residential treatment centers for children. Demonstration projects are also supported in this area. Several proj- ects were funded to test programs concerned with adoptions of handi- capped children. These projects coordinated community resources and efforts in recruiting and preparing potential adoptive families, selecting and placing handicapped children with these families, and assisting the establishment of relationships with community groups. Child Development and Family Life This program area focuses on the interrelationships among important elements of the child-rearing environment: the child and the family, and the larger societal and in- stitutional contexts. Research and demonstration projects are focused on: o describing and analyzing the ways in which families deal with situations such as divorce, remarriage, employment of the mother or family, and unemployment;
258 SURVEY OF FEDERAL AGENCIES o how families interact with or are treated by social institutions for child development; and o how families and institutions work together to ensure that the needs of children are met over the years so that development is not impaired. The Child Development and Family Life program area supports re- search in the areas described below: o Family Interface with Schools and Other Institutions, which in- cludes a study of family style and interactions with external institu- tions. Interactions and involvement among parent, professional, and child are also studied. o Family Styles, including studies on child-rearing practices of young white mothers; an empirical investigation of the effect of parent imprisonment on the socialization of black children; consequences of divorce to children; and cognitive development of early childhood. o Television, including a study of television's content and children's social attitudes; children's critical evaluation of television content; and parental supervision of children's social learning from television. o Social Ecology, including a study of the modification of children's racial attitudes; racial misidentification and attitudes about self among preschool children; the development of parental attachments; the ef- fect of family structural variables on the social mobility of black families; and an empirical study of black families. Demonstrations are also funded. A well-known demonstration is the Parent and Child Development Centers. At these centers, mothers of infants are trained to be "developmental agents" for their children. The purpose of the demonstration is to show that training mothers may be an important alternative to day care and preschool early childhood intervention strategies. The centers are also used as laboratories to learn more about infant development. The development of materials is also supported in this area. As part of the Education for Parenthood program, a curriculum was developed to help teenagers prepare for parenthood through learning about chil- dren. This curriculum was intended to be used in conjunction with Education for Parenthood work study projects that would give students actual experience with young children. PROJECT HEAD START Project Head Start is a comprehensive preschool program aimed at providing developmental services to disadvantaged
HEW: Welfare Agencies 259 children and their families. Although Head Start itself was once a dem- onstration, it has moved out of the demonstration category and has become a large operating program. Today, Head Start supports dem- onstration and evaluation activities geared to strengthening it as a na- tional program. Head Start supports a large program of evaluation designed to strengthen the Head Start Program. Head Start evaluations assess both the general effects and the efficiency of its programs and services. The Home Start program was evaluated during fiscal 1975. Head Start demonstration programs have two goals: (1) finding ways to improve local Head Start performance in the areas of health and nutrition services, parent involvement, services to handicapped chil- dren, and basic program management; and (2) expanding the range of options available to local communities for designing and organizing the delivery of child development services. Examples of such demonstra- tions are listed below. Developing New Approaches for Providing Head Start Services to Handicapped Children This demonstration program is part of an overall Head Start improvement and innovation effort emphasizing individualized approaches to meeting the unique needs and the poten- tial of each child in the program. Projects selected to participate in the program will develop and test alternative approaches to more effective delivery of services to preschool handicapped children and their families. Home Start Experimental Program Home Start is a demonstration for disadvantaged preschool children and their families. It is a home- based program that demonstrates ways of providing Head Start-type comprehensive services to preschool-age children in their own homes. Home Start builds upon existing family strengths and assists parents in their role as the most important developmental influence in their chil- dren's lives. Child and Family Resource Programs (CFRP) This program broadens the Head Start focus from the preschool-age child to the entire family. The CFRP approach is to use a Head Start program as a base for developing a community-wide delivery system linking a vari- ety of programs and services to children and their families. The goal of the demonstration is adaptation of the program by local Head Start programs and other state and local agencies in many different com- munities. The CFRP program is thus a good example of a policy im- plementation demonstration. CHILD ABUSE AND NEGLECT This is the largest program area in OCD, part of a larger effort to improve the identification, treatment, and
260 SURVEY OF FEDERAL AGENCIES prevention of child abuse and neglect. OCD also serves as the lead federal agency in the Interdepartmental Committee on Child Abuse and Neglect. The program is carried out by the National Center on Child Abuse and Neglect. The center serves as a catalyst for identification and treatment programs of child abuse and neglect and supports a variety of activities. The center's research program is focused primarily on the causes of abuse and neglect in the context of the family. Research examines the legal bases for child protection. Examples of research include: o abuse and neglect among low-income families: a comparative study of adequate and inadequate child care; o identification and definition of factors causally associated with child abuse and neglect; o an exploratory study defining and classifying cases of child abuse; and o a controlled study of social, familial, individual, and interaction factors in child abuse. Research is also examining the relationship, if any, between drug and alcohol abuse and child abuse. Research is being supported to develop methods to assess the effectiveness of treatment services for child abuse and neglect. A large part of the child abuse and neglect program is devoted to funding demonstrations to test various methods of treating child abuse cases and combating child abuse. Thirty-five demonstration projects are now being funded to develop and improve services concerning child abuse. Twelve demonstration centers are testing a variety of direct service programs for the identification, prevention, and treat- ment of child abuse and neglect. These services include direct investi- gation of cases, provision of treatment, and referral and follow-up ser- vices. Centers also conduct public education and assist local agencies in establishing or improving child abuse programs. Eight demonstra- tion projects are providing direct services concerning child abuse to populations with special obstacles to service deliveryâsuch as mili- tary families, Native Americans, and isolated rural children and their families. Dissemination is another major aspect of the OCD'S child abuse pro- gram. The agency supports a National Clearinghouse for Child Neglect and Abuse, which systematically collects data and other information pertaining to the nature, incidence, and characteristics of child neglect and abuse. Periodic reports and analysis of data are published by the
HEW.- Welfare Agencies 261 clearinghouse for public and professional use in the planning of child abuse research and services. OCD also supports 16 resource centers across the nation. These cen- ters provide a range of supportive activities to providers of community services in an attempt to assist them in using resources more effec- tively. Technical assistance, a major method for dissemination, is pro- vided to state and local agencies to help them establish or improve child abuse programs. For Further Information See Research, Demonstration and Evaluation Studies, and Planning and Implementing Child Abuse and Neglect Service Programs: The Experience of Eleven Demonstration Projects, which are both publications of OCD, or write Administration for Children, Youth and Families, Research and Evaluation Division, Department of Health, Educa- tion, and Welfare, Room 5044, Donohoe Building, 400 Sixth Street, S.W., Washington, D.C. 20201. Office of Youth Development Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 434 434 469 469 903 1976 750 750 750 1977 750 350 1.100 1.100 The mission of the Office of Youth Development (OYD), which is now consolidated in the Administration for Children, Youth and Families, is to assist in the removal of barriers to the development of young people. To carry out that mission, the office works directly with youth-serving organizations and youth groups. The office serves as the federal gov- ernment's agent for youth activities, one of which in recent years has been the development and implementation of programs to help runa- way youths and their families. The office administers grants to states, localities, and nonprofit institutions to provide services to runaway youths. Research Research is supported in several areas. Secondary analyses of avail- able data and research studies are performed to identify emerging is-
262 SURVEY OF FEDERAL AGENCIES sues and problems facing young people. This analysis assists the office in determining both short- and long-term priorities. OYD also supports research that identifies and describes the major youth programs sup- ported by the private sector and analyzes both effective methods of achieving youth participation and the barriers to it. In addition, re- search is now supported to provide the knowledge needed to strengthen state and local service delivery to runaway youths. This area includes the study of aftercare treatment of runaway youths and alternative care for those unable to return home. Program Evaluation OYD supported an evaluation in fiscal 1977 to assess the effectiveness of various service programs for runaway youths. For Further Information Write Administration for Children, Youth and Families, Department of Health, Educa- tion, and Welfare, Room 5030. Donohoe Building, 400 Sixth Street, S.W.. Washington. D.C. 20201. ADMINISTRATION FOR HANDICAPPED INDIVIDUALS In the July 1977 reorganization of the Office of Human Development, the Administration for Handicapped Individuals was created. The new administration will be responsible for all OHDS activities targeted to- ward handicapped persons. The goal of the reorganization is to reduce fragmentation in order to focus on the needs of handicapped persons. Table 11-4 presents the major agencies consolidated within the new TABLE 11-4 Administration for Handicapped Individuals (fiscal 1977, Smillions) Social Knowledge Production and Application Agency Obligations Rehabilitation Services Administration 11.8 Development Disabilities Office 2.7 TOTAL 14.5
HEW: Welfare Agencies 263 administration and their fiscal 1977 social knowledge production and application obligations. For Further Information Write Administration for Handicapped Individuals, Office of Human Development Ser- vices, Department of Health, Education, and Welfare, Room 30006, HEW South, Washington, D.C. 20201. Rehabilitation Services Administration Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 6.240 2.017 8it 9.075 299 343 770 1.412 10.487 1976 6.784 2.428 81I 10.023 2M 472 909 1.669 11.692 1977 6.715 1.560 1.725 10.000 100 828 1.440 1.788 11.788 The major activity of the Rehabilitation Services Administration (RSA), which is now incorporated in the Administration for Handicapped In- dividuals, is providing support to state programs of vocational rehabili- tation. RSA works with state rehabilitation agencies and other private and voluntary agencies to provide services for handicapped people to assist them in finding employment. RSA also provides leadership in the planning, coordination, and development of service programs for the handicapped. Research Approximately one-third of RSA'S research is social. The remainder of the agency's research is concerned with medical rehabilitation. RSA is also concerned with the use and development of new technologies to meet the needs of the severely handicapped. (The support of medical research and technological developments has been excluded from the survey.) The agency's social research is concentrated in the following areas: UNIVERSE OF NEEDS This area seeks to determine the number of dis- abled individuals in the population served and to ascertain their needs.
264 SURVEY OF FEDERAL AGENCIES REHABILITATION SERVICES This area is concerned with the provision of services to the disabled. Studies focus on the psychosocial adjust- ments of disabled individuals and their employment opportunites. Studies focus on job development, barrier removal, and community alternatives to institutionalization. MANAGEMENT OF VOCATIONAL REHABILITATION SYSTEM Management research is concerned with the delivery of state and private rehabilita- tion services. Research is under way to improve management in con- sumer involvement, program planning, decision making, and program control. Policy Formulation Demonstrations These demonstrations seek to emphasize different rehabilitation ap- proaches for the severely disabled. One project used rehabilitated per- sons in a role-model capacity to stimulate others who are undergoing rehabilitation. Other projects have explored the use of cable television for the instruction of homebound persons and comprehensive service delivery approaches to severely disabled populations. New service de- livery methods have been tested in state vocational rehabilitation agen- cies. Dissemination RSA places much emphasis on bringing into practice the knowledge and methods derived from its research and demonstration project. The agency has funded research utilization laboratories to package and disseminate information. Other dissemination activities include: fund- ing of research utilization specialists in state vocational rehabilitation agencies; dissemination of numerous audiovisual materials; abstract- ing, indexing, and systematically distributing research reports and briefing materials; and the planning of a national rehabilitation informa- tion center. Program Evaluation The program evaluation activities of RSA have two goals: to provide a systematic approach for studying the impact, effectiveness, and effi- ciency of state agency operations; and to develop information for the purpose of policy planning and program management. RSA has evalu- ated its management information and utilization systems as well as other aspects of the federal vocational rehabilitation program.
HEW: Welfare Agencies 265 For Further Information Write Rehabilitation Services Administration, Department of Health. Education, and Welfare, 330 C Street, S.W., Washington D.C. 20201. Office for Developmental Disabilities Social Knowledge Production and Application Obligalions (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 942 304 76 I.322 1.322 1976 1.975 KB 679 3.457 100 100 3.557 1977 1.680 450 536 2.666 100 100 2.766 The Office for Developmental Disabilities, which is now incorporated into the Administration for Handicapped Individuals, is concerned with those who have developmental disabilities, such as mental retar- dation and cerebral palsy, that originate in childhood, continue indefi- nitely, and constitute a substantial handicap. The office has three basic purposes: o to improve the planning capacity at state and local levels to use effectively the resources currently available to the developmentally disabled; o to serve as a catalyst to stimulate expansion of services for devel- opmentally disabled persons at the state and local level; and o to establish an integrated network within which services at the state and local level will be coordinated. Research The office conducts research in several areas. It collects and analyzes nationwide data on trends in the quality, extent, and scope of services provided to the developmentally disabled. Individuals in various states receiving services were tracked on a longitudinal basis to assess their individual progress and the effectiveness of services provided. Cost- benefit studies, research on the legal rights of the handicapped, and a National Center for Law and the Handicapped are supported. Re- search is conducted on community alternatives and institutional reform related to the treatment of the developmentally disabled.
266 SURVEY OF FEDERAL AGENCIES Policy Formulation Demonstrations These demonstrations are geared to testing alternative service delivery mechanisms for the developmentally disabled. Client advocacy pro- grams have been tested in some localities. Program Evaluation Evaluations are funded to assess the services currently being provided to developmentally disabled persons. An evaluation is being made to examine the standards and quality assurance mechanisms applicable to residential facilities and community agencies. For Further Information Write Office for Developmental Disabilities, Department of Health, Education, and Wel- fare, 330 C Street, S.W., Washington. D.C. 20201. ADMINISTRATION FOR NATIVE AMERICANS Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- man of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1977 1.000 1.000 1.000 Administration for Native Americans, which was formerly the Office of Native American Programs, provides a departmental focus for the special concerns of American Indians, Alaskan Natives, and Native Hawaiians. The administration is responsible for providing policy guidance to the secretary, administering grant programs to eligible In- dian groups, and providing liaison with other federal agencies in Indian affairs. Grants are provided to strengthen the capability of Native American organizations, support community services, and encourage community development. Research A research plan was developed by the administration during fiscal 1976. The plan was implemented in fiscal 1977 with research obliga- tions of $1 million. Research was funded on the following areas.
HEW: Welfare Agencies 267 COMMUNITY PLANNING AND MANAGEMENT RCSCaTCh prOJCCtS aTC CX- amining current planning and management activities of tribal govern- ments and are identifying deficiencies in the planning resources of Native American communities. SOCIAL AND ECONOMIC INFRASTRUCTURES OF NATIVE AMERICAN COM- MUNITIES Research is attempting to identify the variables that in- crease or maintain self-sufficiency and their relationship to other as- pects of community life. Empirical measures of self-determination and self-sufficiency are being developed. IDENTIFICATION AND ELIMINATION OF CRITICAL SERVICE GAPS Baseline information is being gathered on the extent of critical gaps in service concerning sustenance, health, education, law and order, and political participation. Alternative methods of filling those gaps are being analyzed. ANALYSIS OF TARGET POPULATION Research is geared to developing an adequate data base on the number of Native Americans. Research is being conducted on methods of reaching the target population and projections of the future growth patterns of target groups. For Further Information Write Administration for Native Americans, Office of Health, Education, and Welfare, 200 Independence Avenue, S.W., Washington, D.C. 20201. SOCIAL AND REHABILITATION SERVICE Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 5.073 1.608 1.667 8.348 1.393 57 1.450 9.798 1976 3.275 1.900 2.004 7.179 2.171 2.171 9.350 1977 2.725 2.000 2.500 7.225 2.175 2.175 9.400 Until 1977, the Social and Rehabilitation Service (SRS) administered grants to states for the federal share of the following state expenditure programs: income assistance (Aid to Families with Dependent Children
268 SURVEY OF FEDERAL AGENCIES and assistance to the aged, blind, and disabled), medical assistance (Medicaid), social services, state and local training, and child welfare services. In addition to financially assisting states to provide medical, monetary, and social services to eligible Americans, the agency also attempted to ensure the best use of tax dollars by keeping those ser- vices as effective and economical as possible. In the reorganization of HEW that took place in March 1977, the responsibilities of SRS were transferred to other agencies within HEW. The Social Security Administration took over the income assistance programs. A new agency, the Health Care Financing Administration, is now responsible for the Medicaid program. The Office of Human De- velopment Services now administers the social service and child wel- fare service programs previously administered by SRS. The research, evaluation, and demonstration activities pertaining to these programs were also dispersed to each appropriate agency. Research and Evaluation The research and evaluation activities in SRS were heavily intertwined. Although obligations were divided between the two activities, they will be discussed jointly. The research and evaluation activities of SRS had two major purposes: to develop the analytical methodologies, program data, and the programmatic knowledge needed to evaluate and imple- ment major policy and program options; and to develop the methodological and technological knowledge necessary to improve both federal, state, and local administration and local delivery of ser- vices. Research and evaluation were performed for social services, health services, income maintenance, and social security. SOCIAL SERVICES For social services, a prime responsibility of SRS was monitoring and evaluating Title XX of the Social Service Amendments of 1974. The legislation required SRS to evaluate the effectiveness of the program, make recommendations to Congress for program im- provements, and examine the appropriateness of existing day care standards. Title XX constitutes a special revenue-sharing approach to those social services previously financed under the public assistance provision of the Social Security Act. A first step in evaluating Title XX was the development of a micro-data reporting system of a sample of social service recipients. These data provide the basis, in conjunction with comparison groups, for evaluating the effectiveness of the pro- gram. Evaluation of Title XX will answer such questions as: whether Title XX services are instrumental in achieving recipient outcomes.
HEW: Welfare Agencies 269 e.g., do Title XX recipients of employment services get and retain more jobs and receive better pay than comparable individuals who do not receive such services? Do Title XX recipients with chronic health care problems who receive services have a better chance of avoiding institutionalization than comparable individuals not receiving such services? Other Title XX activities focus on evaluating state social service planning processes, citizen input into the planning process, and improved social service program management. Responsibility for Title XX now resides in the Administration for Public Services, which has a research and evaluation arm. HEALTH SERVICES In the area of health services, SRS research and evaluation projects included examining claims processing procedures in eight states to reveal opportunities for the improvement of controls over erroneous expenditures; developing corrective action programs designed to reduce eligibility and payment errors in the Medicaid pro- gram; developing a hospital cost model that describes the interrelation- ships between supply and demand for hospital beds and other cost factors; and an analysis of the new "reasonable cost reimbursement" policy. INcoME MAINTENANCE A variety of activities concerned with income maintenance was supported by SRS. A series of projects on the devel- opment of state forecasting capability, a micro-simulation model of the Aid to Families with Dependent Children program, and an analysis of caseload and cost dynamics were completed. Another study examined the effect of "income disregard" policies. Increased emphasis was placed on management studies of public assistance programsâ effective organization, staffing, needed management control, optimal technology, impact of multiple program administration, etc. As part of these efforts, studies were funded on the capability of states to detect fraud and abuse in assistance programs. SOCIAL SECURITY Finally, research primarily concerned with social security was funded. Examples included the use of health and rehabili- tation services by recipients and the cost-effectiveness of such services in relation to employability. Policy Formulation Demonstrations Another major responsibility of SRS was testing alternative methods of service delivery. A large policy formulation demonstration is the Early
270 SURVEY OF FEDERAL AGENCIES and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, which aims to demonstrate and assess the cost-effectiveness of alterna- tive methods and settings to ensure accessibility and effective use of EPSDT services at the state and local level. Other policy formulation demonstrations have tested monthly reporting systems; alternative payment systems; community-wide, long-term care models; and a so- cial service voucher system. Policy Implementation Demonstrations These projects are geared to give high visibility to innovative projects in the hope that they will be adopted by others. Examples include the Brockton Multi Service Center, which was funded to bring into full operation a viable, documented, operating model of a comprehensive, local-level human service planning and delivery system. Another proj- ect was funded as a model of a comprehensive management system for the purchase of services at the state level. SOCIAL SECURITY ADMINISTRATION Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 16.761 5.839 22.600 485 485 23 .085 1976 15.650 9.350 25.000 702 702 25.702 1977 17.650 9.350 27.000 653 653 27.653 Prior to 1977, the Social Security Administration administered three major programs: Social Security (Old Age, Disability, and Survivors Insurance), Medicare, and the Supplemental Security Income Pro- gram. The original Social Security Act of 1935 gave the agency continu- ing responsibility for research related to the problems of income secu- rity. The agency has built a strong in-house research capability, and today over two-thirds of its research is conducted intramurally by the Office of Research and Statistics. Throughout the history of the social security system, research has been an important element contributing to agency policy making and program administration. The 1977 reorganization of HEW transferred responsibility for the Medicare program from the Social Security Administration to the
HEW: Welfare Agencies 271 Health Care Financing Administration. The following research areas were transferred: Current Medicare Survey, Health Insurance and Re- lated Research, and the National Health Insurance Model. The health policy formulation demonstrations were also transferred to the Health Care Financing Administration. Research A large portion of the agency's research involves the collection and analysis of statistical data. The Study Project decided that it is more appropriate to classify the agency's activities as research than as gen- eral purpose statistics, even though statistics are collected by the agency. The Social Security Administration supports research in the following areas (fiscal 1977 obligations are presented in parentheses). ECONOMIC AND LONG-RANGE STUDIES ($2. 3 million) This activity fo- cuses on long-range research designed to project and interpret chang- ing demographic, economic, and social trends as they relate to eco- nomic and social policy. This research includes social security financ- ing, the economic effects of social security, the relationships of social security to private income maintenance programs, and the develop- ment of aggregate measures such as social welfare expenditures, eco- nomic projections, and labor market studies. A major activity is the development of an econometric model of the social security sector. RETIREMENT HISTORY STUDY ($1.2 million) This is & 10-year longi- tudinal study designed to provide insight into the dynamics of the retirement process. The data it produces will provide information on actual changes in the lives of workers as a consequence of retirement and aging, contrasted with changes inferable from cross-sectional studies. CROSS-SECTION RETIREMENT AND SURVIVORS STUDIES ($0.4 million) Cross-sectional surveys of the socioeconomic status of selected popu- lation groups are undertaken recurrently to provide the basis for ap- praising the adequacy of the social security program. OTHER RETIREMENT AND SURVIVOR STUDIES ($1.0 million) This gram examines the composition of social security beneficiary rolls in order to evaluate the effectiveness of the program in providing eco- nomic security to certain sectors of society. Research analyzes em- ployment and earning patterns of women and assesses the effects of
272 SURVEY OF FEDERAL AGENCIES work history on the benefit rights of recently retired women. Analysis is undertaken to yield insights into the role of social security benefits for blacks and other minority groups that have been disadvantaged by social and economic conditions or racial discrimination. CURRENT MEDICARE SURVEY ($2.0 million) The current Medicare sur- vey is a monthly survey of aged and disabled beneficiaries that pro- vides current estimates on medical care services used and charges incurred by persons covered under the program. The Current Medicare Survey is the only source of information on the number and kind of physicians' services used by Medicare beneficiaries. HEALTH INSURANCE PROGRAM STATISTICS ($2.3 million) AS 3 b uct of the claims review and payment process. Medicare program data are used to answer questions related to the Medicare system: how much money is being spent, how many people are being serviced, what kind of services are being used and to what extent. Routing and special reports are issued on charges, use, geographic variations, and other health sector information. HEALTH INSURANCE AND RELATED RESEARCH ($1.9 million) The health insurance research program has primary responsibility for the con- tinuing review of the existing Medicare program, the extent to which it meets medical care needs, and its effect on medical prices and on the health care industry, including the interaction of public and private programs. Among areas of particular concern are: health care provider cost analysis and cost monitoring; evaluation of utilization review and control; and drug studies, including research on the drug prices and market data. DISABILITY SURVEYS ($0.4 million) The purpose of disability surveys is to examine the economic, medical, and social consequences of limi- tations on work activity of the disabled person and his or her family, including eligibility for public income maintenance programs. OTHER DISABILITY RESEARCH ($1.2 million) This program compiles and analyzes the data collected through the operation of the disability insurance program. The characteristics of workers awarded and denied benefits, the subsequent experience of denied applicants and be- neficiaries terminated because of return to work, trends in the disabil- ity population, effects of alternative eligibility requirements or defini- tions of disability, and related questions are examined. Longitudinal
HEW: Welfare Agencies 273 studies provide information on the duration of disability and sub- sequent employment and benefit experience. OASDI PROGRAM ST ATI sTi cs ($2.0 million) Statistics derived from the Old Age and Survivors Disability Insurance programs are analyzed. These statistics provide employment and earning records (in particular, the continuous work history sample), which are used alone or in con- junction with survey data to study the earnings history of selected groups. From the continuous work history sample, a 10-year longitudi- nal employee data base has been developed. SUPPLEMENTAL SECURITY INCOME (SSl) STUDIES ($2.0 million) studies are being undertaken to evaluate the effective- ness of supplemental security income benefits in providing economic security for aged, blind, and disabled persons with incomes below specific levels. A survey of low-income aged and disabled persons will identify and describe the ssi target population prior to the program's formal enactment and assess the subsequent income and social effect of ssi on the original target population. NATIONAL HEALTH INSURANCE MODEL($0.5 million) A model IlllS K'lMl developed to estimate national health insurance costs and distrib- utive effects. Included in the analysis are such areas as: the demand for medical services, including estimates of price and income elas- ticities for different types of medical care services; pricing behavioral responses of medical care providers, including physicians and hospi- tals; and the effects of costs of private-public coverage. New models are being developed to explain the interactions between the supply of health care services, consumer demand for the services, and govern- ment regulatory action. Policy Formulation Demonstrations The Social Security Amendments of 1972 authorized the Social Secu- rity Administration to conduct experiments on alternative methods of health care reimbursements. Experiments are being conducted in the following six areas. PROSPECTIVE REIMBURSEMENT STUDIES TllC ObjCCt Of these CXpCri- ments is to determine the relative advantages and disadvantages of various methods of setting rates on a prospective basis under existing laws.
274 SURVEY OF FEDERAL AGENCIES ALTERNATIVE PHYSICIAN PAYMENT ARRANGEMENTS TllCSC CXperi- ments concern patterns of physicians' practices, consideration in set- ting their fees and billing for services, and method of payment for physicians' services by third-party payers and beneficiaries. PHYSICIAN EXTENDER REIMBURSEMENT The goals of these CXperi- ments are to determine under what circumstances Medicare, Medicaid, and other federal health insurance programs should reimburse for physician extenders and the most appropriate, equitable, and noninflationary methods and amounts of that reimbursement. AMBULATORY SURGERY The purpose of these experiments is to deter- mine whether provision of services provided by ambulatory facilities, which are not presently Medicare-qualified providers, results in more economical and more effective use of services. DURABLE MEDICAL EQUIPMENT These experiments are designed to study whether unreasonable expenses result from prolonged rentals of durable medical equipment. INCENTIVES REIMBURSEMENT These experiments assess the impact of experimental programs on the health care system in general and Medi- care programs in particular. Experimental programs have been ad- dressed to improving hospital efficiency by offering incentive pay- ments for "savings earned" as a result of budget review, industrial engineering, etc. LONG-TERM CARE REIMBURSEMENT These experiments will assess whether a nursing home reimbursement rate system will be able to ensure that quality is maintained and upgraded if currently deficient. For Further Information See Work Plan. FY1977 and 1978 and the Social Security Bulletin (monthly publication) which are both publications of the Social Security Administration. To obtain the Work Plan or other information on the SSA. write Social Security Administration. Office of Research and Statistics. Department of Health. Education, and Welfare. Room 1121. Universal Building North, 1875 Connecticut Avenue, N.W.. Washington, D.C. 20009. For information on the health research and demonstrations formerly sponsored by the Office of Research and Statistics, write Office of Policy, Planning and Research, Health Care Financing Administration. Department of Health. Education, and Welfare. Room 5082. HEW South, 330 C Street, S.W.. Washington, D.C. 20201.
