Health-Care Utilization as a Proxy in
Disability Determination
Committee on Health Care Utilization and Adults with Disabilities
Board on Health Care Services
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and the Social Security Administration (Contract SS00-13-60048, Task Order 8). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-46918-0
International Standard Book Number-10: 0-309-46918-X
Digital Object Identifier: https://doi.org/10.17226/24969
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Health-care utilization as a proxy in disability determination. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24969.
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COMMITTEE ON HEALTH CARE UTILIZATION AND ADULTS WITH DISABILITIES
DAN G. BLAZER (Chair), J.P. Gibbons Professor of Psychiatry Emeritus, Duke University Medical Center
JEFF BAZARIAN, Professor of Emergency Medicine, University of Rochester
JENNIFER BOGNER, Professor, Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center
ANNETTE L. FITZPATRICK, Research Professor and Associate Dean for Academic Services, University of Washington School of Public Health
TRACIE C. HARRISON, Professor and Director, Center for Excellence in Long Term Care, School of Nursing, The University of Texas at Austin
PHILIP D. HARVEY, Leonard M. Miller Professor of Psychiatry, University of Miami Miller School of Medicine
MIGUEL HERNAN, Kolokotrones Professor of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University
RENEE Y. HSIA, Professor and Director of Health Policy Studies, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
NICOLE MAESTAS, Associate Professor of Health Care Policy, Harvard Medical School
JUDITH MCKENZIE, Professor and Division Chief, Division of Occupational Medicine, University of Pennsylvania
KATHLEEN J. MULLEN, Senior Economist and Director, RAND Center for Disability Research, RAND Corporation
LINDA ANH NGUYEN, Clinical Associate Professor of Medicine, Director, Gastrointestinal Motility and Neurogastroenterology, Stanford Medical Center
ALBERT J. OSBAHR III, Medical Director, Corporate Health Services, Spartanburg Regional Healthcare System
KEVIN A. SCHULMAN, Professor of Medicine, Duke University
SETH SEABURY, Director, Keck-Schaeffer Initiative for Population Health, University of Southern California
DONALD H. TAYLOR, JR., Professor, Sanford School of Public Policy, Duke University
Consultants to the Committee
AMY BERNSTEIN, Independent Consultant
NORMAN GROSSBLATT, Editor
NANETTE K. WENGER, Professor of Medicine (Cardiology) Emeritus, Emory University School of Medicine
Study Staff
CAROLYN FULCO, Scholar
BERNICE CHU, Associate Program Officer
JOSEPH GOODMAN, Senior Program Assistant
SHARYL NASS, Director, Board on Health Care Services
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Reviewers
This consensus study report was reviewed in draft form by persons chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets institutional standards of quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following for their review of this report:
ANDREA L. CHEVILLE, Mayo Clinic
NICOLAAS E. DEUTZ, Texas A&M University
JOHN H. EXTON, Vanderbilt University School of Medicine
JODY SCHIMMEL HYDE, Mathematica Policy Research
ELLEN R. MEARA, The Dartmouth Institute for Health Policy & Clinical Practice
VINCENT MOR, Brown University
SHARON-LISE T. NORMAND, Harvard Medical School
HAROLD POLLACK, The University of Chicago
MICHELLE PUTNAM, Simmons College
CAROL A. ROMANO, Uniformed Services University of the Health Sciences
GEORGE TRIADAFILOPOULOS, Stanford University
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of the report was overseen by ELAINE L. LARSON, Columbia University, and KENNETH I. SHINE, Dell Medical School of The University of Texas. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
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Contents
The Social Security Disability Insurance Program
The Social Security Disability Determination Process
Trends in Health-Care Utilization
2 FACTORS THAT AFFECT HEALTH-CARE UTILIZATION
Differences in Health-Care Utilization Associated with Selected Characteristics
3 CHANGING PATTERNS OF HEALTH INSURANCE AND HEALTH-CARE DELIVERY
Health Insurance in the United States
The Health-Care Delivery System Before the Patient Protection and Affordable Care Act
How the Patient Protection and Affordable Care Act Changed the Health-Care Delivery System
Effect of the Patient Protection and Affordable Care Act on Health-Care Utilization
Effect of the Patient Protection and Affordable Care Act on People with Disabilities
4 HEALTH-CARE UTILIZATIONS AS PROXIES FOR LISTING-LEVEL SEVERITY
Congenital Disorders That Affect Multiple Body Systems
How Health-Care Utilizations Interfere with the Ability to Work
5 PROXIES FOR DETERMINING LISTING-LEVEL SEVERITY
Health-Care Utilizations for Constructing Classifiers of Listing-Level Severity
Characteristics of Classifiers
Tradeoffs in the Classification of Listing-Level Severity
Choice of Classifier as a Value Judgment
Acronyms and Abbreviations
| ACA | Patient Protection and Affordable Care Act |
| ADA | Americans with Disabilities Act of 1990 |
| ADL | activity of daily living |
| AF | atrial fibrillation |
| AHRQ | Agency for Healthcare Research and Quality |
| AMA | American Medical Association |
| ANPRM | Advance Notice of Proposed Rulemaking |
| APCD | All-Payer Claims Databases |
| ARRA | American Recovery and Reinvestment Act |
| ASL | American Sign Language |
| BMI | body mass index |
| BNP | brain natriuretic peptide |
| CDC | Centers for Disease Control and Prevention |
| CFR | Code of Federal Regulations |
| CHD | coronary heart disease |
| CHF | congestive heart failure |
| CKD | chronic kidney disease |
| CMS | Centers for Medicare & Medicaid Services |
| COBRA | Consolidated Omnibus Budget Reconciliation Act of 1985 |
| COPD | chronic obstructive pulmonary disease |
| CVD | cardiovascular disease |
| DOD | US Department of Defense |
| EAP | Employee Assistance Program |
| ED | emergency department |
| EDSS | Expanded Disability Status Scale |
| EMR | electronic medical record |
| EMS | emergency medical services |
| EMTALA | Emergency Medical Treatment and Labor Act |
| FEV | Forced Expiratory Volume |
| FIM | functional independence measure |
| FMLA | Family and Medical Leave Act of 1993 |
| FY | fiscal year |
| GCS | Glasgow Coma Scale |
| GERD | gastroesophageal reflux disease |
| GI | gastrointestinal |
| HCBS | home- and community-based services |
| HCUP | Healthcare Cost and Utilization Project |
| HDHP | high deductible health plan |
| HF | heart failure |
| HHS | US Department of Health and Human Services |
| HITECH | Health Information Technology for Economic and Clinical Health Act |
| HSA | health savings account |
| IBD | inflammatory bowel disease |
| ICD | International Classification of Diseases |
| IHD | ischemic heart disease |
| IHS | Indian Health Service |
| IOM | Institute of Medicine |
| KCCQ | Kansas City Cardiomyopathy Questionnaire |
| KFF | Kaiser Family Foundation |
| Listings | Social Security Listing of Impairments |
| LTSS | long-term services and supports |
| MEPS | Medical Expenditure Panel Survey |
| MeSH | Medical Subject Headings |
| MI | myocardial infarction |
| NAWHC | National Association of Worksite Health Centers |
| NCHS | National Center for Health Statistics |
| NCQA | National Committee for Quality Assurance |
| NEDS | Nationwide Emergency Department Sample |
| NETT | Neurological Emergencies Treatment Trials |
| NHIS | National Health Interview Survey |
| NIS | National Inpatient Sample |
| NPRM | Notice of Proposed Rulemaking |
| NRD | Nationwide Readmissions Database |
| OIG | Office of the Inspector General |
| OMB | Office of Management and Budget |
| PCMH | patient-centered medical home |
| PCP | primary care provider |
| PM&R | physical medicine and rehabilitation |
| PMADL | Performance Measure for Activity of Daily Living |
| POS | point of service |
| PPO | preferred provider organization |
| QDR | National Healthcare Quality and Disparities Report |
| QOL | quality of life |
| SASD | State Ambulatory Surgery and Services Databases |
| SCD | sequential compression device |
| SEDD | State Emergency Department Database |
| SEER | Surveillance, Epidemiology, and End Results |
| SES | socioeconomic status |
| SGA | substantial gainful activity |
| SID | state inpatient database |
| SLE | systemic lupus erythematosus |
| SNF | skilled nursing facility |
| SOT | statement of task |
| SSA | Social Security Administration |
| SSDI | Social Security Disability Insurance |
| SSI | Supplemental Security Income |
| TAVR | transcatheter aortic valve replacement |
| TBI | traumatic brain injury |
| TBSA | total body surface area |
| USCB | US Census Bureau |
| VA | US Department of Veterans Affairs |
| VHD | valvular heart disease |
| VTE | venous thromboembolism |
| WC | workers’ compensation |
