The Aging Population in the Twenty-First Century Statistics for Health Policy (1988) / Chapter Skim
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10 Enhancing the Utility of Statistical Systems
10 Enhancing the Utility of Statistical Systems
Pages 202-235
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From page 202... ...
This small amount of duplication is intended to help individuals concerned with improving data resources for a specific policy area, e.g., long-term care, since it might not otherwise be clear that a general recommendation would be important and relevant to a specific policy area. The first section discusses issues pertaining to national data.
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From page 203... ...
The role of administrative records in policy making and research is also considered, as is the importance of designing surveys and administrative record systems in a manner that permits linkage between data systems. The second section recognizes the importance of states both as sources and users of federal statistics and identifies several actions that could increase the value of federal statistics for use by states.
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From page 204... ...
Responsibilities for the collection, processing, analysis, and dissemination of statistics are shared among program and statistical agencies. In the Department of Health and Human Services, for example, the National Center for Health Statistics is a major federal statistical agency, but several program agencies such as the Social Security Administration and the Health Care Financing Administration have large statistical program based on administrative records,
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From page 205... ...
There are costs resulting from this decentralized structure related to ensuring the development of a comprehensive, nonduplicative, accurate, efficient, and accessible body of statistical information for the analysis of social, economic, and environmental issues. Problems in the data system are particularly likely to arise either when agencies share substantive responsibilities or when no single agency can be clearly identified as the most logical one to assume a responsibility.
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From page 206... ...
Legislative Authority for Statistical Policy Office of Management and Budget Since 1981, the legislative authority for the coordination and oversight of federal statistical programs has stemmed from The Paperwork Reduction Act of 1980 (44 U.S.C. S.3501-3520, in particular S.3504 (ad.
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From page 207... ...
Congress recently passed The Paperwork Reduction Reauthorization Act of 1986, providing funding for OIRA for fiscal years 1987-1989 and amending the original act to correct problems surfaced during oversight hearings conducted by the House Committee on Government Operations and the Senate Committee on Governmental Affairs. A new requirement of the 1986 act with respect to the statistical policy and coordination functions is that the director of OMB include in an annual report to Congress (Council of Professional Associations on Federal Statistics, 1986:2~: (A)
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From page 208... ...
A`l~ninistration on Aging A more specific legislative mandate for coordinating fecleral statistical programs specifically on the elclerly population is in the Older Americans Act of 1965, as amencleci, which assigns to the Aciministration on Aging (AOA) the responsibility to "gather statistics in the fielc]
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From page 209... ...
The purpose of the summit was to determine how the federal statistical system can provide the data needed to answer policy questions for an aging society in a cost-efficient manner. Participating agency directors prepared statements of their views on the vital issues regarding the elderly and agreed to establish an Interagency Forum on Aging-Related Statistics to encourage cooperation among the federal agencies in developing data on the older population (see Chapter 1 for more discussion of the forum)
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From page 210... ...
commends the initiative taken by the NIA and the Census Bureau that led to the establishment of the Forum on Aging-Related Statistics it is an import ant first step to improving interagency coordination of statistical programs related to aging an activity that should be institutionalized. Recommendation 10.1: The pane!
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From page 211... ...
However, it should be clear that there are several areas in which the absence of coordination has direct effects that increase the inefficiencies of statistical programs. Failures of coordination, planning, and setting priorities lead to duplication of efforts, lesser sharing of data bases that might otherwise be of interagency use, unmet data needs, and inappropriate design of data bases for a broad array of data users.
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From page 212... ...
In this decentralized environment, there are at least six issues of coordination and planning related to statistical surveys and administrative data on the elderly population that need to be addressed In an interagency context and by parties with the ability to influence the outcome of contested deliberations. The discussion of these issues here is limited to their relationships to statistical surveys; a subsequent section of the chapter discusses issues pertaining to administrative records.
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From page 213... ...
Table 10.1 shows the projected sharp increase in the total elderly population and the substantial increases among the very old over the period 1980 to 2010. Surveys designed in the 1980s for a sample of the entire population may include too small a number of the age group 65 and over to answer many questions for detailed age subgroups of this population.
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From page 214... ...
Uniform Definitions, Concepts, and CIassificatione Surveys (and administrative record systems) that collect related information do not always do so using the same definitions and concepts, even though doing so would increase the usefulness of each of the information sources involved.
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From page 215... ...
Although a data-producing agency may allocate limited resources by reducing the periodicity of a survey, this may have severe consequences for policy analysts. A recent example of this was the National Nursing Home Survey, which had originally been planned to be conducted every three years; eight years lapsed between the last two such surveys.
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From page 216... ...
The periodicity should be established with due consideration of seasonality, secular trends, the frequency of changes in policy, the importance of the issues addressed in public policy, and the timing of related data collections. Data Access Although data producers in the federal government have placed greater attention in recent years on producing public use tapes and providing greater access to data, more attention still needs to be paid to this area.
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From page 217... ...
Not only should access be provided to files created for the purpose of providing statistical information, but it should also be Improved for statistical files created from adrn~nistrative record systems. Recommendation 10.4: The pane!
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From page 218... ...
The Bureau of the Census and the National Center for Health Statistics are the only statistical agencies that now have a statutory basis to ensure the confidentiality of their records. Although other agencies, such as the Bureau of Labor Statistics, have no statutory basis to guarantee the confidentiality of their data collections, they do so on their own, and because of their effectiveness in honoring that guarantee they have obtained a high level of voluntary reporting.
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From page 219... ...
A~ninistrative Records There are two major sources for developing information on the elderly surveys of individuals that have the capacity for including characteristics on a personal basis such as health status or demographic characteristics and administrative records that have information relative to an individual's participation in a government program in conjunction with certain characteristics of the individual. Surveys are based on well defined sampling frames and are generalizable to well-defined population groups, whereas administrative records provide information only for individuals using a service or selected into a program.
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From page 220... ...
The statistical agencies, to secure their own data collections, must take special care in how they handle these records and how they share data with program agencies. Recommendation 10.6: The pane} recommends that greater use be made of administrative records as a source of statisti cal information on the elderly.
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From page 221... ...
The process draws on the strengths of administrative records when they are turned to as a source of possibly more accurate data than could be obtained in an interview setting. Linkage of administrative data with survey data can also enrich the administrative data system.
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From page 222... ...
We have singled out the last survey for discussion since it has the potential for providing longitudinal data on the health of the elderly and for relating health to income. Surrey of Income and Program Participation The Survey of Income and Program Participation, first administered in October 1983, is a nationally representative household survey that provides detailed longitudinal information on income, living arrangements, disability, assets and liabilities, government transfer program eligibility and participation, pension coverage, taxes, and many other characteristics of individuals.
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From page 223... ...
The Bureau is exploring the possibility of matching administrative records from the Social Security Administration with the SIPP records to provide additional information on the elderly. Records
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From page 224... ...
programs is increasingly undertaken through the allocation of resources by state governments to targeted populations identified through county and other substate units. For example, through the Older Americans Act, state governments receive federal funds in support of a broad range of nutrition and social services.
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From page 225... ...
Vital Statistics and Data on Mortality Vital statistics representing data on births, deaths, marriages, divorces, and other demographic indicators, constitute a critical national resource, yet represent primarily a data collection activity on the part of state governments. As part of the Vital Statistics Cooperative Program, states collect their vital statistics data and subsequently make them part of the national data system through contracts with the National Center on Health Statistics.
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From page 226... ...
A number of federal agency surveys include specific measures of health and disability, yet most such surveys provide only national estimates or state estimates without statistical detail at the substate level. By contrast, health policy planning and scientific analyses undertaken for an aging society require detailed age and age-sex distributions of disability.
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From page 227... ...
It is imperative that the major statistical agencies of the federal government, not just the specialized age-related or health-related agencies, routinely report detailed age data beyond age 65, so that the requisite planning and analytic data sets will then become more broadly available. For purposes such as assessing the potential impact of changes in the age for eligibility for Medicare or Social Security, distributions by single year of age are needed.
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From page 228... ...
A complementary source of age-detailed substate data is reflected in another existing data dissemination model: the County and City Data Book represents an especially rich collection of substate data that has been produced in printed form by the Census Bureau for many years. Its value is enhanced by the fact that it includes, in addition to population census data: a selection of vital statistics; housing data; education and crime statistics; data on poverty, employment, and unemployment; statistics on doctors, nurses, dentists, hospitals, and nursing homes; and substate information on Social Security and Medicare, including dollars distributed and persons involved.
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From page 229... ...
Timely Substate Data Health planners in state, county, and local areas require information on the size and distribution of the elderly population in order to budget for community health services, hospital beds, nursing homes, and other related services. Decennial figures from the Census of Population and Housing are soon outdated.
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From page 230... ...
Despite the fact that these nutrition and social service programs reflect their state en c] local implementations, the statistical data that describe the programs represent important national data, since nutrition and social programs are significant factors in maintaining the health and independence of the older population.
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From page 231... ...
Private Data Bases Very few private data bases in the health area are publicly available, and there is no central repository enumerating all private data bases. Data bases are therefore examined for the industries considered most pertinent to health policy for an aging population, namely hospitals, nursing homes, HMOs, hospices, private insurance companies, and professional associations.
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From page 232... ...
The AHCA plans to expand its data collection efforts to include services utilization and opinions on current issues and has indicated that the data could be made available within the applicable strictures of confidentiality. Health Maintenance Organization Data A different arena, one that has undergone substantial growth and change, is the health maintenance organization industry.
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From page 233... ...
Commercial Health Insurance Data The Health Insurance Association of America, whose membership represents 95 percent of the commercial health insurance busies ness, currently is involved in three major data collection efforts. The Survey of Hospital Semi-Private Room Charges is currently available to the public at reproduction cost.
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From page 234... ...
, and professional activities. The Socioeconomic Characteristics of Medical Practice file, published annually, contains information on the practice characteristics of a sample of active nonfederal office and hospital-based physicians drawn from the Masterfile, for example, patient care activities by specialty, professional expenses, fee schedules, and number of hours per week devoted to patient care.
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From page 235... ...
The AMA Masterfile identifies physicians speciaTizing in geriatrics; the ADA sample survey contains an item for age of patients; and the ANA specifies nursing home as a place of employment. Since the elderly use all types of services of physicians, dentists, and nurses, these files can provide information on the availability of professional services to the population of all ages, including the elderly, but not on the elderly as a group with special needs.
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