The nation's health care system has changed dramatically and the country is debating further significant changes. Comprehensive information is needed to guide policymakers in understanding and evaluating the current problems and in formulating federal health care policy. This book contains an evaluation of the plan developed by the National Center for Health Statistics for restructuring its existing provider surveys. It identifies current and future data needed by researchers and policymakers to assess the effect of changes in financing, organization, and delivery of health care on access, quality, costs, and outcomes of care and determines the extent to which the design and content of the proposed survey can meet these data needs. The book goes beyond a simple review and recommends a design framework to develop a coordinated and integrated data system to gather information about people and their illness over time and to link this information to costs and health care outcomes.
The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, "peer" countries. In light of the new and growing evidence about the U.S. health disadvantage, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study the issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries examined whether the U.S. health disadvantage exists across the life span, considered potential explanations, and assessed the larger implications of the findings. U.S. Health in International Perspective presents detailed evidence on the issue, explores the possible explanations for the shorter and less healthy lives of Americans than those of people in comparable countries, and recommends actions by both government and nongovernment agencies and organizations to address the U.S. health disadvantage.
The State Children's Health Insurance Program (SCHIP) was established by Congress to provide health insurance to uninsured children whose family income was too high for Medicaid coverage but too low to allow the family to obtain private health insurance coverage. The enabling legislation for SCHIP, included in the Balanced Budget Act of 1997, made available to states (and the District of Columbia) almost $40 billion over a 10-year period for this program. Like Medicaid, SCHIP is a joint federal-state program, with funding from both sources, but it is implemented by the states. Thus, there are SCHIP programs in all of the states and the District of Columbia. The National Research Council, through the Committee on National Statistics, was asked to explore some of the ways in which data analysis could be used to promote achievement of the SCHIP goal of expanding health insurance coverage for uninsured children from low-income families. To inform its work, the panel for this project held a workshop to bring together state SCHIP officials and researchers to share findings and methods that would inform the design, implementation, and evaluation of SCHIP at the state and national levels. In keeping with this charge, this report is limited to discussions at the workshop. It does not attempt to provide a summary of all the state programs nor a comprehensive review of the literature. Data Needs for the State Children's Health Insurance Program concludes that data are insufficient in the individual states to provide a clear picture of the impact of SCHIP on the number of children who are eligible for the program, the rate at which eligible children are enrolled in the program, and the rate at which they are retained in the program once enrolled. This situation is due, in part, to the fact that sample sizes in national surveys are too small to provide detailed data for individual states. In addition, the great amount of movement of children among health insurance categories-Medicaid, SCHIP, private insurance, or no insurance at all-makes it difficult for states to count the number of children in specific categories at a particular point in time. The panel specifies a number of practices that could be implemented to improve the overall functioning of SCHIP and the ability of policy makers to evaluate the program. Foremost among these are: (1) developing more uniform ways of estimating eligibility and health insurance coverage among the states; (2) sharing among the states effective methods for outreach; (3) taking qualitative information into account, in addition to quantitative information, in assessing variation among states in enrollment and disenrollment; and (4) implementing longitudinal studies to track the movement of children among the various insurance statuses.
The National Children's Study (NCS) is planned to be the largest long-term study of environmental and genetic effects on children's health ever conducted in the United States. It proposes to examine the effects of environmental influences on the health and development of approximately 100,000 children across the United States, following them from before birth until age 21. By archiving all of the data collected, the NCS is intended to provide a valuable resource for analyses conducted many years into the future. This book evaluates the research plan for the NCS, by assessing the scientific rigor of the study and the extent to which it is being carried out with methods, measures, and collection of data and specimens to maximize the scientific yield of the study. The book concludes that if the NCS is conducted as proposed, the database derived from the study should be valuable for investigating hypotheses described in the research plan as well as additional hypotheses that will evolve. Nevertheless, there are important weaknesses and shortcomings in the research plan that diminish the study's expected value below what it might be.
The United States has seen major advances in medical care during the past decades, but access to care at an affordable cost is not universal. Many Americans lack health care insurance of any kind, and many others with insurance are nonetheless exposed to financial risk because of high premiums, deductibles, co-pays, limits on insurance payments, and uncovered services. One might expect that the U.S. poverty measure would capture these financial effects and trends in them over time. Yet the current official poverty measure developed in the early 1960s does not take into account significant increases and variations in medical care costs, insurance coverage, out-of-pocket spending, and the financial burden imposed on families and individuals. Although medical costs consume a growing share of family and national income and studies regularly document high rates of medical financial stress and debt, the current poverty measure does not capture the consequences for families' economic security or their income available for other basic needs. In 1995, a panel of the National Research Council (NRC) recommended a new poverty measure, which compares families' disposable income to poverty thresholds based on current spending for food, clothing, shelter, utilities, and a little more. The panel's recommendations stimulated extensive collaborative research involving several government agencies on experimental poverty measures that led to a new research Supplemental Poverty Measure (SPM), which the U.S. Census Bureau first published in November 2011 and will update annually. Analyses of the effects of including and excluding certain factors from the new SPM showed that, were it not for the cost that families incurred for premiums and other medical expenses not covered by health insurance, 10 million fewer people would have been poor according to the SPM. The implementation of the patient Protection and Affordable Care Act (ACA) provides a strong impetus to think rigorously about ways to measure medical care economic burden and risk, which is the basis for Medical Care Economic Risk. As new policies - whether part of the ACA or other policies - are implemented that seek to expand and improve health insurance coverage and to protect against the high costs of medical care relative to income, such measures will be important to assess the effects of policy changes in both the short and long term on the extent of financial burden and risk for the population, which are explained in this report.
The Survey of Income and Program Participation (SIPP) is a national, longitudinal household survey conducted by the Census Bureau. SIPP serves as a tool to evaluate the effectiveness of government-sponsored social programs and to analyze the impacts of actual or proposed modifications to those programs. SIPP was designed to fill a need for data that would give policy makers and researchers a much better grasp of how effectively government programs were reaching their target populations, how participation in different programs overlapped, and to what extent and under what circumstances people transitioned into and out of these programs. SIPP was also designed to answer questions about the short-term dynamics of employment, living arrangements, and economic well-being. The Census Bureau has reengineered SIPPâ€"fielding the initial redesigned survey in 2014. This report evaluates the new design compared with the old design. It compares key estimates across the two designs, evaluates the content of the redesigned SIPP and the impact of the new design on respondent burden, and considers content changes for future improvement of SIPP.
The nation's health care system has changed dramatically and the country is debating further significant changes. Comprehensive information is needed to guide policymakers in understanding and evaluating the current problems and in formulating federal health care policy. This book contains an evaluation of the plan developed by the National Center for Health Statistics for restructuring its existing provider surveys. It identifies current and future data needed by researchers and policymakers to assess the effect of changes in financing, organization, and delivery of health care on access, quality, costs, and outcomes of care and determines the extent to which the design and content of the proposed survey can meet these data needs. The book goes beyond a simple review and recommends a design framework to develop a coordinated and integrated data system to gather information about people and their illness over time and to link this information to costs and health care outcomes.
It has become trite to observe that increases in health care costs have become unsustainable. How best for policy to address these increases, however, depends in part on the degree to which they represent increases in the real quantity of medical services as opposed to increased unit prices of existing services. And an even more fundamental question is the degree to which the increased spending actually has purchased improved health. Accounting for Health and Health Care addresses both these issues. The government agencies responsible for measuring unit prices for medical services have taken steps in recent years that have greatly improved the accuracy of those measures. Nonetheless, this book has several recommendations aimed at further improving the price indices.
Beginning in 2006, the Census Bureau embarked on a program to reengineer the Survey of Income and Program Participation (SIPP) to reduce its costs and improve data quality and timeliness. The Bureau also requested the National Academies to consider the advantages and disadvantages of strategies for linking administrative records and survey data, taking account of the accessibility of relevant administrative records, the operational feasibility of linking, the quality and usefulness of the linked data, and the ability to provide access to the linked data while protecting the confidentiality of individual respondents. In response, this volume first examines the history of SIPP and reviews the survey's purpose, value, strengths, and weaknesses. The book examines alternative uses of administrative records in a reengineered SIPP and, finally, considers innovations in SIPP design and data collection, including the proposed use of annual interviews with an event history calendar.
It is not news that each of us grows old. What is relatively new, however, is that the average age of the American population is increasing. More and better information is required to assess, plan for, and meet the needs of a graying population. The Aging Population in the Twenty-First Century examines social, economic, and demographic changes among the aged, as well as many health-related topics: health promotion and disease prevention; quality of life; health care system financing and use; and the quality of careâ€"especially long-term care. Recommendations for increasing and improving the data availableâ€"as well as for ensuring timely access to themâ€"are also included.
This book reviews the uses and abuses of microsimulation modelsâ€"large, complex models that produce estimates of the effects on program costs and who would gain and who would lose from proposed changes in government policies ranging from health care to welfare to taxes. Volume 1 is designed to guide future investment in modeling and analysis capability on the part of government agencies that produce policy estimates. It will inform congressional and executive decision makers about the strengths and weaknesses of models and estimates and will interest social scientists in the potential of microsimulation techniques for basic and applied research as well as policy uses. The book concludes that a "second revolution" is needed to improve the quality of microsimulation and other policy analysis models and the estimates they produce, with a special emphasis on systematic validation of models and communication of validation results to decision makers.
The United States has seen major advances in medical care during the past decades, but access to care at an affordable cost is not universal. Many Americans lack health care insurance of any kind, and many others with insurance are nonetheless exposed to financial risk because of high premiums, deductibles, co-pays, limits on insurance payments, and uncovered services. One might expect that the U.S. poverty measure would capture these financial effects and trends in them over time. Yet the current official poverty measure developed in the early 1960s does not take into account significant increases and variations in medical care costs, insurance coverage, out-of-pocket spending, and the financial burden imposed on families and individuals. Although medical costs consume a growing share of family and national income and studies regularly document high rates of medical financial stress and debt, the current poverty measure does not capture the consequences for families' economic security or their income available for other basic needs. In 1995, a panel of the National Research Council (NRC) recommended a new poverty measure, which compares families' disposable income to poverty thresholds based on current spending for food, clothing, shelter, utilities, and a little more. The panel's recommendations stimulated extensive collaborative research involving several government agencies on experimental poverty measures that led to a new research Supplemental Poverty Measure (SPM), which the U.S. Census Bureau first published in November 2011 and will update annually. Analyses of the effects of including and excluding certain factors from the new SPM showed that, were it not for the cost that families incurred for premiums and other medical expenses not covered by health insurance, 10 million fewer people would have been poor according to the SPM. The implementation of the patient Protection and Affordable Care Act (ACA) provides a strong impetus to think rigorously about ways to measure medical care economic burden and risk, which is the basis for Medical Care Economic Risk. As new policies - whether part of the ACA or other policies - are implemented that seek to expand and improve health insurance coverage and to protect against the high costs of medical care relative to income, such measures will be important to assess the effects of policy changes in both the short and long term on the extent of financial burden and risk for the population, which are explained in this report.
The National Children's Study (NCS) is planned to be the largest long-term study of environmental and genetic effects on children's health ever conducted in the United States. It proposes to examine the effects of environmental influences on the health and development of approximately 100,000 children across the United States, following them from before birth until age 21. By archiving all of the data collected, the NCS is intended to provide a valuable resource for analyses conducted many years into the future. This book evaluates the research plan for the NCS, by assessing the scientific rigor of the study and the extent to which it is being carried out with methods, measures, and collection of data and specimens to maximize the scientific yield of the study. The book concludes that if the NCS is conducted as proposed, the database derived from the study should be valuable for investigating hypotheses described in the research plan as well as additional hypotheses that will evolve. Nevertheless, there are important weaknesses and shortcomings in the research plan that diminish the study's expected value below what it might be.
The State Children's Health Insurance Program (SCHIP) was established by Congress to provide health insurance to uninsured children whose family income was too high for Medicaid coverage but too low to allow the family to obtain private health insurance coverage. The enabling legislation for SCHIP, included in the Balanced Budget Act of 1997, made available to states (and the District of Columbia) almost $40 billion over a 10-year period for this program. Like Medicaid, SCHIP is a joint federal-state program, with funding from both sources, but it is implemented by the states. Thus, there are SCHIP programs in all of the states and the District of Columbia. The National Research Council, through the Committee on National Statistics, was asked to explore some of the ways in which data analysis could be used to promote achievement of the SCHIP goal of expanding health insurance coverage for uninsured children from low-income families. To inform its work, the panel for this project held a workshop to bring together state SCHIP officials and researchers to share findings and methods that would inform the design, implementation, and evaluation of SCHIP at the state and national levels. In keeping with this charge, this report is limited to discussions at the workshop. It does not attempt to provide a summary of all the state programs nor a comprehensive review of the literature. Data Needs for the State Children's Health Insurance Program concludes that data are insufficient in the individual states to provide a clear picture of the impact of SCHIP on the number of children who are eligible for the program, the rate at which eligible children are enrolled in the program, and the rate at which they are retained in the program once enrolled. This situation is due, in part, to the fact that sample sizes in national surveys are too small to provide detailed data for individual states. In addition, the great amount of movement of children among health insurance categories-Medicaid, SCHIP, private insurance, or no insurance at all-makes it difficult for states to count the number of children in specific categories at a particular point in time. The panel specifies a number of practices that could be implemented to improve the overall functioning of SCHIP and the ability of policy makers to evaluate the program. Foremost among these are: (1) developing more uniform ways of estimating eligibility and health insurance coverage among the states; (2) sharing among the states effective methods for outreach; (3) taking qualitative information into account, in addition to quantitative information, in assessing variation among states in enrollment and disenrollment; and (4) implementing longitudinal studies to track the movement of children among the various insurance statuses.
The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, "peer" countries. In light of the new and growing evidence about the U.S. health disadvantage, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study the issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries examined whether the U.S. health disadvantage exists across the life span, considered potential explanations, and assessed the larger implications of the findings. U.S. Health in International Perspective presents detailed evidence on the issue, explores the possible explanations for the shorter and less healthy lives of Americans than those of people in comparable countries, and recommends actions by both government and nongovernment agencies and organizations to address the U.S. health disadvantage.
The retirement income security of older Americans and the cost of providing that security are increasingly the subject of major debate. This volume assesses what we know and recommends what we need to know to estimate the short- and long-term effects of policy alternatives. It details gaps in data and research and evaluates possible models to estimate the impact of policy changes that could affect retirement income from Social Security, pensions, personal savings, and other sources.
Every year workers' low-back, hand, and arm problems lead to time away from jobs and reduce the nation's economic productivity. The connection of these problems to workplace activities-from carrying boxes to lifting patients to pounding computer keyboards-is the subject of major disagreements among workers, employers, advocacy groups, and researchers. Musculoskeletal Disorders and the Workplace examines the scientific basis for connecting musculoskeletal disorders with the workplace, considering people, job tasks, and work environments. A multidisciplinary panel draws conclusions about the likelihood of causal links and the effectiveness of various intervention strategies. The panel also offers recommendations for what actions can be considered on the basis of current information and for closing information gaps. This book presents the latest information on the prevalence, incidence, and costs of musculoskeletal disorders and identifies factors that influence injury reporting. It reviews the broad scope of evidence: epidemiological studies of physical and psychosocial variables, basic biology, biomechanics, and physical and behavioral responses to stress. Given the magnitude of the problem-approximately 1 million people miss some work each year-and the current trends in workplace practices, this volume will be a must for advocates for workplace health, policy makers, employers, employees, medical professionals, engineers, lawyers, and labor officials.
The United States is viewed by the world as a country with plenty of food, yet not all households in America are food secure, meaning access at all times to enough food for an active, healthy life. A proportion of the population experiences food insecurity at some time in a given year because of food deprivation and lack of access to food due to economic resource constraints. Still, food insecurity in the United States is not of the same intensity as in some developing countries. Since 1995 the U.S. Department of Agriculture (USDA) has annually published statistics on the extent of food insecurity and food insecurity with hunger in U.S. households. These estimates are based on a survey measure developed by the U.S. Food Security Measurement Project, an ongoing collaboration among federal agencies, academic researchers, and private organizations. USDA requested the Committee on National Statistics of the National Academies to convene a panel of experts to undertake a two-year study in two phases to review at this 10-year mark the concepts and methodology for measuring food insecurity and hunger and the uses of the measure. In Phase 2 of the study the panel was to consider in more depth the issues raised in Phase 1 relating to the concepts and methods used to measure food security and make recommendations as appropriate. The Committee on National Statistics appointed a panel of 10 experts to examine the above issues. In order to provide timely guidance to USDA, the panel issued an interim Phase 1 report, Measuring Food Insecurity and Hunger: Phase 1 Report. That report presented the panel's preliminary assessments of the food security concepts and definitions; the appropriateness of identifying hunger as a severe range of food insecurity in such a survey-based measurement method; questions for measuring these concepts; and the appropriateness of a household survey for regularly monitoring food security in the U.S. population. It provided interim guidance for the continued production of the food security estimates. This final report primarily focuses on the Phase 2 charge. The major findings and conclusions based on the panel's review and deliberations are summarized.
This book evaluates changes needed to improve the usefulness and cost-effectiveness of the Survey of Income and Program Participation (SIPP). Conducted by the Census Bureau, SIPP is a major continuing survey that is designed to provide information about the economic well-being of the U.S. population and its need for and participation in government assistance programs (e.g., social security, Medicare, Medicaid, food stamps, AFDC). This volume considers the goals for the survey, the survey and sample design, data collection and processing systems, publications and other data products, analytical techniques for using the data, the methodological research and evaluation to implement and assess the redesign, and the management of the program at the Census Bureau.
Disparities in health and health care across racial, ethnic, and socioeconomic backgrounds in the United States are well documented. The reasons for these disparities are, however, not well understood. Current data available on race, ethnicity, SEP, and accumulation and language use are severely limited. The report examines data collection and reporting systems relating to the collection of data on race, ethnicity, and socioeconomic position and offers recommendations.
Each year's poverty figures are anxiously awaited by policymakers, analysts, and the media. Yet questions are increasing about the 30-year-old measure as social and economic conditions change. In Measuring Poverty a distinguished panel provides policymakers with an up-to-date evaluation of Concepts and procedures for deriving the poverty threshold, including adjustments for different family circumstances. Definitions of family resources. Procedures for annual updates of poverty measures. The volume explores specific issues underlying the poverty measure, analyzes the likely effects of any changes on poverty rates, and discusses the impact on eligibility for public benefits. In supporting its recommendations the panel provides insightful recognition of the political and social dimensions of this key economic indicator. Measuring Poverty will be important to government officials, policy analysts, statisticians, economists, researchers, and others involved in virtually all poverty and social welfare issues.
This book analyzes the consequences of violence and strategies for controlling them. Included are reviews of public perceptions and reactions to violence; estimates of the costs; the commonalities and complementarities of criminal justice and public health responses; efforts to reduce violence through the prediction and classification of violent offenders; and the relationships between trends in violence and prison population during a period of greatly increased use of incarceration.
Policy makers need information about the nation—ranging from trends in the overall economy down to the use by individuals of Medicare—in order to evaluate existing programs and to develop new ones. This information often comes from research based on data about individual people, households, and businesses and other organizations, collected by statistical agencies. The benefit of increasing data accessibility to researchers and analysts is better informed public policy. To realize this benefit, a variety of modes for data access— including restricted access to confidential data and unrestricted access to appropriately altered public-use data—must be used. The risk of expanded access to potentially sensitive data is the increased probability of breaching the confidentiality of the data and, in turn, eroding public confidence in the data collection enterprise. Indeed, the statistical system of the United States ultimately depends on the willingness of the public to provide the information on which research data are based. Expanding Access to Research Data issues guidance on how to more fully exploit these tradeoffs. The panel’s recommendations focus on needs highlighted by legal, social, and technological changes that have occurred during the last decade.
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