suffering from conditions of the circulatory system or disabling musculoskeletal conditions. In recent years new beneficiaries are more likely to be younger and have mental impairments. They are likely to remain on the rolls longer.

Many factors have shaped the disability programs over the years, including economic conditions; the changing nature of work; the maximum level of gainful activity allowed for people on disability; the incentives and increased outreach by SSA and disability advocates; legislative actions, court decisions, and administrative initiatives undertaken by SSA in the way disability decisions are made; public perception about the ease of qualifying for benefits; eligibility for medical benefits through Medicare or Medicaid; demographic composition and characteristics of the population; and the types of impairments of applicants that are recognized for disability cash benefits. However, the impact of any one factor on the demand for, and the provision of, disability benefits is difficult to determine definitively in the absence of data.

The challenge for SSA is to acquire these data and use them to manage the disability programs more effectively. The disability rolls are projected to grow over the coming decades as the baby boom generation reaches the age of increased likelihood of developing disabilities. The gradual increase from 65 to 67 in full retirement age also means that disabled workers may remain on the disability rolls for two additional years before converting to the old age survivor benefits. Ongoing and future research using new data sources should provide information about current enrollment in disability programs and allow projections of future growth and program costs. The results should lead to clearer and more workable policies, rules and guidelines to operate its programs.


In 1996, SSA requested that the Institute of Medicine (IOM), in collaboration with the National Research Council’s Committee on National Statistics (CNSTAT) conduct an independent review of the statistical design and content of the disability survey under development (the National Study of Health and Activity (NSHA)) and of its research plan for the redesign of the disability decision process. The committee’s specific tasks include, but are not limited to, the following:

  • review the scope of work for the NSHA request for proposal and the design and content of the survey as proposed by the survey contractor;

  • review and evaluate the preliminary design of the NSHA (the protocol developed by Westat, Inc.) and subsequent modifications

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