| ||||||||||||||||||||||||||||||
|
|
|||||||||||||||||||||||||||||
| Copyright © 2009. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 47
-->
Appendix C
Major Survey Sources, Health And Social Welfare Programs
The content and design of four major surveys may need to be modified to permit them to track eligibility, participation, and outcomes of changes in health and social welfare programs:
Current Population Survey (CPS) March Income Supplement;
Survey of Income and Program Participation (SIPP);
National Health Interview Survey (NHIS); and
Medical Expenditure Panel Survey (MEPS).
This appendix briefly describes key features of the design and content of these surveys that are relevant to program eligibility and participation.
The CPS March Income Supplement
Design
The CPS is a monthly survey of 50,000 households, of which about 47,000 are successfully interviewed. The core questionnaire asks about current employment status and is the basis of the monthly unemployment rate statistics. The sample represents the civilian, noninstitutionalized population in the 50 states and District of Columbia and is designed to be state-representative. There is a rotation group design, in which one-eighth of the households are new to the survey each month. Household addresses are retained in the sample for 4 months, dropped for 8 months, and returned to the sample for another 4 months, so that there is 50 percent overlap in the sample of addresses from year to year. (The survey interviews people who currently live at each sample address; it does not follow individuals who move.)
The March income supplement obtains detailed information for sample members aged 15 and older on income and work experience for the previous calendar year. The sample for March includes an additional 2,500 housing units, interviewed the previous November, that contained at least one person of Hispanic origin. The sample also includes people in the Armed Forces living off post or with their families on post. Some respondents to the core questionnaire do not respond to the March income supplement.
OCR for page 48
-->
Content (March 1996 Survey)
Demographic Characteristics
Age
Sex
Race
Origin or descent
Relationship to reference person
Marital status
Parent (if in household)
Veteran status
Level of education; school enrollment
Place of residence (including country if abroad) 1 year ago
Citizenship
Current Labor Force Status
Work status last week
Reason for temporary absence from job last week
Hours worked, total and overtime, last week
Weeks looking for work
When last worked
Reasons not looking for work
Usual work hours per week
Usual hourly wage or usual gross earnings per week
[Note: There are no questions on volunteer work or participation in work training programs.]
Work Experience Last Year
Whether worked last year
Whether looked for work; how many weeks working or on layoff
Reason did not work; did not look for work
Weeks worked
Hours usually worked per week
Number of weeks worked less than 35 hours per week; reason
Income and Program Participation Last Year
Earnings
Total gross earnings from longest job held
Tips, bonuses, overtime pay or commissions from longest job held
Net earnings from business or farm for the year and each quarter
Earnings from all other jobs
Tips, bonuses, etc. from all other jobs
OCR for page 49
-->
Program cash payments (generally includes basis of payment—whether weekly, monthly, quarterly, etc.; number of payments; who in household received; reasons for receipt)
State or federal unemployment compensation
Supplemental unemployment benefits
Union unemployment or strike benefits
Worker's compensation payments
Social Security payments last year and month
Social Security received for children last year and month
Supplemental Security Income
SSI received for children
Public assistance or welfare payments from state or local welfare office; type of assistance (AFDC, other, both)
Veterans' payments by type
Survivors' benefits by type (e.g., private or public widows' pensions, estates, trusts, annuities; excluding Social Security or VA)
Disability benefits by type (excluding Social Security or VA)
Pension or retirement benefits by type (excluding Social Security or VA)
Asset income (generally includes who owns, basis of payment, number of payments)
Interest income
Dividend income
Property income (including rent, royalties, income from estates or trusts)
Other Income
Child support payments
Alimony payments
Regular financial assistance from friends or relatives
Income from hobbies, home businesses, or farms not already covered
Income from unemployment compensation, severance pay, welfare, foster child payments, or other money income not already covered
Educational assistance from Pell Grants; from other sources
In-Kind Program Participation
Number of children who ate lunch at school; number who qualified for free or reduced price lunch
Whether live in public housing project or have subsidized rent
Whether household received food stamps; who covered; monthly amount; number of months
Receipt of heating assistance; amount
[Note: There are no questions on welfare program participation prior to the previous year.]
Health and Health Insurance Coverage
Health problem that prevents or limits work
Ever retired or left a job for health reasons
Self-assessment of health status (poor to excellent)
OCR for page 50
-->
Health insurance coverage from current or former employer or union; policyholders; who covered; whether current or former employer or union paid all, part, or none of premium
Health insurance coverage purchased directly; policyholders; who covered
Health insurance coverage from non-household member; who covered Medicare coverage; who covered
Medicaid coverage; who covered; number of months covered
CHAMPUS or CHAMPVA coverage; who covered
Coverage by any other state health insurance plan or any other coverage (plans in 26 states listed as possibilities); who covered
[Note: Above questions are for coverage any time during previous year; type of coverage last week also ascertained. There are no questions on reasons for lack of coverage.]
OCR for page 51
-->
The Survey of Income and Program Participation
Design
The Survey of Income and Program Participation (SIPP) is a rotating panel survey of samples of household members interviewed at 4-month intervals. Beginning in 1983, the survey followed adult members of initially-sampled households (sample sizes ranged from 12,500 to 23,600 households) for 32 months; a new panel was introduced each February. Data were also obtained for children living with adult sample members and for adults and children who joined the household of an adult sample member. Under a redesign introduced in 1996, the survey is following samples of adults and children in about 37,000 initially-sampled households for 48 months; a new panel will be introduced every 4 years. About 8-9 percent of eligible households did not respond in Wave 1 of SIPP for the most recent three panels (1992, 1993, and 1996), and another 5-6 percent did not respond at Wave 2; by Wave 4, cumulative sample loss was 18-20 percent for these three panels. The SIPP sample is not designed for state representation. The sample for the 1996 panel overrepresents household addresses identified as low income in the 1990 decennial census. The design of SIPP may change if the survey is made the source of official poverty statistics, as recommended by a National Research Council panel.
The SIPP core questionnaire covers demographic characteristics; work experience, earnings, program participation, and transfer income by month for the 4 months preceding the interview; and asset income for the 4-month period. In addition, each interview wave includes one or more topical modules, which cover a variety of topics. (Some modules are repeated in each panel; others are modified to respond to current policy needs.)
Content Changes
Some changes were recently made to the content of the 1996 SIPP panel to respond to legislated changes in social welfare programs. Beginning in Wave 4 (administered in summer 1997), references to AFDC were changed to cash assistance. Also, the variable topical module in Wave 8 (to be administered in fall 1998) will be devoted exclusively to measuring participation and benefits under welfare reform, recognizing the potential for an increase in the amount and type of in-kind benefits.
Content (Core, 1996 Panel)
Demographic Characteristics
Age
Sex
Race
Origin or descent
Relationship to reference person
For children, whether biological, step, foster, or adopted
Marital status
Parent (if in household)
Veteran status and when served
Educational attainment; school enrollment
[Note: There are no questions on citizenship.]
OCR for page 52
-->
Labor Force Participation in Past 4 Months1
Whether had at least one paid job or did any work for money in past 4 months
Whether worked for employer, self-employed, both, something else (e.g., odd job)
Whether did any unpaid work in family business or farm
Reason did not work
Which weeks worked; which weeks with a job but not paid and why
Any time on layoff in past 4 months; whether had date to return to work
Any time looking for work in past 4 months; which weeks
If could have started a job (or returned to one), reason why didn't
How many employers in past 4 months
Start and end dates (if applicable) for each employer for which worked during past 4 months
Reason stopped working for an employer
Number businesses (including farm or professional practice) had alone or jointly in past 4 months; whether active in business or own as investment only
Start and end dates (if applicable) for each business; reason gave up a business
Usual hours per week per employer
Regular pay rate at end of month 4 (or when left job); how often paid
Usual hours involved in each business; whether received regular salary or other income
Reason worked less than 35 hours per week
Current labor force status (as of date of interview)
[Note: There are no questions on volunteer work or participation in work training programs.]
Previous Work Experience (Wave 1 Topical Module)
Before started current job (if applicable), what year last worked at a paid job or business and when started that job
How old when first worked 6 straight months at some job or business
Main reason never worked 6 straight months
Whether worked at least 6 straight months in each year since first job
How many years did not work 6 straight months
Whether has generally worked 35 hours or more per week
Whether any periods of 6 or more months when did not work because taking care of a child, elderly person, or disabled person; when most recent such period and how long; how many such periods; when first such period
Income and Program Participation (for each person)2
Earnings (for each of 4 months)
Gross earnings from each employer (how paid)
Tips, bonuses, overtime pay, or commissions
1
For the 1996 panel, the reference period for labor force questions was expanded to include the period in the interview month prior to the interview date together with the four preceding months.
2
Recipiency of income and benefits in the 1996 panel is ascertained for the period in the interview month preceding the interview date in addition to the preceding four months.
OCR for page 53
-->
Any other pay
How much received from business
Net profit or loss from business
Income from freelancing, consulting, moonlighting
Program cash payments (for each of 4 months; reason for receipt for some income types—retired, disabled, widowed or surviving child, spouse or dependent child, other reason; composition of the recipient unit for some income types; age when began receiving disability income; reason why and when applied for and reason why stopped receiving AFDC, SSI, and some other income types; recipiency history for AFDC and SSI in Wave 1)
Social Security
Supplemental Security Income; whether ever applied; whether ever received; when first received and for how long
SSI on behalf of children
Separate SSI payment from state or local welfare office
Unemployment compensation
Workers' compensation
Veterans' compensation by type
Payments from own sickness, accident, or disability insurance policy
Employer disability payments
Employer or union pension
Federal civilian pension
State government pension
Local government pension
U.S. military pension
National Guard or Reserve Forces retirement
Railroad Retirement
Black lung payments
Other disability payments
Other pension payments
Regular retirement income from paid-up insurance policy or annuity
Payments from estate or trust
AFDC; whether ever applied; whether ever received; when first received and for how long; number of times received
General Assistance
Other welfare
Child support as bonus or pass-through from AFDC
Asset holdings and asset income (whether owned separately or jointly; value; 4-month income amounts where applicable)
U.S. Government savings bonds (E or EE)
IRA or Keogh account; whether received lump sum or regular payments in last 4 months
401(k) or thrift plan
Interest earning checking account
Savings account
Money market deposit account
OCR for page 54
-->
Certificate of deposit (CD)
Mutual funds
Stocks
Municipal or corporate bonds
U.S. government securities
Mortgages from which payments are received
Rental property
Royalties
Any other financial investments not already mentioned
Rental property (gross and net income)
Mortgages
Royalties
Other Income
Severance pay when left job during past 4 months; amount
Lump sum payments from pension when left job during past 4 months; type; amount; whether and how much rolled over into an IRA or other retirement account
Foster child care payments
Child support payments
Alimony payments
Any other income
Educational assistance by type
In-kind program participation (recipiency history for food stamps in Wave 1)
Whether live in public housing project
Whether rent subsidized by federal, state, or local government
When first applied and moved into public or subsidized housing; whether on waiting list
Amount of monthly rent (excluding subsidy); whether pay for utilities
Whether authorized to receive food stamps; whether ever applied; when first received and how long; how many times received; amounts in last 4 months; composition of the recipient unit
Whether on WIC, the Women, Infants, and Children nutrition program and composition of the recipient unit
Energy Assistance; 4-month amount
Which children ate lunch and/or breakfast at school; whether free or reduced price
Health and Health Care Use
Whether health prevents working at a job or business or limits kind of work can do
Whether ever retired from a job or business
[Note: Wave 2 includes a topical module on work disability history; Wave 4 includes a topical module on disability; Waves 6 and 11 include a topical module on functional limitations and disability for adults and children.] [Note: Waves 3, 6, 9, and 12 include a topical module on medical expenses and utilization of health care for adults and children.]
OCR for page 55
-->
Health Insurance Coverage (for each person; which months covered)
Medicare
Medicaid (when coverage started; whether person's children were covered; which children covered and which months)
Any other assistance program that pays for medical care (whether person's children were covered)
Whether covered under health insurance plan in own name or as family member on another person's plan
Type of coverage (current or former employer, union, CHAMPUS, CHAMPVA, military/VA, privately purchased, obtained in some other way)
Whether current or former employer union paid all, part, or none of premium
Who else covered by plan
Whether plan covers anyone not living in household
Reason for not being covered
If now covered, when ever not covered
If not now covered, when covered previously
OCR for page 56
-->
Schedule of Topical Modules for the 1996 Panel of the Survey of Income and Program Participation
Wave and Time Period
Topical Modules
Last Time Asked and Question Source
1:
April 1996-July 1996
Recipiency History
1993 Wave 1
Employment History
1993 Wave 1
2:
Aug. 1996-Nov. 1996
Work Disability History
1993 Wave 2
Education and Training History
1993 Wave 2
Marital History
1993 Wave 2
Migration History
1993 Wave 2
Fertility History
1993 Wave 2
Household Relationships
1993 Wave 2
3:
Dec. 1996-March 1997
Assets, Liabilities, and Eligibility
1993 Wave 7
Medical Expenses/Utilization of Health Care, Adults and Children
1993 Wave 7/New
Work Related Expenses
New
Child Support Paid
New
4:
April 1997-July 1997
Annual Income and Retirement Accounts
1993 Wave 8
Taxes
1993 Wave 8
Work Schedule
1993 Wave 9
Child Care
1993 Wave 9
Disability Questions
New
5:
Aug. 1997-Nov. 1997
School Enrollment and Financing
1993 Wave 8
Child Support Agreements
1993 Wave 9
Support for Non-Household Members
1993 Wave 9
Disability:
Functional Limitations and Disability, Adults
1993 Wave 6
Functional Limitations and Disability, Children
1993 Wave 6
Employer Provided Health Benefits
New
6:
Dec. 1997-March 1998
Children's Well-being
1993 Wave 6
Assets, Liabilities, and Eligibility
1996 Wave 3
Medical Expenses/Utilization of Health Care, Adults and Children
1996 Waves 3 and 6
Work Related Expenses
1996 Wave 3
Child Support Paid
1993 Wave 3
OCR for page 57
-->
Schedule of Topical Modules for the 1996 Panel of the Survey of Income and Program Participation (continued)
Wave and Time Period
Topical Modules
Last Time Asked and Question Source
7:
April 1998-July 1998
Annual Income and Retirement Accounts
1996 Wave 4
Taxes
1996 Wave 4
Retirement and Pension Plan Coverage
New
Home Health Care
New
8:
Aug. 1998-Nov. 1998
Adult Well-being
1993 Wave 9
Welfare Reform
New
9:
Dec. 1998-March 1999
Assets, Liabilities, and Eligibility
1996 Wave 6
Medical Expenses/Utilization of Health Care, Adults and Children
1996 Wave 6
Work Related Expenses
1996 Wave 6
Child Support Paid
1996 Wave 6
10:
April 1999-July 1999
Annual Income and Retirement Accounts
1996 Wave 7
Taxes
1996 Wave 7
Work Schedule
1996 Wave 4
Child Care
1996 Wave 4
11:
Aug. 1999-Nov. 1999
Child Support Agreements
1996 Wave 5
Support for Non-Household Members
1996 Wave 5
Disability:
Functional Limitations and Disability, Adults
1996 Wave 5
Functional Limitations and Disability, Children
1996 Wave 5
Variable topical modules to be determineda
NA
12:
Dec. 1999-March 2000
Assets, Liabilities, and Eligibility
1996 Wave 9
Medical Expenses/Utilization of Health Care, Adults and Children
1996 Wave 9
Work Related Expenses
1996 Wave 9
Child Support Paid
1996 Wave 9
Variable topical modules to be determineda
NA
NOTE: Information current as of October 31, 1997.
a Children's well-being will be included in Wave 11 or 12.
OCR for page 58
-->
The National Health Interview Survey
Design
The National Health Interview Survey (NHIS) is a continuing cross-sectional survey that is the principal source of information on the health of the civilian noninstitutionalized population of the United States. The NHIS data are collected through personal interviews that are conducted each week of the year. (Each household is interviewed once, and each week's sample is representative of the universe.) The current annual sample size is about 49,000 households and is designed to oversample black people. The sample is designed to be state-representative. The annual response rate is about 95 percent. The questionnaire consists of two basic parts: (1) a set of basic health and demographic items, and (2) one or more sets of questions on current health topics. The basic or core items are repeated each year and constitute about one-third of the questionnaire.
Content (1996 Core)
Demographic Characteristics
Age
Sex
Race
Ethnic origin
Relationship to reference person (including whether biological, adoptive, step, or foster relationship)
Marital status; whether ever married
Educational attainment
Whether attending or ever attended Head Start (for children under 6)
Place of birth (state or country)
[Note: There are no questions on citizenship.]
Labor Force Status Last Week and Year
Work status last week
Hours worked last week
Whether usually work 35 hours or more
Reason for not working last week
Ever worked previous calendar year
Months worked
[Note: There are no questions on volunteer work or participation in work training programs.]
Income and Program Participation Last Year
Earnings from all jobs and businesses last year for each adult (aged 18 or older or married)
Whether anyone in family and who received:
Wages and salaries
Self-employment income including business and farm income
OCR for page 59
-->
Social Security or Railroad Retirement
Pensions from other sources
Supplemental Security Income; whether because of disability; ever applied
Social Security Disability Insurance; whether because of disability; ever applied
Welfare, AFDC, or General Assistance; number of months received
Interest income
Dividend or property income
Child support
Any other source
Total combined family income from all sources
Who authorized to receive food stamps; months authorized (amounts not ascertained)
[Note: There are no questions on welfare program participation prior to the previous year.]
Health And Health Care Use
As reported by family respondent, information about family members on:
Health status and limitation of activities
Injuries in past 3 months
Access to health care (whether family member didn't get care or delayed in seeking care because couldn't afford it)
Hospital utilization in past 12 months
Health care contacts in 2-week period
Whether any family member received care 10 or more times in past 12 months
For adults, extensive questions on:
Health conditions (long list, some ever reported, some last 12 months, some last 3 months)
Emotional feelings in last 30 days (e.g., hopeless, nervous)
Health indicators (e.g., days lost from work, days bedridden, health better or worse)
Limitation of activities (e.g., walking, bending) and related health conditions
Health behaviors (tobacco use, exercise, alcohol use)
Access to health care
Dental care
Health care provider contacts in past 12 months
Immunizations (flu shots and pneumonia vaccinations)
For children, questions on:
Conditions, limitation of activity, health status
Mental health
Access to health care
Dental care
Health care provider contacts in last 12 months
Immunizations
Health Insurance Coverage
Whether health insurance offered through workplace
Who in family has coverage; type
Type of Medicare coverage; whether signed up with an HMO
For Medicaid, whether can see any doctor; whether need referrals
For private coverage, whether obtained through employer or union; who pays premiums; how much
OCR for page 60
-->
family spent for premiums including payroll deductions; whether HMO, IPA, PPO, or other type of plan
If no coverage, when last was covered; reasons for no longer having coverage
Whether ever lacked coverage in previous 12 months; number of months
Total family expenditures for medical care (excluding premiums, non-prescription drugs, costs for which expect to be reimbursed)
OCR for page 61
-->
Medical Expenditure Panel Survey
Design
The Medical Expenditure Panel Survey (MEPS) is a redesign of the 1987 National Medical Expenditure Survey (NMES). Predecessor surveys to NMES were the 1981 National Medical Care Utilization and Expenditure Survey (NMCUES) and the 1977 National Medical Care Expenditure Survey (NMCES).
The 1987 NMES consisted of five rounds of data collection between February 1987 and July 1988 for a sample of 14,000 households, including oversamples of blacks, Hispanics, people aged 65 and older, low-income people, and people with functional limitations. Surveys were also conducted of physicians and health care facilities providing care to members of the household sample during 1987 and of employers and insurance companies responsible for their insurance coverage. The NMES also included an institutional survey of 13,000 residents of nursing and personal care homes, psychiatric hospitals, and facilities for the mentally retarded.
MEPS is a continuing panel survey, begun in 1996. It follows samples of households in 5 personal interviews and 1 telephone interview over almost 30 months, with a new panel introduced every year. The 1996 sample is 10,500 households. The sample was drawn from the 1995 National Health Interview Survey sample, making it possible to integrate the NHIS data with MEPS data for MEPS sample households. MEPS also includes surveys of providers, employers, and insurance companies of household sample members, as well as a nursing home survey.
The MEPS provider survey includes hospitals, physicians, and home health care providers and obtains information to supplement responses to the MEPS household survey, including information to help estimate medical care expenses of people enrolled in health maintenance organizations and other types of managed care plans. The MEPS health insurance provider survey includes employers, unions, and private insurance companies and obtains detailed information on the health insurance plans of MEPS respondents and other health plans available to, but not chosen by, respondents. The employer component uses the same questionnaire as that used for the National Employer Health Interview Survey, which is a large annual survey of employers about their health insurance plans, beginning in 1997. (NEHIS was first conducted in 1994.)
The MEPS national nursing home expenditure survey gathers information from a sample of 800 nursing homes and more than 5,000 residents on the characteristics of the facilities and services offered, expenditures and sources of payment on an individual resident level, and resident characteristics, including functional limitation, cognitive impairment, age, income, and insurance coverage. The survey also collects data on the availability and use of community-based care prior to admission to nursing homes.
Content (1996 MEPS Household Survey; Summary Description)
Family Demographic Characteristics
Age
Sex
Race/ethnicity
Family relationship
Marital status
Military status
Education
OCR for page 62
-->
Employment
Information on jobs held or retired from for household members aged 16 and older, including:
Hours worked
How long worked at job
Wages
Whether health insurance offered
Whether self-employed
Type of business/industry
Job title/main duties
Periods of unpaid leave (for people currently working)
Whether ever worked and reasons for not working (for adults not currently working)
Household Income and Assets
Value of major common assets
Information on annual income from a number of potential sources asked once each year of participation in the survey; sources include:
Wages
Social Security
AFDC
SSI
Interest income
Rental income
Royalties
Health Status (asked once a year for each family member)
Overall physical and mental health status
Activity and functional limitations
Mental health assessment
For children, special health and education services they receive
Health Conditions
Medical conditions for each family member (provided by household respondent)
Pregnancy status for women ages 15 to 45
Health Care Use
Hospital stays
Emergency room visits
Outpatient department visits
Medical provider visits
Dental care
Home health care
Prescription medicines
Over-the-counter medications
OCR for page 63
-->
Other medical expenses
[Information collected includes when and where the use occurred, what happened during the encounter, the reason for it, and other characteristics, depending on the type of care received.]
Charge And Payment (for each medical care use reported by household)
Whether a bill/statement received for the care and, if not, why not (e.g., Medicaid, HMO)
The charge, if any, for medical care
Which sources paid (family, insurance) for the care
How much each source paid for the care
Whether there was a discrepancy between the charge and the total payments, and why (discount, professional courtesy)
Access To Care (asked once a year)
Each family member's usual source of health care (or that they do not have one)
Reason for not having a usual source of health care
Confidence and satisfaction with the quality of care received from a usual source of care
Barriers to receiving health care, including experiencing difficulty, delaying, or not receiving health
care due to cost, insurance problems, time constraints, or other reasons
Health Insurance Coverage
Public insurance coverage
Medicare
Medicaid (including Medicaid waiver programs)
CHAMPUS/CHAMPVA
Other government programs
Private insurance coverage (including policyholder, covered individuals, and covered months)
Employer-sponsored coverage
Directly purchased insurance (e.g., through a group, association, school, etc.)
If not insured, length of uninsured spell
If privately or publicly insured, whether covered under a managed care plan
Satisfaction with health plan, including satisfaction with choice of providers, difficulty in seeing specialists, plan coverage, plan costs, overall satisfaction
Representative terms from entire chapter:
program participation
Items in cart [1]
