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Appendix B EDects of Budgetary Constraints on Federal Statistical Programs The federal statistical agencies have responded to the changing fiscal environment of the last decade with a variety of broad policy changes and specific program adjustments. In many cases, these changes have been made hastily, without adequate consideration of their short- and long-term consequences, and thus have not supported the development of well-informed public policy. In an era when the economy and the society are changing rapidly, these changes may be reducing the quantity and quality of vital information available to the public and private sectors for setting policy. With respect to the tasks of this panel, it is clear that the demographics of the elderly population are changing rapidly, that technology in health care and delivery systems is developing at a swift pace, and that the challenges posed to the medical community derive from the fact that the health care needs of an elderly population are not strictly defined by medical problems, but involve the social structures, home systems, and economic capacities of people as well. As concerns statistics on the elderly, federal statistical agencies have been making changes to programs and policies in recent years that involve one or more of the following: (1) changing the focus from policy-oriented statistical programs to those that support the administrative aspects of government; (2) reducing the periodicity (or frequency of data collection) of major surveys; (3) reducing the coverage of surveys, through deletion of specific subpopulations from the universes of interest or through reduction of sample size; (4) re- ducing data quality, in the areas of data collection, data processing, 281

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282 AGING POPULATION IN THE TWENTY-FIRST CENTURY and data dissemination; (5) reducing the timeliness of data dissem- ination, both in terms of hard-copy reports and of public-use data files; and (6) postponing or elirn~nating the regular review of data needs in developing areas, usually in the interest of protecting core programs within agencies. Specific examples of the types of adjustments cited above are considered in the following sections, which examine the programs of the specific agencies that most directly affect the information bases available for supporting policy development in aging. BUREAU OF TEE CENSUS There have been important effects of budget reductions on the products associated with the decennial census program. Unidentifi- able effects on data quality may have been caused by the large-scare release of temporary employees hired to process the 1980 census early in the 1980s. A reduction-in-force of the permanent staff, conducted at the same time, caused major dislocation within the Bureau, both reducing total staff resources and relocating employees throughout the agency. Such a relocation has meant that even experienced staff have been placed in positions for which they lack job training, expe- rience, and possibly suitability for the position. As a result of these personnel dislocations and budget cuts, there were long delays in the release of the detailed reports and public-use data products from the census, with some reports delayed until 1985. In addition, although Public Law 9~52 requires a mid-decade census to be conducted in 1985 (and every 10 years thereafter), funds for this program have not been made available since 1980. In 1985, there was no mid-decade census, and there are no plans as of this writing to conduct one in 1995. This program would have produced small-area data on rela- tively small subpopulations, including the elderly, on a quinquennial rather than a decennial basis. Some reports from the 1980 census of interest to researchers in the field of aging were also cancelled. The most important examples are two reports on the older population, one of which would have provided detail on population characteristics of the elderly and the other on their housing characteristics. Other reports that would have produced information on the elderly population along with more general information have been cancelled. These include reports on minority populations, the characteristics of the poverty population, and the sources and structure of household and family income.

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EFFECTS OF B ED GETARY CONSTRAINTS 283 Because of a reduction of $1 million in the amount originally pro- posed for the Survey of Income and Program Participation (SIPP), the sample size of the survey has been reduced by 22.5 percent. A loss of precision of the estimates derived from the survey will result, particularly in the case of small subpopulations such as the elderly. NATIONAL CENTER FOR HEALTH STATISTICS In general, the major adjustment made by the National Center for Health Statistics in response to budget reductions has been to stretch out the frequency of its data collections. With respect to the elderly, a major example of this phenomenon is the National Nursing Home Survey, one of four major surveys of health care providers conducted by the Center. Prior to 1980, the frequency of this survey was every three years. Its most recent administration, in 1985, followed a gap of eight years. The next data collection for this survey is currently planned to begin in 1991, but it will be combined with other data collections to be conducted on an ongoing basis. The periodicity of other surveys conducted by the Center has also been decreased, including the National Ambulatory Medical Care Survey, the National Master Facility Inventory, the National Medical Care Utilization and Expenditure Survey, and the National Health and Nutrition Examination Survey. In addition, four medical care provider surveys are slated to be combined into one. Data on the elderly, as well as the rest of the population, will be affected by these changes. The National Ambulatory Medical Care survey serves as the only national source of information on the characteristics of ambulatory medical care received by the elderly (and others) in physicians' offices. The National Master Facility Inventory is the only national source of information on the number of nursing home beds. The National Health and Nutrition Examination Survey has been stretched out from a planned Year cycle to a 10-year one. NHANES is the only national survey that actually includes physical examination of the respondent. The lengthening of the periodicity will create gaps in knowledge of the changing nutritional and health practices of the population. In 1985 the sample size of the National Health Interview Survey was cut by one-fourth for budgetary reasons; it would have been cut by one-half had NCHS not been able to find reimbursable funding from another agency. To cope with the erects of reduced funding

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284 AGING POPULATION IN THE TWENTY-FIRST CENTURY again in the fiscal 1986 budget, and with the 4.7 percent sequestration in the fiscal 1986 budget imposed by the Gramm-Rudman-Hollings Law, NCHS cut the 1986 sample by one-quarter. These cuts will affect the reliability of statistics on subpopulations typically covered in this survey. For 1987, funding was provided for only half the sample, but additional funds from the National Cancer Institute for a supplement on cancer made it possible to conduct a survey on a full sample. In future years, NCHS plans to fund this survey only at the half-sample level, with funding for larger samples to be sought from interested agencies. NATIONAL CENTER FOR HEALTH SERVICES RESEARCH While the National Center for Health Services Research does not engage in routine data collection activities similar to those conducted by the other federal agencies discussed in this appendix' it does rely heavily on data sets generated and maintained by such agencies in the conduct of its extramural research program. Such data sets typically constitute the data on which its funded research studies are based. Hence, reductions in sample size, periodicity, and the quality of surveys and administrative records available to the Center affect the nature of the research that can be performed and thus the adequacy of the information available for policy development. In addition, the Center's total budget for any one fiscal year affects the amount of research that can be supported. Since 1973, when the budget was $58 million, it decreased each year until 1982, when it reached $10 million. Since 1985 the budget has risen to the high teens, which is Tow compared with the early 1970s, and even lower when considered in constant dollars. Currently, the Center is conducting a new medical expenditure survey, called the National Medical Expenditure Survey, for which it received initial planning funds in fiscal 1986. The design, conduct, and analysis of the NMES is expected to take about five years. HEALTH CARE FINANCING ADMINISTRATION The Health Care Financing Administration cosponsored, with the Office of the Assistant Secretary for Planning and Evaluation, the 1982 National Long-Term Care Survey, a unique source of infor- mation about the major source of health care costs for the elderly. To reduce initial costs, the size of the survey was reduced to approxi- mately 6,300 noninstitutionalized persons with an impairment. This

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EFFECTS OF BUDGETARY CONSTRAINTS 285 reduction eliminated coverage of the nonelderly impaired population in Tong-term care facilities. Although originally designed as a longitu- dinal survey, in 1982 it was decided to conduct it as a one-tune survey because of the high costs of longitudinal surveys. In 1984, however, a decision was made to reinterview the original sample and expand that sample to include (a) people who in 1982 were not functionally impaired, (b) the population that was impaired and institutionalized in 1982, and (c) people who became eligible for Medicare on the basis of age between 1982 and 1984. The 1984 survey was cosponsored by HCFA and the National Center for Health Services Research. As a result of the sequencing of these decisions, the costs associated with following up the sample will actually be greater, and segments of the original sample may be lost. NATIONAL INSTITUTE OF MENTAL HEALTH In fiscal 1986, the National Mental Health Statistical Program budget was reduced by 27 percent, followed by an additional reduc- tion in fiscal 1987. The Survey and Reports Branch experienced a decrease of 42 percent in research contract and direct operations funds from fiscal years 1985 to 1987, followed by level funding in fis- cal 1988. Affected programs include facility and patient surveys, sta- tistical improvement technical assistance, and applied demographic research. These budget reductions necessitated a change in the pe- riodicity of the facility survey from two to four years, and a change in the periodicity of the patient survey from five to eight years. In addition, the capacity to provide timely data will be diminished, as will the capability to collaborate with the states, local providers, and the mental health community. SOURCES OF INFORMATION In addition to conversations with staffin the respective agencies, much of the material in this appendix has been drawn from four reports examining trends in federal statistical programs in recent years: James R. Storey. Recent Changes in the Availability of Federal Data on the Aged. The Gerontological Society of America. Washing- ton, D.C. February 11, 1985.

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286 AGING POPULATION IN THE TWENTY-FIRST CENTURY James R. Storey. Availability of Federal Data on the Aged: Re- cent Changes and Future concerns. The Gerontological Society of America. Washington, D.C. June 3, 1986. U.S. Congress, House of Representatives, Committee on Govern- ment Operations. The Federal Statistical System: 1980 to 1985. 98th Congress, Second Session. November 1984. U.S. Congress, House of Representatives, Committee on Gov- ernment Operations. An Update on the Status of Major Federal Statistical Agencies: Fiscal Year 1986. 99th Congress, First Session. May 1985.