|
Items in cart [1] |
Questions? Call 888-624-8373 |
| 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 281
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
OCR for page 282
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.
OCR for page 283
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
OCR for page 284
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
OCR for page 285
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.
OCR for page 286
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.
Representative terms from entire chapter:
budget reductions
