Disabled Worker's Risk of Hospitalization and Death
McCoy, John L., Iams, Howard M., Health Care Financing Review
This article reports the results of a multiple logistic regression analysis pertaining to the relative risk of death and hospitalization of disabled workers who were interviewed in the 1982 NBS. Compared with a large body of knowledge concerning the elderly, relatively little is known about survival status and patterns of inpatient care received by new disabled-worker beneficiaries of Social Security Disability Insurance (SSDI).
We first provide a brief discussion of the SSDI program's eligibility determination procedures. This is followed by a presentation of research methods and data sources which include linked NBS, Medicare, and Social Security administrative records. Next, we present a profile of disabled workers and a comparison of 1982 NBS sociodemographic and health characteristics with inpatient status and survival. Following this, research variables are discussed within the context of the Andersen health services utilization model, and relative risk functions of death and hospitalization are computed. Finally, we discuss the implications of the findings for further research and for informing social and health care policy
We focus on inpatient care because of its rapidly rising costs and because, as noted, very little is known about the acute health care behavior and needs of recently disabled workers. We are interested in alternative predictions of two specific health outcomes: survival status and the use of inpatient services in short-stay hospitals.
Most of what is generally known about functionally impaired persons has been obtained from national survey estimates of the non-institutionalized population. However, there are substantial health and demographic differences between persons represented in sample surveys who report functional limitations and impairments and those who receive Federal disability benefits based on medical and clinical evidence in accordance with Social Security program eligibility criteria.
In order to meet SSDI guidelines, disabled-worker applicants must have severe functional limitations and impairments expected to last for at least 1 year or result in death. As an illustration of the highly selective nature of the program, in 1981 (the year of NBS sample selection) only 30 percent of all claims submitted to SSA met acceptance criteria (U.S. House of Representatives, Committee on Ways and Means, 1989).
SSDI is part of the Old Age, Survivors, and Disability Insurance program (popularly known as Social Security). SSDI assists primarily the working population who meet both the SSDI definition of disability and insured status requirements. As previously noted, in order to receive benefits, a disabled worker must be unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment expected to result in death or to last for a continuous period of at least 12 months. In addition, an applicant must meet certain insured-status requirements; i.e., be fully and currently insured.(1) In 1982, the year in which the NBS was conducted, there were approximately 2.6 million disabled-worker beneficiaries, representing a rate of 18.3 disabled workers per 1,000 persons 18-64 years of age. Disabled-worker prevalence rates increased during the 1960s and 1970s, declined in the early 1980s, and then gradually increased from 1984 to 1986 (McCoy and Weems, 1989). The number of new awards increased from 297,000 in 1982 to 425,600 in 1989 (Social Security Administration, 1990).
DATA AND METHODS
Data were obtained from the disabled-worker cohort interviewed in the 1982 NBS and from its inpatient record information represented in the Medicare Automated Data Retrieval System (MADRS).(2) Data pertaining to all deaths that occurred before January 1989 were extracted from the SSA Master Beneficiary Record. An analysis of SSA's death reporting system indicates that it is 90 percent accurate in the short run, and that the remaining cases mainly result in delayed but accurate reporting (U. …