The U.S. Department of Agriculture Economic Research Service (USDA/ERS) maintains four highly related but distinct geographic classification systems to designate areas by the degree to which they are rural. The original urban-rural code scheme was developed by the ERS in the 1970s. Rural America today is very different from the rural America of 1970 described in the first rural classification report. At that time migration to cities and poverty among the people left behind was a central concern. The more rural a residence, the more likely a person was to live in poverty, and this relationship held true regardless of age or race. Since the 1970s the interstate highway system was completed and broadband was developed. Services have become more consolidated into larger centers. Some of the traditional rural industries, farming and mining, have prospered, and there has been rural amenity-based in-migration. Many major structural and economic changes have occurred during this period. These factors have resulted in a quite different rural economy and society since 1970. In April 2015, the Committee on National Statistics convened a workshop to explore the data, estimation, and policy issues for rationalizing the multiple classifications of rural areas currently in use by the Economic Research Service (ERS). Participants aimed to help ERS make decisions regarding the generation of a county rural-urban scale for public use, taking into consideration the changed social and economic environment. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Official U.S. Rural Area Classification Systems 3 Other Rural Area Classification Systems Used in the United States and Internationally 4 Changes in Society and Economy and Their Impact on Rural Area Classifications 5 Different Ways to Conceptualize Rural Areas in Metropolitan Society 6 Uses of Current Rural Classification Systems 7 Changes in Social Science Data and Methods 8 Evaluating the Reliability and Validity of Rural Area Classifications 9 Closing Remarks Bibliography Appendix A: ERS Goals for Workshop on Rural Classifications Appendix B: Historical Development of ERS Rural-Urban Classification Systems--John Cromartie Appendix C: Workshop Agenda and List of Participants Appendix D: Biographical Sketches of Steering Committee Members Committee on National Statistics

The Society Security disability program faces urgent challenges: more people receiving benefits than ever before, the prospect of even more claimants as baby boomers age, changing attitudes culminating in the Americans With Disabilities Act. Disability is now understood as a dynamic process, and Social Security must comprehend that process to plan adequately for the times ahead. The Dynamics of Disability provides expert analysis and recommendations in key areas: Understanding the current social, economic, and physical environmental factors in determining eligibility for disability benefits. Developing and implementing a monitoring system to measure and track trends in work disability. Improving the process for making decisions on disability claims. Building Social Security's capacity for conducting needed research. This book provides a wealth of detail on the workings of the Social Security disability program, recent and emerging disability trends, issues and previous experience in researching disability, and more. It will be of primary interest to federal policy makers, the Congress, and researchers?and it will be useful to state disability officials, medical and rehabilitation professionals, and the disability community. Table of Contents Front Matter Summary 1 Introduction 2 Dynamics of SSA's Disability Programs 3 Conceptual Issues in Defining Work Disability 4 Survey Measurement of Disability 5 A Work Disability Monitoring System 6 Improving the Disability Decision Process 7 Enhancing SSA's Research Capacity References Acronyms and Abbreviations Appendix A Committee Meetings and Presenters of Testimony Appendix B Workshop Agendas and Presenters Appendix C Committee Recommendations Biographical Sketches of Committee Members Conceptual Issues in the Measurement of Work Disability Methodological Issues in the Measurement of Work Disability SSA's Disability Determination of Mental Impairments: A Review Toward an Agenda for Research Survey Design Options for the Measurement of Persons with Work Disabilities Persons with Disabilities and Demands of the Contemporary Labor Market Index

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care. Table of Contents Front Matter Executive Summary Introduction Profile of Long-Term Care State of Quality of Long-Term Care Information Systems for Monitoring Quality Improving Quality Through External Oversight Strengthening the Caregiving Work Force Building Organizational Capacity Reimbursing to Improve Quality of Care Closing Remarks References Appendix A: Committee Meetings and Presenters of Testimony Appendix B: Separate Dissenting Opinions Acronyms Biographical Sketches of Committee Members Index

The Social Security Administration (SSA) is engaged in redesigning its disability determination process for providing cash benefits and medical assistance to blind and disabled persons under the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program (Title II and Title XVI of the Social Security Act). The agency has undertaken a multiyear research effort to develop and test the feasibility, validity, reliability, and practicality of the redesigned disability determination process before making any decision about its national implementation. Survey Measurement of Work Disability reviews and provides advice on this research. One of the major areas for review is the ongoing independent, scientific review of the scope of work, design, and content of the Disability Evaluation Study (DES) and the conduct of the study by the chosen survey contractor. This report identifies statistical design, methodological, and content concerns and addresses other issues as they arise.

Developing credible short-term and long-term projections of Medicare health care costs is critical for public- and private-sector policy planning, but faces challenges and uncertainties. There is uncertainty not only in the underlying economic and demographic assumptions used in projection models, but also in what a policy modeler assumes about future changes in the health status of the population and the factors affecting health status , the extent and pace of scientific and technological breakthroughs in medical care, the preferences of the population for particular kinds of care, the likelihood that policy makers will alter current law and regulations, and how each of these factors relates to health care costs for the elderly population. Given the substantial growth in the Medicare population and the continued increases in Medicare, Medicaid, and private health insurance spending, the availability of well-specified models and analyses that can provide useful information on the likely cost implications of health care policy alternatives is essential. It is therefore timely to review the capabilities and limitations of extant health care cost models and to identify areas for research that offer the most promise to improve modeling, not only of current U.S. health care programs, but also of policy alternatives that may be considered in the coming years. The National Research Council conducted a public workshop focusing on areas of research needed to improve health care cost projections for the Medicare population, and on the strengths and weaknesses of competing frameworks for projecting health care expenditures for the elderly. The workshop considered major classes of projection and simulation models that are currently used and the underlying data sources and research inputs for these models. It also explored areas in which additional research and data are needed to inform model development and health care policy analysis more broadly. The workshop, summarized in this volume, drew people from a wide variety of disciplines and perspectives, including federal agencies, academia, and nongovernmental organizations. Table of Contents Front Matter 1 Introduction 2 Current Models of Health Care Cost Projections 3 Modeling Medical Technology 4 Factors Affecting Health Status 5 Participants' Views on Needed Research References Appendixes Appendix A: Predicting Medicare Cost Growth--John N. Friedman Appendix B: Workshop Agenda and Presenters Appendix C: Biographical Sketches of Steering Committee Members Committee on National Statistics

The United States has seen major advances in medical care during the past decades, but access to care at an affordable cost is not universal. Many Americans lack health care insurance of any kind, and many others with insurance are nonetheless exposed to financial risk because of high premiums, deductibles, co-pays, limits on insurance payments, and uncovered services. One might expect that the U.S. poverty measure would capture these financial effects and trends in them over time. Yet the current official poverty measure developed in the early 1960s does not take into account significant increases and variations in medical care costs, insurance coverage, out-of-pocket spending, and the financial burden imposed on families and individuals. Although medical costs consume a growing share of family and national income and studies regularly document high rates of medical financial stress and debt, the current poverty measure does not capture the consequences for families' economic security or their income available for other basic needs. In 1995, a panel of the National Research Council (NRC) recommended a new poverty measure, which compares families' disposable income to poverty thresholds based on current spending for food, clothing, shelter, utilities, and a little more. The panel's recommendations stimulated extensive collaborative research involving several government agencies on experimental poverty measures that led to a new research Supplemental Poverty Measure (SPM), which the U.S. Census Bureau first published in November 2011 and will update annually. Analyses of the effects of including and excluding certain factors from the new SPM showed that, were it not for the cost that families incurred for premiums and other medical expenses not covered by health insurance, 10 million fewer people would have been poor according to the SPM. The implementation of the patient Protection and Affordable Care Act (ACA) provides a strong impetus to think rigorously about ways to measure medical care economic burden and risk, which is the basis for Medical Care Economic Risk. As new policies - whether part of the ACA or other policies - are implemented that seek to expand and improve health insurance coverage and to protect against the high costs of medical care relative to income, such measures will be important to assess the effects of policy changes in both the short and long term on the extent of financial burden and risk for the population, which are explained in this report. Table of Contents Front Matter Summary PART I: REVIEW AND RECOMMENDATIONS 1 Introduction 2 Concepts of Medical Care Economic Burden and Risk 3 Concepts of Resources 4 Measures of Medical Care Economic Risk and Recommended Approach 5 Data Sources 6 Implementing Measures of Medical Care Economic Burden and Risk References Acronyms and Abbreviations Appendix: Biographical Sketches of Panel Members and Staff PART II: RESOURCES FOR THE STUDY: DEVELOPING A MEASURE OF MEDICAL CARE ECONOMIC RISK - WORKSHOP SUMMARY 1 Introduction 2 Context for the Workshop 3 Measuring Medical Care Economic Risk 4 Issues in the Development of Thresholds 5 Issues in Defining Resources 6 Implementation Issues 7 Recap of Issues and Next Steps References Appendix: Workshop Agenda and Presenters PART III: RESOURCES FOR THE STUDY: BACKGROUND PAPERS Conceptual Framework for Measuring Medical Care Economic Risk--Sarah Meier and Barbara Wolfe Incorporating Data on Assets into Measures of Financial Burdens of Health--Jessica S. Banthin and Didem Bernard An Assessment of Data Sources for Measuring Medical Care Economic Risk--John L. Czajka Committee on National Statistics Institute of Medicine

Improving the Measurement of Late-Life Disability in Population Surveys summarizes a workshop organized to draw upon recent advances to improve the measurement of physical and cognitive disability in population surveys of the elderly population. The book questions whether or not the measures of activities of daily living and instrumental activities of daily living used in many population surveys are sufficient as the primary survey-based indicators of late-life disability. If not, should they be refined or should they be supplemented by other measures of disability in surveys? If yes, in what ways should disability measures be changed or modified to produce population estimates of late-life disability and to monitor trends? The book also discusses what further research is needed to advance this effort. Table of Contents Front Matter 1 Introduction 2 Challenges to Improving Measurement of Late-Life Functioning and Disability 3 Potential Methods for Revising Measures to Foster Comparability Across Subgroups 4 Improving the Validity of Cross-Population Comparisons 5 Measuring Functioning and Disability in Context 6 Research and Development Toward Improved Measures of Late-Life Disability References Appendix A: Population Survey Measures of Functioning: Strengths and Weaknesses--Barbara M. Altman Appendix B: Workshop Agenda and Presenters Appendix C: Biographical Sketches of Steering Committee Members Committee on Population Committee on National Statistics

The United States is viewed by the world as a country with plenty of food, yet not all households in America are food secure, meaning access at all times to enough food for an active, healthy life. A proportion of the population experiences food insecurity at some time in a given year because of food deprivation and lack of access to food due to economic resource constraints. Still, food insecurity in the United States is not of the same intensity as in some developing countries. Since 1995 the U.S. Department of Agriculture (USDA) has annually published statistics on the extent of food insecurity and food insecurity with hunger in U.S. households. These estimates are based on a survey measure developed by the U.S. Food Security Measurement Project, an ongoing collaboration among federal agencies, academic researchers, and private organizations. USDA requested the Committee on National Statistics of the National Academies to convene a panel of experts to undertake a two-year study in two phases to review at this 10-year mark the concepts and methodology for measuring food insecurity and hunger and the uses of the measure. In Phase 2 of the study the panel was to consider in more depth the issues raised in Phase 1 relating to the concepts and methods used to measure food security and make recommendations as appropriate. The Committee on National Statistics appointed a panel of 10 experts to examine the above issues. In order to provide timely guidance to USDA, the panel issued an interim Phase 1 report, Measuring Food Insecurity and Hunger: Phase 1 Report. That report presented the panel's preliminary assessments of the food security concepts and definitions; the appropriateness of identifying hunger as a severe range of food insecurity in such a survey-based measurement method; questions for measuring these concepts; and the appropriateness of a household survey for regularly monitoring food security in the U.S. population. It provided interim guidance for the continued production of the food security estimates. This final report primarily focuses on the Phase 2 charge. The major findings and conclusions based on the panel's review and deliberations are summarized. Table of Contents Front Matter Executive Summary 1 Introduction 2 History of the Development of Food Insecurity and Hunger Measures 3 Concepts and Definitions 4 Survey Measurement of Food Insecurity and Hunger 5 Item Response Theory and Food Insecurity 6 Survey Vehicles to Measure Food Insecurity and Hunger 7 Applicability of Food Insecurity Outcomes for Assessment of Program Performance 8 Closing Remarks References Acronyms and Abbreviations Appendix A Current Population Survey Food Security Supplement Questionnaire, December 2003 Appendix B Biographical Sketches of Panel Members and Staff Index