Current Awareness in Aging Research (CAAR) Report #348--July 27, 2006


CAAR (Current Awareness in Aging Research) is a weekly email report produced by the Center for Demography of Health and Aging at the University of Wisconsin-Madison that helps researchers keep up to date with the latest developments in the field. For more information, including an archive of back issues and subscription information see:


I. Data:

1. MEDICAL EXPENDITURE PANEL SURVEY: "MEPS HC-084: 2005 P9R3/P10R1 Population Characteristics," (Agency for Healthcare Research and Quality, July 2006, data in .zip and .exe self-decompressing ASCII and SAS transport format, SAS and SPSS programming statements, documentation in HTML, .pdf or ASP codebook format). Note: "The data consist of 2005 data obtained in Round 3 of Panel 9 and Round 1 of Panel 10 of the MEPS Household Component and contains variables pertaining to survey administration, demographics, employment, health status, and health insurance."


II. Reports and articles:


A. "Medicare Physician Services: Use of Services Increasing Nationwide and Relatively Few Beneficiaries Report Major Access Problems," (GAO-06-704, July 2006, .pdf format, 61p.).

B. "Medicare Outpatient Payments: Rates for Certain Radioactive Sources Used in Brachytherapy Could Be Set Prospectively," (GAO-06-635, July 2006, .pdf format, 28p.).

Note: This is a temporary address. GAO reports are always available at:

3. MEDICAL EXPENDITURE PANEL SURVEY REPORT: "Trends in the Pharmaceutical Treatment of Hypertension, 1997 to 2003," by G. Edward Miller and Marc Zodet (Research Findings No. 25, July 2006, .pdf format, 31p.).


A. "Comparison of Fourth Quarter 2005 Average Sales Prices to Average Manufacturer Prices: Impact on Medicare Reimbursement for Second Quarter 2006,"(OEI-03-06-00370, June 2006, .pdf format, 14p.).


In 2005, Medicare began paying for most Part B drugs using a new methodology based on average sales prices (ASP). Pursuant to section 1847A(d)(3) of the Social Security Act, OIG must notify the Secretary of the Department of Health and Human Services if the ASP for a particular drug exceeds the drug's average manufacturer price (AMP) by a threshold of 5 percent. If that threshold is met, section 1847A(d)(3) of the Act grants the Secretary authority to disregard the ASP pricing methodology for that drug and substitute the payment amount for the drug code with the lesser of the widely available market price for the drug (if any) or 103 percent of the AMP. Based on our analysis of data from the fourth quarter of 2005, 46 of 341 Healthcare Common Procedure Coding System (HCPCS) codes had an ASP that exceeded the AMP by at least 5 percent. Twenty of the 46 HCPCS codes were previously eligible for price adjustment as a result of an earlier comparison between ASPs and AMPs, which was performed using data from the third quarter of 2004. If reimbursement amounts for all 46 codes had been based on 103 percent of AMP during the second quarter of 2006, we estimate that Medicare expenditures would have been reduced by $16 million.

B. "Review of Claims Billed by Independent Diagnostic Testing Facilities for Services Provided to Medicare Beneficiaries During Calendar Year 2001,"(A-03-03-00002, June 2006, .pdf format, 28p.).


Our objectives were to determine whether: (1) services that IDTFs provided to Medicare beneficiaries with 100 or fewer services during CY 2001 were (a) reasonable and necessary, (b) ordered by a physician, and (c) sufficiently documented in accordance with Federal laws, regulations, and guidelines; and, (2) IDTFs operated in accordance with their initial enrollment applications and subsequent updates filed with the carriers. Services that IDTFs provided to Medicare beneficiaries were not always reasonable and necessary, ordered by a physician, or sufficiently documented. Of the 230 sampled beneficiaries, who received 1,804 IDTF services, 80 beneficiaries received 1,231 services that did not comply with applicable Federal laws, regulations, and guidelines. We also found a marked pattern of repetitive use of services. Fifty-five of the sampled beneficiaries accounted for 1,095 of the 1,231 questioned services. These beneficiaries received their services from IDTFs in California and Florida.

Of the 219 IDTFs that provided services to the sampled beneficiaries, 191 did not comply with initial enrollment application and subsequent update requirements. IDTFs did not report operational changes such as the identity and number of technicians, supervising and interpreting physicians, type and model number of equipment, and tests performed. IDTFs also failed to report changes in their ownership and location.

We recommended that CMS require its carriers to: (1) recover the $164,839 in overpayments that we identified; (2) perform follow-up reviews to identify and recover a potential $71.5 million in improper payments made to IDTFs by the 10 selected carriers, in particular those in California and Florida; and (3) consider performing site visits to monitor compliance with IDTFs' initial enrollment applications and subsequent updates should funding become available.

In its comments on our draft report, CMS agreed with the first two recommendations subject to verification of the overpayments by the Medicare contractors and other conditions. With respect to the third recommendation, CMS stated that, because of funding limitations, it was not able to require Medicare carriers to conduct site visits to monitor IDTF compliance. While we continue to believe that onsite visits are a useful tool to ensure that only legitimate IDTFs are enrolled in the Medicare program, we have modified our third recommendation to acknowledge those funding limitations.

C. "Nursing Home Complaint Investigations," (OEI-01-04-00340, July 2006, .pdf format, 34p.).


This report assesses (1) whether State agencies investigate nursing home complaints in accordance with program requirements, and (2) CMS's monitoring of State agency performance in investigating nursing home complaints. OIG found that State agencies did not investigate some of the most serious nursing home complaints within the required timeframe, including 7 percent of complaints alleging immediate jeopardy and 27 percent of complaints alleging actual harm (high). In addition, while the Federal complaint tracking system, ASPEN Complaints/Incidents Tracking System (ACTS), shows potential for managing complaints, State agencies have not taken full advantage of this system. Finally, CMS oversight of nursing home complaint investigations is limited. OIG found that CMS conducts few Federal Oversight and Support Surveys (FOSS), which allow CMS's regional offices an opportunity to observe a State agency's complaint investigation process. However, CMS guidance states that State agencies should provide CMS with at least 2 weeks' advance notice of scheduled surveys, thus limiting the use of the FOSS for the most serious nursing home complaints. OIG recommends that CMS require State agencies to meet the 10-day timeframe for investigating complaints involving actual harm (high), increase oversight of the State agencies, and offer additional ACTS training to its regional offices as well as State agencies. OIG also recommended that CMS remove the 2-week advance notice period for FOSS. CMS concurred with our first three recommendations, but did not concur that it should eliminate the 2-week advance notice for FOSS.

5. _MORBIDITY AND MORTALITY WEEKLY REPORTS_ RECOMMENDATIONS AND REPORTS: "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)," (Vol. 55, RR10, July 28, 2006, .pdf and HTML format, 42p.).



6. US DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE OF THE ASSISTANT SECRETARY FOR PLANNING AND EVALUATION REPORT: "Examination of Texas Rider 37: A Medicaid 'Money Follows the Person' Long-Term Care Initiative," by Barbara A. Ormond, Anna S. Sommers and Kirsten J. Black (May 2006, .pdf and HTML format, 63p.).

7. US NATIONAL INSTITUTE ON AGING PRESS RELEASE: "Keep it Cool with Hot Weather Advice for Older People," (July 24, 2006).

8. CENTER FOR RETIREMENT RESEARCH AT BOSTON COLLEGE ISSUE BRIEF: "Will We Have To Work Forever?" by Alicia H. Munnell, Marric Buessing, Mauricio Soto, and Steven A.Sass (WOB No. 4, July 2006, .pdf format, 8p.).


A. "The Employment-Based Pension System: Evolution or Revolution?" by John A.
MacDonald (Vol. 27, No. 7, July 2006, .pdf format, 12p.).

B. "Savings Needed to Fund Health Insurance and Health Care Expenses in Retirement," by Paul Fronstin (EBRI Issue Brief No. 295, July 2006, .pdf format, 32p.).

10. CENTER FOR POLICY RESEARCH [SYRACUSE UNIVERSITY] POLICY BRIEF: "How Will Declining Rates of Marriage Reshape Eligibility for Social Security?" Madonna Harrington Meyer, Douglas A. Wolf, and Christine L. Himes (No. 33/2006, July 2006, .pdf format, 21p.).


A. "Medicare: The Basics," by Tricia Neuman (July 2006, PowerPoint format).

B. "Medicare Finance," by Jack Ebeler (July 2006, PowerPoint format).

C. "Part D Issue," Marilyn Moon (July 2006, PowerPoint format).

D. "Seniors' Early Experiences With Their New Medicare Drug Plans-June 2006," (July 2006, .pdf format, 31p.).

Related Press Release:

12. MILLIMAN CONSULTANTS AND ACTUARIES REPORT: "Milliman 2006 Pension Study," (July 2006, .pdf format, 20p.).

13. ILCUSA REPORT: "ILC Policy Report," (International Longevity Center, USA, July 2006, .pdf format, 5p.). The ILC Policy Report is "a monthly compilation of longevity news and trends in the U.S. and abroad."


A. "Veterans on Community Aged Care Packages," (Aged care series No. 9, July 2006, .pdf format, 120p.).

B. "The ins and outs of residential respite care," (AIHW bulletin No. 43, July 2006, .pdf format, 19p.).

C. "National evaluation of the Aged Care Innovative Pool Dementia Pilot," (Aged care series No. 10, July 2006, .pdf format, 468p.).

15. SOUTH KOREA NATIONAL STATISTICS OFFICE NEWS RELEASE: "Supplementary Results of the Economically Active Population Survey for the Old Population Aged 55 to 79," (July 12, 2006).

16. STATISTICS CANADA REPORT: "Aging Well: Time Use Patterns of Older Canadians, 2005," by Susan Stobert, Donna Dosman, and Norah Keating (General Social Survey on Time Use: Cycle 19, July 2006, .pdf format, 28p.).

Related article:


A. "Alzheimer's disease {beta}-amyloid peptides are released in association with exosomes," by Lawrence Rajendran, Masanori Honsho, Tobias R. Zahn, Patrick Keller, Kathrin D. Geiger, Paul Verkade, and Kai Simons (Vol. 103, No. 30, July 25, 2006, p. 11172-11177).

B. "Drusen, choroidal neovascularization, and retinal pigment epithelium dysfunction in SOD1-deficient mice: A model of age-related macular degeneration," by Yutaka Imamura, Setsuko Noda, Kouhei Hashizume, Kei Shinoda, Mineko Yamaguchi, Satoshi Uchiyama, Takahiko Shimizu, Yutaka Mizushima, Takuji Shirasawa, and Kazuo Tsubota (Vol. 103, No. 30, July 25, 2006, .pdf and HTML format,p. 11282-11287). Note: _PNAS_ is providing open access to the full-text of this article.


III. Working Papers:


A. "Do the Elderly Reduce Housing Equity? An International Comparison," by Jappelli Tullio and Chiuri Maria (Working Paper No. 436, June 2006, .pdf format, 25p.).


We explore the shape of the elderly homeownership rate using a collection of microeconomic surveys of 17 OECD countries. In most, the survey is repeated over time. This allows us to construct an international dataset of repeated cross-sectional data, merging 59 national household surveys on about 300,000 individuals. We find that ownership rates decline considerably after age 60 in most countries. However, a large part of the decline should be attributed to cohort effects. After adjusting for such effects, we find that ownership rates fall after age 70 at a rate of about half a percentage point per year. Interestingly, ownership trajectories are quite similar across countries - with the exceptions of Finland and Canada - and unrelated to a wide set of indicators that we examine.

B. "Income Inequality over the Later-life Course: A Comparative Analysis of Seven OECD Countries," by Prus Steven and Brown Robert (Working Paper No. 435, June 2006, .pdf format, 16p.).


This paper examines income inequality over stages of the later-life course (age 45 and older) and systems that can be used to mitigate this inequality. Two hypotheses are tested: Levels of income inequality decline during old age because public benefits are more equally distributed than work income; and, because of the progressive nature of government benefits, countries with stronger public income security programs are better able to reduce income inequalities during old age. The analysis is performed by comparing age groups within seven OECD countries (Canada, Germany, the Netherlands, Norway, Sweden, the United Kingdom, and the United States) using Luxembourg Income Study data. Both hypotheses are supported. Several conclusions are drawn from the findings.


A. "Determinants and Consequences of Bargaining Power in Households," by Leora Friedberg and Anthony Webb (Working Paper No. w12367, July 2006, .pdf format, 41p.).


A growing literature offers indirect evidence that the distribution of bargaining power within a household influences decisions made by the household. The indirect evidence links household outcomes to variables that are assumed to influence the distribution of power within the household. In this paper, we have data on whether a husband or wife in the Health and Retirement Study "has the final say" when making major decisions in a household. We use this variable to analyze determinants and some consequences of bargaining power. Our analysis overcomes endogeneity problems arising in many earlier studies and constitutes a missing link confirming the importance of household bargaining models. We find that decision-making power depends on plausible individual variables and also influences important household outcomes, with the second set of results much stronger than the first set. Current and lifetime earnings have significant but moderate effects on decision-making power. On the other hand, decision-making power has important effects on financial decisions like stock market investment and total wealth accumulation and may help explain, for example, the relatively high poverty rate among widows.

B. "Charting the Economic Life Cycle," by Ronald Lee, Sang-Hyop Lee, and Andrew Mason (Working Paper No. w12379, July 2006, .pdf format, 24p.).


Understanding the economic lifecycle - how it varies and why - is important in its own right, but is also critical to understanding how changes in population age structure influence many features of the macroeconomy. Economic behavior over the life cycle can be summarized by the average levels of consumption and labor earnings at each age, as shaped by biology, culture, institutions and individual choice. Here we present estimates of these in detail for the US and Taiwan, showing the roles played by public and familial transfer systems as well as asset accumulation, and present more basic profiles for selected additional countries drawing on studies from a larger project. Average economic dependency occurs when consumption exceeds labor earnings, typically in childhood and old age. A changing population age distribution alters the relative numbers of weighted consumers and producers, as summarized by the support ratio. The 'demographic dividend' occurs during a sustained period of improving support ratios during the demographic transition, as can be shown using these profiles. The estimated cross-sectional age profiles of labor income have a broadly similar hump shape. However, there are striking contrasts in the timing of earnings over the life cycle. The consumption profiles reveal even more striking contrasts, with a flat age profile of total adult consumption in Taiwan and a steeply rising one in the U.S. We believe these differences reflect the extended family versus the state as the primary locus of transfers to the elderly. Profiles for private consumption are also quite variable, with Indonesia peaking early around age 25, Taiwan being essentially flat, and the US peaking late at around 55. Private expenditures on education show wide variations, with unusually high expenditures in some Asian countries. Because of possible public-private substitutions, it is questionable to assign causality to either for differences in total consumption, but it is hard to avoid noticing that without public spending on Medicare and institutional Medicaid in the U.S., total consumption would decline after 55, whereas with them, it rises strongly. There is only a short period of life during which production exceeds consumption barely more than 30 years in the US, Taiwan, and Thailand. The brevity of this phase contrasts sharply with high life expectancy, approaching 80 years in many countries.

20. ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT ECONOMICS DEPARTMENT: "Assessing the 2005 Czech Proposals for Pension Reform," by Philip Hemmings and Edward Whitehouse (Economics Department Working Paper No. 496, July 2006, .pdf and MS Word format, 29p.).


The Czech Republic faces one of the largest demographic challenges in the OECD area and making sure the public pension system is able to cope with rapid population ageing is important for long-term fiscal stability and social welfare. This paper assesses five proposals for pension reform made in late 2005 with a view to helping progress towards a final decision on reform. The proposals cover a wide range of options: only parametric change of the current pay-as-you-go (PAYG) system, systems combining a PAYG pension with a second-pillar (defined contribution), a flat-rate pension and a system of notional accounts. The analysis uses OECD simulation models to compare the proposals in terms of fiscal sustainability, safety nets, early retirement incentives, diversification into private provision, simplicity and the pensions-earnings link.

21. CENTER FOR ECONOMIC STUDIES/Ifo INSTITUTE FOR ECONOMIC RESEARCH (CESifo) [UNIVERSITY OF MUNICH, GERMANY]: "Intergenerational Risk Sharing by Means of Pay-as-you-go Programs - an Investigation of Alternative Mechanisms," by Ø ystein Thøgersen (CESifo Working Paper No. 1759, July 2006, .pdf format, 24p.).


A pay-as-you-go (paygo) pension program may provide intergenerational pooling of risks to individuals' labor and capital income over the life cycle. By means of a model that provides illuminating closed form solutions, we demonstrate that the magnitude of the optimal paygo program and the nature of the underlying risk sharing effects are very sensitive to the chosen combination of risk concepts and stochastic specification of long run aggregate wage income growth. In an additive way we distinguish between the pooling of wage and capital risks within periods and two different intertemporal risk sharing mechanisms. For realistic parameter values, the magnitude of the optimal paygo program is largest when wage shocks are not permanent and individuals in any generation are considered from a pre-birth perspective, i.e. a 'rawlsian risk sharing' perspective is adopted.

22. INSTITUTE FOR THE STUDY OF LABOR (IZA) [UNIVERSITY OF BONN, GERMANY]: "The Location of Immigrants at Retirement: Stay/Return or 'Va-et-Vient'?" by Augustin de Coulon and François-Charles Wolff (IZA Discussion Paper No. 2224, July 2006, .pdf format, 28p.).


In this paper, we investigate the location choice of immigrants when retiring. In a context where labour considerations no longer matter, the location decisions are expected to depend not only on a comparison of standard-of-living between the origin and host countries, but should also be affected by the strength of family relationships. Assuming that migrants derive some satisfaction from contact and visits with other family members, we suggest that migrants may choose a third type of migration move beyond the standard stay/return decision called the 'va-et-vient', where individuals choose to share their time across the host and the origin country. In the empirical analysis, we investigate the determinants of the location intention when retiring using a recent data set on migrants currently living in France. We find that the migrant's choice is significantly related to the location of other family members and that those determinants vary with respect to the different preferred choices.

23. DEPARTMENT OF ECONOMICS [UNIVERSITY OF OSLO]: "Early Retirement and Company Characteristics," by Erik Hernæs, Fedor Iskhakov, and Steinar Strøm (Memorandum No. 16/2006, June 2006, .pdf format, 31p.).


Early retirement decisions derived from a structural model with economic incentives and firm workforce changes, are estimated on Norwegian linked household and firm data. For households in which the wife is the first to become eligible for early retirement, the impact on early retirement of a reduction in the firm workforce is stronger relative to economic incentives than is the case for men, in particular in the private sector. Both for men and women, also an expansion of the firm workforce implies a higher retirement probability. The eligibility age in the early retirement programme has gradually been reduced from 66 in 1989 to 62 in 1998. We find that the economic incentives relative to the push factor have become more important, both for men and women, the lower the eligibility age is.


IV. Journal Tables of Contents (check your library for availability):

24. American Journal of Geriatric Psychiatry (Vol. 14, No. 8, August 1, 2006).

25. European Journal of Palliative Care (Vol. 13, No. 4, 2006).

26. Journal of Aging Studies (Vol. 20, No. 3, Sept. 2006). Note: Full electronic text of this journal is available in the EBSCO Host Academic Search Elite Database. Check your library for the availability of this database and this issue.

27. Journals of Gerontology Series A: Biological Sciences and Medical Sciences (Vol. 61, No.7, July 1, 2006). Note: Full electronic text of these journals is available in the ProQuest Research Library. Check your library for the availability of these databases and these issues.

28. Medical Care (Vol. 44, No. 8, August 2006).

29. Omega: The Journal of Death and Dying (Vol. 52, No. 3, 2005).

30. Research on Aging (Vol. 28, No. 5, Sept. 1, 2006). Note: Full electronic text of these journals is available in the ProQuest Research Library and the EBSCO Host Academic Search Elite Database. Check your library for the availability of this database and these issues.

31. AMEDEO MEDICAL LITERATURE: Note: "AMEDEO has been created to serve the needs of healthcare professionals, including physicians, nurses, pharmacists, administrators, other members of the health professions, and patients and their friends. They can easily access timely, relevant information within their respective fields... All AMEDEO services are free of charge. This policy was made possible thanks to generous unrestricted educational grants provided by AMGEN, Berlex, Eisai, Glaxo Wellcome, Novartis, Pfizer, Roche, and Schering AG."

A. Osteoporosis: Literature for the week of July 26, 2006:

B. Alzheimer's Disease: Literature for the week of July 26, 2006:

C. Parkinson's Disease: Literature for the week of July 26, 2006:

D. Prostate Cancer: Literature for the week of July 26, 2006:

E. Stem Cell Research: Literature for the week of July 26, 2006:

F. Ophthalmology: Literature for the week of July 26, 2006:

AMEDEO Literature Guide:


V. Books:

32. NATIONAL ACADEMIES PRESS: _Aging in Sub-Saharan Africa: Recommendations for Furthering Research_ edited by Barney Cohen and Jane Menken (2006, ISBN: 0309102812, OpenBook format, 450p.).


VI. Funding Opportunities:

33. NIH: "Ruth L. Kirschstein National Research Service Awards for Individual Predoctoral Fellowships (F31) to Promote Diversity in Health-Related Research," (US National Institutes of Health, National Institute on Aging, in conjunction with other agencies, PA-06-481, July 21, 2006).


VII. Conferences:

34. MEDICAL EXPENDITURE PANEL SURVEY: "Three-Day Instructional and Computer Hands-On AHRQ Conference Center, September 6-8, 2006," (Agency for Healthcare Research and Quality).


VIII. Legislation Information Updates:

35. US SENATE SPECIAL COMMITTEE ON AGING HEARING TESTIMONY: "At Home DNA Tests: Marketing Scam or Medical Breakthrough?" a hearing held July 27, 2006.

Hearing testimony (.pdf format):


A. "Medicare Physician Payment: How to Build a Payment System that Provides Quality, Efficient Care for Medicare Beneficiaries, Day 1," a hearing held July 25, 2006.

Hearing testimony:

B. "Medicare Physician Payment: How to Build a Payment System that Provides Quality, Efficient Care for Medicare Beneficiaries, Day 2," a hearing held July 27, 2006.

Hearing testimony:




Charlie Fiss
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