Current Awareness in Aging Research (CAAR) Report #43--July 27, 2000

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:


A. "Deaths: Final Data for 1998," (_NCHS_, July 2000, (PHS) 2000-1120, .pdf format, 106 p.).

To view the report click on "View/download PDF".

B. "National Ambulatory Medical Care Survey: 1998 Summary," (_NCHS_, July 2000, Advance Data 315, .pdf format, 26 p.).

To view the report click on "View/download PDF".

C. "National Hospital Ambulatory Medical Care Survey: 1998 Outpatient Department Summary," (_NCHS_, July 2000, Advance Data 317, .pdf format, 24 p.).

To view the report click on "View/download PDF".

D. "Mammography on the Rise for Women Age 50 and Over," (_NCHS_, July 2000). Note: Data used for this news release is taken from "Health, United States, 2000 With Adolescent Health Chartbook," (_NCHS_, (PHS) 00-1232, 2000, 456 p.).

To view the Chartbook, click on "View/Download PDF".

To download the tables in "Health, United States, 2000," from the NCHS ftp site (tables are in Excel and Lotus format), go to:



"2000 Social Security Bulletin Current Operating Statistics ," (_Social Security Administration_, .pdf format, July 2000).




"Medicare+Choice (M+C) Enrollees Affected by Non-Renewals and Service Area Reductions for 2001," (_HCFA_, July 24, 2000, HTML and Excel 97 format).

Click on "Download" to get to the Excel file.


"Protecting Medicare Beneficiaries After Medicare+Choice Organizations Withdraw and Medicare+Choice Enrollees Affected by Non-Renewals and Service Area Reductions for 2001," (_HCFA_, July 24, 2000, HTML format).

"Statement by Nancy-Ann DeParle Administrator, Health Care Financing Administration MEDICARE+CHOICE Plan Nonrenewals," (_HCFA_, July 24, 2000, HTML format).

4. _HRS/AHEAD DATA ALERTS_: The University of Michigan Institute for Social Research Health and Retirement Study/Asset and Health Dynamics Among the Oldest Old (HRS/AHEAD) website announced three data corrections and the release of two data files:


"Correction to NDI Years in Tracker File Documentation," (_HRS/AHEAD Tracker File, Version 1.0, July 26, 2000).

"Correction to Definition of Assets in Imputation Data," (_AHEAD Wave 2 [1995] Public Release_, July 25, 2000).

"Corrections to ID variables in HRS 1998 preliminary release," (_HRS 1998 Preliminary Release Version 1_, July 24, 2000).


"1999 HRS Experimental Mailout Data Available," (_HRS_, July 25, 2000).

"1998 HRS Preliminary Imputation Data Available," (_HRS_, July 26, 2000).

Note: HRS/AHEAD requires registration prior to downloading data files.

II. Reports and articles:

5. _U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICE--OFFICE OF INSPECTOR GENERAL_ OAS REPORT: "Follow-up Review of the Health Care Financing Administration's Efforts to Assure Employer Group Health Plan Compliance with Medicare Secondary Payer Data Match Requirements," (_Office of Audit Services, A-02-98-01036, .pdf format, 24 p., July 18, 2000).

>Summary: The Health Care Financing Administration (HCFA) contacts employers for group health plan information on employees covered by Medicare. The HCFA has obtained group health plan information from approximately 1.7 million employers, which represent about 87 percent of the employers contacted from 1991 through 1997. The use of this employer provided group health plan information has resulted in approximately $2.5 billion in Medicare secondary payer (MSP) savings. However, the HCFA has not used all available remedies to obtain this information from the remaining 13 percent of employers who have chosen not to respond to the legislatively mandated request for information. As a result of not having this data, we estimate that HCFA has paid out as much as $282 million in Medicare funds for which group health insurance plans were liable. In this final report to HCFA we recommended, among other things, that HCFA assess civil monetary penalties against employers who refuse to respond to the requests for group health plan information on Medicare beneficiaries. The HCFA concurred with our recommendations and has agreed to take corrective action

Click on "Complete Text of Report" to view the full-text .pdf:


6. _U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICE--OFFICE OF INSPECTOR GENERAL_ OAS REPORT: "Follow-Up Audit of Medicare Reimbursements to Hospital Outpatient Department Laboratories for Additional Hematology Indices," (_Office of Audit Services, A-01-99-00521, .pdf format, 18 p., July 17, 2000).

>Summary: A prior audit report disclosed inappropriate Medicare payments for the additional hematology indices that were a by-product of the automated results provided by the hematology profile tests which calculate and measure all indices simultaneously. The Health Care Financing Administration (HCFA) agreed that these codes were not valid for Medicare reimbursement and removed the codes from the Medicare fee schedules effective January 1999. This final audit report points out, however, that a significant number of payments for these tests were made from the time of our prior audit (December 1995) to the date the procedure codes were eliminated from the fee schedules. Based on a statistical sample, we estimated that inappropriate payments totaled about $14 million during this period. We recommended that HCFA direct the fiscal intermediaries (FIs) to recover the estimated $14 million in overpayments made to providers for reimbursement of additional hematology indices. The HCFA concurred with our recommendation and indicated that it will ensure that the FIs begin appropriate recovery efforts.

Click on "Complete Text of Report" to view the full-text .pdf:


"New List of Drugs, Biologics, Devices, and New Technology Services for the Outpatient Prospective Payment System ," (_HCFA_, July 26, 2000, MSWORD and .pdf format). Note: To find the list, scroll down to "Site Content," and for the first item click on "Microsoft Word" or Adobe Acrobat."


8. _NEW ENGLAND JOURNAL OF MEDICINE_ ARTICLE ABSTRACT: "Intravenous Nesiritide, a Natriuretic Peptide, in the Treatment of Decompensated Congestive Heart Failure," by Wilson S. Colucci, et. el. (_New England Journal of Medicine_, Vol. 343, No. 4, July 27, 2000). Note: Your organization may have access to full electronic text (HTML and .pdf formats) of this article. Check your organization's library.


9. _NEW ENGLAND JOURNAL OF MEDICINE_ BOOK REVIEW: "Cancer in the Elderly," edited by Carrie P. Hunter, Karen A. Johnson, and Hyman B. Muss, reviewed by Lodovico Balducci (_New England Journal of Medicine_, Vol. 343, No. 4, July 27, 2000). Note: "Cancer in the Elderly" is published by Marcel Dekker (New York, 2000, 606 p., ISBN 0-8247-0278-6).


10. _BRITISH MEDICAL JOURNAL (BMJ)_ ARTICLE AND EDITORIAL: "Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study," by Lynn Caruana, et. al. (_BMJ_, Vol. 321, Issue 7255, July 22, 2000, 215-218 p., HTML and .pdf format).

_EDITORIAL_: "Can heart failure be diagnosed in primary care?" by Richard Hobbs (_BMJ_, Vol. 321, Issue 7255, July 22, 2000, 188-189 p., HTML and .pdf format)

11. _JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (JAMA)_ ARTICLE: "Effect of Treating Isolated Systolic Hypertension on the Risk of Developing Various Types and Subtypes of Stroke," by H. Mitchell Perry, Jr, MD, et. al. (_JAMA_, Vol. 284, No. 4, 465-471 p., July 26, 2000, .pdf format).

To view the full-text article go to:

Then click on "PDF OF THIS ARTICLE" on the left side of the page.



"Are Therapies for the Treatment and Prevention of Stroke Cost Saving?" (_Drug and Therapy Perspectives_ via Medscape, Vol. 15, No. 12, 2000). Note: Medscape requires free registration before providing articles.



"5th European Congress on Menopause," by Lorraine Dennerstein (_Medscape Women's Health_, Vol. 5, No. 4, 2000): Note: Medscape requires free registration before providing articles.


14. _URBAN INSTITUTE--RETIREMENT PROJECT_ RESEARCH BRIEF: Employee Stock Ownership Plans: A Status Report," by Pamela Perun (_Urban Institute_, June 2000, .pdf and HTML format, 8 p.).

Click on "PDF FORMAT" to view the full-text in .pdf.


III. Working Papers:


"The Impact of Thailand's AIDS Epidemic on Older Persons: Quantitative Evidence from a Survey of Key Informants," by Knodel, John, Chanpen Saengtienchai, Wassana Im-em, and Mark VanLandingham (_Population Studies Center_, PSC Research Report 00-448, July 2000, .pdf format, 56 p.).

Abstract: Discussions of the AIDS epidemic rarely consider the impact on older persons and when they do, focus is typically on those who are infected themselves. Virtually no systematic quantitative assessments exist of the involvement of parents or other older generation relatives in the living and caretaking arrangements of persons with AIDS in either the West or the developing world. We assess the extent of such types of involvement in Thailand and examine the parental characteristics associated with them. We also examine the economic impact on the families and parents through expenditures on treatments and a number of other routes. Interviews with local key informants in the public health system in an extensive sample of rural and urban communities provided quantitative information on a total of 963 adult cases who either had died of AIDS or were currently symptomatic.

The results indicate that a substantial proportion of persons with AIDS move back to their communities of origin at some stage of the illness. Two-thirds of the adults who died of AIDS either lived with or adjacent to a parent by the terminal stage of illness and a parent, usually the mother, acted as a main caregiver for about half. For 70 percent, either a parent or other older generation relative provided at least some care. The vast majority of the parents were age 50 or more and many were age 60 or older. The economic impacts appear to be severe for only a minority of parents although those who are from the poorer economic strata are particularly likely to be substantially affected adversely. The wide availability of government health insurance likely moderates the economic impact on families.

A substantial majority of families in the upper north are reported to be open to the community about a family member being ill with AIDS but only about half of families outside the upper north were considered to be open. Negative community reactions during the time of illness to families with a member who had AIDS was reported for a fifth of the families in the upper North and a third elsewhere. Following the death, few cases of residual negative reaction were reported anywhere.

This extent of older generation involvement in living and caregiving arrangements appears to be far greater in Thailand than in Western countries such as the US. We interpret the difference as reflecting the contrasting epidemiological and socio-cultural situations in Thailand and the West. The fact that older people in Thailand, and probably many other developing countries, are extensively impacted by the AIDS epidemic through their involvement with their infected adult children has important implications for public health programs that address caretaker education and social and economic support.

Click on the "PDF" icon next to the title to view the full-text paper.



"Living Arrangements and Support Relationships Among Elderly Indonesians: Case Studies from Java and Sumatra," by Victoria Beard and Yacobus Kunharibowo (_RAND_, 00-08, DRU-2323-NIA/WFHF, 31 p., 2000). Note: This paper is not available in electronic format, but can be order at no charge. You can order the paper by going to:



A. "The Distributional Burden of Taxing Estates and Unrealized Capital Gains at the Time of Death," by James M. Poterba and Scott Weisbenner (_National Bureau of Economic Research_, W7811, July 2000, .pdf format, 41 p.).

Abstract: The 1998 Survey of Consumer Finances provides information on household wealth ownership that can be used to estimate the effect of changing the Unified Estate and Gift Tax Credit on estate tax revenues. The survey also includes data on the prices at which assets were purchased, along with information on their market values. This makes it possible to compare the revenue yield and the distributional consequences of taxing estates with those of taxing unrealized capital gains on assets held by individuals who die. This paper uses data from the Survey of Consumer Finances to estimate the revenue effects of changes in both estate tax provisions and capital gains tax rules. It finds that among those with small estates ($1 million or less), taxing capital gains at death would collect more revenue than the current estate tax from roughly half of the decedents. For those with larger estates, replacing the estate tax with a tax on unrealized gains at death would result in a substantial reduction in total tax payments. The revenue estimates and distributional analyses assume no change in the current capital gains realization behavior of taxpayers, even if the tax law changes. This is an important limitation, and the paper notes several directions for further research that might help to relax this assumption.

Go to "This paper is available in PDF format" and click on "PDF" to get to the full-text version of this file.

B. "Mortality Risk, Inflation Risk, and Annuity Products," by Jeffrey R. Brown, Olivia S. Mitchell, and James M. Poterba (_National Bureau of Economic Research_, W7812, July 2000, .pdf format, 34 p.).

Abstract: As growing numbers of retirees reach retirement age with substantial balances in self-directed retirement plans, annuities are likely to become increasingly important instruments for drawing down retirement savings. This study explores recent trends in the pricing of single-premium annuity products in the United States. Virtually all of the annuity products currently available in the United States offer fixed nominal payouts, rather than an inflation-linked payout stream. After describing the money's worth' of the various types of nominal annuity products, this study considers the extent to which existing U.S. private annuity markets provide retirees with inflation-protected retirement income flows. Although there is effectively no market yet for inflation-indexed annuities in the United States, such products are available in other countries. The paper concludes by summarizing recent data on the pricing of both nominal and inflation-linked annuities in the United Kingdom and several other nations.

Go to "This paper is available in PDF format" and click on "PDF" to get to the full-text version of this file.

C. "Elderly Asset Management and Health: An Empirical Analysis," by Jonathan S. Feinstein and Chih-Chin Ho (_National Bureau of Economic Research_, W7814, July 2000, .pdf format, 41 p.).


We present models of asset management by the elderly. We focus on saving, spend-down of assets, and gift-giving, and the influence of health on these precesses. We also study the evolution of elderly health and the impact of economic variables on health outcomes. We present results from estimating our models using data from waves one and two of the AHEAD dataset. Our model of asset management links elderly decisions about saving, spend-down of assets, and gift-giving in a system of equations. We divide households for which head and partner (if present) are in poor health and those for which head and partner are in good health; our specification allows for differences in health to affect both the average level of economic outcomes and the marginal effects of income and wealth on the outcomes. We also include in our model a set of sociodemographic control variables. Our model of health outcomes links health in the preceding period to health in the current period, allowing for three outcomes good health, poor health, or death. In our models of health outcomes we include variables measuring health in the previous period, wealth, age, education, and control variables. Our main results are the following. First, results for gift-giving suggest that at least some elderly do plan their estate transfer - those that have established trust funds or for which households assets exceed the estate tax filling threshold have a significantly greater propensity to give gifts. Second, the average level of gift-giving is lower for those in poor health, but the marginal effect of increasing wealth on gift-giving is much greater. This result is important in showing the ways in which health can interact with economic variables in influencing economic decision-making. Third, income is an important determinant of saving and spend-down. Fourth, other things equal, households that save are also more likely to give gifts. Fifth, sudden changes in family structure and health are associated with changing patterns of economic behavior - most especially, becoming a widow or widower is associated with a significant increase in the likelihood both of spending out of assets and of making gifts. Finally, variables related to children have less effect on propensity to give gifts than expected - the only variable that has a significant effect is the number of children for which parents cannot provide income information, suggesting that the quality of the relationship between parents and children is important for gift-giving.

Go to "This paper is available in PDF format" and click on "PDF" to get to the full-text version of this file.


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

18. CARL Uncover Journal Tables of Contents. Follow the instructions below to access tables of contents. CARL Uncover provides fee based document delivery services for selected journals.

A. Point your browser to:

B. click on "Search Uncover"
C. click on "Search Uncover Now"
D. Type the Journal Name in the search box and click the radio button "Journal Title Browse"
E. click on the journal name
F. click on "journal issues"
G. click on the issues identified below

American Journal of Epidemiology (Vol. 152, No. 2, July 15, 2000).

Population and Development Review (Vol. 26, No. 2, June 01, 2000).


V. Legislative Actions:


On July 21, 2000, the Senate Committee on Health, Education, Labor, and Pensions favorably reported to the full Senate a re-authorization of the Older Americans Act of 1965. This bill (S. 1536, as amended) includes a proposal by the Administration on Aging for the National Family Caregiver Support Program.

The Department of Health and Human Services, Administration on Aging has created a Web site to track the re-authorization of the Older Americans Act. The URL for the site is:



20. _DEPARTMENT OF HEALTH AND HUMAN SERVICES--ADMINISTRATION ON AGING_ GRANT ANNOUNCEMENT: Racial and Ethnic Approaches to Community Health 2010 for the Elderly (REACH 2010)

SUMMARY: The Administration on Aging (AoA) announced in the Federal Register of July 21, 2000 of Fiscal Year 2000 that it will hold a competition for grant awards to support Racial and Ethnic Approaches to Community Health 2010 for the Elderly (REACH 2010) as authorized by Title IV, Section 424 of the Older Americans Act, as amended (P.L. 102-375). This accompanying set of materials comprises the application kit for preparing and submitting grant proposals to compete for these project awards.



21. _ACADEMY FOR HEALTH SERVICES RESEARCH AND HEALTH POLICY_ CONFERENCE WEB SITE: "Fall Seminars in Health Services Research Methods: 'Using Federal and State Databases'".

The conference will be held at the Georgetown University Conference Center, in Washington, D.C. (October 30-November 1, 2000). The conference is sponsored by The Academy for Health Services Research and Health Policy, and is co-sponsored by four Federal agencies (NCHS, Department of Veterans Affairs, Health Care Financing Administration, and Agency for Healthcare Research and Quality). The Seminars will focus on six-to-eight databases over the three day, with overviews and discussion of lessons learned in the field.

For information on scheduled sessions, scroll to the bottom of the page and click on one of the three date. Registration information is also available.


The conference will be held at the Penn Stater Conference Center Hotel, State College, PA (October 9-10).

This conference will give equal emphasis to the refinement of theoretical issues and to the assembling of current empirical knowledge on the role of mastery and control in older populations. The far-reaching goal of this conference is to gain a better understanding of personal control and how it functions as a protective mechanism in the lives of older people. Four central goals will be explored:

1. the nature of mastery and control and its dimensional properties;
2. the social, economic, and experimental conditions that sustain or change the levels of older people's sense of mastery and control;
3. the role of mastery and control over the life course and during pivotal life transitions; and
4. the consequences of mastery and control for health and well-being.

Approval to offer 10.5 Continuing Education (CE) credits for psychologists has been requested from the Penn State Consortium





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