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Health-Care Utilization as a Proxy in Disability Determination (2018) / Chapter Skim
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5 Proxies for Determining Listing-Level Severity
Pages 89-96

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From page 89...
... Listing-level severity is defined in step 3 of the disabilitydetermination process (see Chapter 1) as referring to an impairment that would qualify a person for Social Security Disability Insurance (SSDI)
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From page 90...
... TABLE 5-1 The Four Categories of People in a Binary Classification Problem True Status Listing-level severity No listing-level severity Positive True positives False positives Classifier Result Negative False negatives True negatives Any study conducted to evaluate a classifier would require enough data to classify all people into one of the four cells of Table 5-1. That requirement implies that a standard of listinglevel severity needs to be developed so that the true status of every person in a study is known.
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From page 91...
... As a result, the classifier "less than 3 hospitalizations" perfectly classifies all members of the population. That is, all disabled people are "true positives," all nondisabled are "true negatives," and there are no false positives or false negatives.
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From page 92...
... However, the relative emphasis on the positive predictive value versus the negative predictive value depends on the goals of the classification. In any case, the decision to privilege false negatives over false positives, or vice versa, is a judgment that SSA would have to make.
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From page 93...
... Here, because of our context, we have focused on the positive predictive value. The decision to privilege false negatives over false positives, or vice versa, is a judgment for SSA to make.
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From page 94...
... DESIGNING A STUDY The performance of a health-care utilization or a combination of health-care utilizations as a classifier of SSDI applications is measured by its positive and negative predictive values for different cutoffs. Calculation of those values requires knowledge of the prevalence of listinglevel severity among SSDI applicants who have a particular medical condition and of the distributions of health-care utilizations that are conditional on listing-level severity.
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From page 95...
... A possible strategy might be to choose classifiers that err on the side of increasing false negatives rather than false positives, that is, classifiers that have higher specificity at the expense of lower sensitivity. However, the relative emphasis on the positive predictive value versus the negative predictive value depends on the goals of the classification.
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From page 96...
... Does Delay Cause Decay? The Effect of Administrative Decision Time on the Labor Force Participation and Earnings of Disability Applicants.
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Key Terms

  • false negatives
  • predictive value
  • positive predictive
  • gainful activity
  • negative predictive

  • level severity
  • false negative
  • false positive
  • value depends
  • discriminatory power

  • incorrectly classified
  • disability insurance
  • true status
  • ssdi applications
  • nondisabled people

  • true positives
  • privilege false
  • increasing false
  • zero false
  • requires knowledge

  • activity regardless
  • provides applicants
  • expert assessments
  • administrative records
  • value versus

  • disability severity
  • people incorrectly
  • application period
  • past ssdi
  • disabled people


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