Assessing uncertainty in the American Indian Trust Fund

Fiscal year-end balances of the Individual Indian Money System (a part of the Indian Trust) were constructed from data related to money collected in the system and disbursed by the system from 1887 to 2007. The data set of fiscal year accounting information had a high proportion of missing values, and much of the available data did not satisfy basic accounting relationships. Instead of just calculating a single estimate and arguing to the Court that the assumptions needed for the computation were reasonable, a distribution of calculated balances was developed using multiple imputation and time series models. These provided information to assess the uncertainty of the estimate due to missing and questionable data.Comment: Published in at http://dx.doi.org/10.1214/09-AOAS274 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Figure 1.-- Potential Types of Health Record Linkages

The purpose of this paper is to provide an introduction or "starter set " for reflecting on human rights issues that arise when bringing together or linking the health records of individuals. In particular, the paper will discuss the potential role of record linkages in the proposed new United States health information system; specifically, how linkage applications may affect both the rights of individuals to privacy and their rights of access to health care services. Four potential types of record linkages will be covered (see Figure 1 below). The primary concern will be with linkages of health records, such as the computerized enrollment and encounter records proposed to be created under the Health Security Act or other health care reform legislation [1]. As the columns of Figure 1 indicate, linkages for both statistical and administrative purposes will be considered. As the rows of Figure 1 imply, there will be a discussion of record linkage within the health system, e.g., records of individuals may be linked to records of providers or insurers. The paper will also consider linkages of health care records with records from other systems, such as vital records or social security, income tax, and welfare program records. In all, the paper is organized into eight sections: the present introduction and statement of purpose (Section 1); a background section on what is meant by record linkage-- both in general and with respect to health record systems (Section 2); then there are four short sections, each devoted to a cell in Figure 1 (Sections 3 to 6); and, finally, a brief overall summary with recommendations (Section 7). The main questions to be addressed throughout are the extent to which linkages should be permitted, for what purposes, and under what conditions. An Afterword has been included (as Section 8) to afford room for a more personal comment