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Note: The essay below appears in Paying for Results in Vocational Rehabilitation (2002, Urban Institute), edited by Kalman Rupp and Stephen H. Bell. To order the full report, please visit the Urban Institute Press' online bookstore.
Contents
Part 1: Context for Assessing the Adequacy of Ticket Payments
- 2 The Ticket to Work Program: The Complicated Evolution of a Simple Idea
By Monroe Berkowitz
- 3 What Do We Know about Disability Beneficiaries' Work and Use of Work Incentives prior to Ticket?
By Chad Newcomb, Suzanne Payne, and Mikki D. Waid
- 4 A Conceptual Model and Evaluation Strategy for the Empirical Study of the Adequacy of Incentives in the Ticket to Work Program
By David C. Stapleton and Gina A. Livermore
- 5 Issues Affecting Alternatives to the Ticket to Work Incentive Structure
By Minh Huynh and Paul O'Leary
- Discussion and Commentary on Part 1
- The Context for Assessing the Adequacy of the Ticket Payment Incentives: What to Expect and How to Evaluate
By Robert Weathers
- Progress and Challenges in Assessing the Ticket to Work Program and Its Effects on Employment
By Robert Moffit
- Pathways to an Effective Ticket to Work
By William E. Kiernan
- Ticket to Work: The Potential for Success
By C. Eugene Steuerle
Part 2: Lessons on Adequacy of Incentives from Other Contexts
- 6 Setting Payments in the Ticket to Work Program: Applying Experience from Capitation Payments in Health Insurance
By Richard G. Frank and Thomas G. McGuire
- 7 What Does the Evidence from Employment and Training Programs Reveal about the Likely Effects of Ticket to Work on Service Provider Behavior?
By Burt S. Barnow and Jeffrey A. Smith
- 8 Performance-Based Contracting to Achieve Employment Goals: Lessons from Programs for Welfare Recipients
By Fredrica D. Kramer, David C. Wittenburg, Pamela A. Holcomb, and Demetra Smith Nightingale
- Discussion and Commentary on Part 2
- What Can Ticket to Work Learn from Other Performance-Based Payment Systems?
By Larry L. Orr
- Ticket to Work and Welfare Parallels
By Howard Rolston
- The Adequacy of Ticket to Work Payments for Hard-to-Serve Beneficiaries: Three Additional Lessons from the Literature
By Craig Thornton
- Insights for Ticket to Work from Health Care
By Randall R. Bovbjerg
Part 3: Subgroup Perspectives
- 9 Provider Incentives and Access in the Ticket to Work Program: Implications of Simulations Based on the Project NetWork Field Experiment
By Kalman Rupp and Stephen H. Bell
- 10 Tickets without Takers? Potential Economic Barriers to the Supply of Rehabilitation Services to Beneficiaries with Mental Disorders
By David Salkever
- 11 Lessons Learned from the Provision and Funding of Employment Services for the MR/DD Population: Implications for Assessing the Adequacy of the SSA Ticket to Work
By Paul Wehman and Grant Revell
- Discussion and Commentary on Part 3
- AOI and the Ticket to Work: Current Status and Issues for the Future
By Leo McManus
- Ticket to Work: Some Restrictions May Apply
By Judith A. Cook
- "Sure, I Want to Work—That's the Ticket": Disability, Human Nature, and the Ticket to Work Program
By Andrew I. Batavia
- The Ticket to Work Emplyment Incentives: A View from the World of Health and Long-Term Care
By Joshua M. Wiener
About the Editors
About the Contributors
A Ticket to Work?
A Preliminary View of Provider Incentives and Access to Services in the Ticket Program
The Ticket to Work and Work Incentives Improvement Act of 1999 (Public Law 106-170), or simply "Ticket to Work" (TTW), initiated a major change in the way employment assistance for disability beneficiaries is financed. Rather than defining specific ways to enhance the human capital and labor market opportunities of targeted individuals, this innovative new initiative focuses primarily on incentives for providers serving beneficiaries of the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs—programs administered by the Social Security Administration (SSA).TTW pays service providers based on the long-run employment success of their clients, with most provider reimbursement tied to beneficiaries' exit from the disability rolls due to their return to work.
Ticket to Work also increases market competition by allowing private employment networks (ENs) to compete for clients with the traditional service providers—state vocational rehabilitation agencies (SVRAs)—through a consumer–choice-driven voucher system. Each eligible SSDI or SSI beneficiary is issued a "ticket"—a special voucher by which that individual may seek employment assistance from qualifying ENs or SVRAs. An EN accepting a ticket assignment is given wide latitude in designing the bundle of employment assistance services best suited to that beneficiary. SSA then pays the EN for each qualifying month the client earns more than a specified amount or is made ineligible for disability payments due to earnings. Provider payments are tied to the government savings presumed to arise from work-related terminations.
TICKET INCENTIVES AND ISSUES
Ticket makes provider revenues from each voucher conditional on client outcomes, not service costs or a predetermined face value. This sharply differs from traditional cost-reimbursement schemes—and from the standard SSA payment strategy for SVRAs that conditions payments on outcomes but provides cost reimbursement once stipulated outcomes are achieved. The Ticket legislation creates two versions of the new outcome-oriented voucher system. Under the outcomes-only (OO) system, providers are paid for the period a beneficiary is ineligible to receive any disability benefits for work-related reasons, up to 60 months. The second new payment mechanism, the milestones-plus-outcomes (MO) system, is a modified version of the "pure" OO system. Under the MO system, ENs receive some partial payments when beneficiaries achieve work-related milestones prior to leaving benefits and correspondingly lower payments once beneficiaries exit, if due to work. ENs are free to choose either scheme, but must do so consistently for all clients. In addition to these two payment options, SVRAs are still allowed to choose traditional cost reimbursement for any individual client if they prefer it to the Ticket payment methods.
The question of this scheme's success—for beneficiaries or for government budget savings—raises a host of analytic issues of interest to social scientists. Virtually no rigorous analysis of provider incentive schemes exists in the vocational rehabilitation literature. However, economists have long recognized that aligning provider incentives with government objectives is a difficult undertaking in many realms. For example, a substantial body of health care financing literature argues that perverse client selection incentives might easily undermine paper savings for the government under capitated health coverage systems. Likewise, considerable research demonstrates the difference between the "gross" and "net" outcomes of interventions like employment assistance. Net outcomes, or "impacts," are unambiguously attributable to the services provided under the given intervention.However, gross outcomes, such as employment rates and benefit program participation, may be affected by a host of other factors. For example, people return to work and SSDI or SSI benefit nonpayment status for many reasons other than the receipt of employment services. Recovery from a disabling condition is one example. The distinction between gross and net outcomes is central to the Ticket incentive problem, since Ticket payments are tied to gross rather than net outcomes. If a beneficiary would return to work and benefits cease even in the absence of Ticket participation, then any resulting Ticket payment can be construed as "deadweight"—a cost that has to be incurred by the government given the Ticket payment system, but does not further the policy's objective. Research during the past 20 years or so on other employment and training programs has demonstrated that deadweight can often be a serious problem.
Using rigorous, independent scholarship by experts in vocational rehabilitation and related fields, this volume of 11 chapters and 12 commentaries illuminates the potential implications of outcome-based financing of employment services for disability beneficiaries. The analytic effort represented here is highly timely, considering that the Ticket legislation requires the Commissioner of Social Security to assess the TTW incentives' adequacy in providing employment assistance to hard-to-serve (HTS) beneficiaries and issue a report by the end of 2002. Furthermore, the law directs the Commissioner to consider possible changes that may be necessary in the Ticket payment system to address adequacy of incentives (AOI) concerns. This is a tall order. The Ticket program is a brand new initiative, and it may take years to obtain reliable information on how the initial program design works. Regardless of whether the congressionally mandated SSA report is actually issued by the end of 2002, or whether some adjustment is made for delays in the implementation of the Ticket program, it is clear that far less than comprehensive empirical information will be available on actual Ticket program performance any time in the near future.
SSA's ADEQUACY OF INCENTIVES WORKSHOP
The law created a Work Incentives Advisory Panel (WIAP) to advise SSA.As one of its key recommendations, the WIAP suggested that SSA make greater use of outside experts to address AOI issues. This recommendation was instrumental in the agency's decision to bring together the experts who contributed to this volume at a technical workshop held in Washington, D.C., on May 21צ22, 2002. SSA contracted with the Urban Institute (UI) to commission papers, which are now arranged as chapters in this document, and organize the workshop. This volume represents a collaborative effort among SSA and UI staff and the academic, private sector, and government researchers who participated in the workshop.
SSA planned the workshop to be a working meeting, providing feedback on papers that can be best described as "works in progress." In organizing the conference, we as coeditors presumed that the issues facing Ticket to Work are not only politically contentious, but also analytically difficult and complex. The chapters and commentaries in this volume contribute to the second of these areas—the technical ramifications of AOI issues. Some of the authors present value judgments as well. However, these chapters are designed only to clarify the technical issues involved and assist policymakers on any side in correctly identifying the implications of policy choices they make or might argue for. Where values and policy priorities are involved, we, as technical experts, leave the resolution of the importance given to different objectives to legitimate actors in the political arena.
Since the Ticket program is a new and fairly innovative method of financing vocational rehabilitation services, much can be learned by bringing together a number of different perspectives. The issues ahead of us are daunting, in part because of the many inherent challenges facing researchers in the disability field generally. In addition, designing any intervention in a situation that can be best characterized by the absence of well-functioning markets gives rise to tricky incentive problems. Measurement issues are also severe because of complex econometric issues, such as the problem of selection bias. Thus, an exchange of ideas among experts focusing on various aspects of the problem makes sense.
We divided the workshop and this volume into three parts. Broadly speaking, part I focuses on the programmatic and policy background, the basic Ticket program structure, and the major challenges future evaluations of the initiative need to tackle. It looks at the economic and political origins of the Ticket reform and the principles that guided its development. A profile of SSDI and SSI work incentives that preceded Ticket is presented, along with a framework for evaluating the changes caused by the new program from the perspective of beneficiaries, providers, and the government. The section concludes by discussing possible provider responses to the new payment rules and ways that payment incentives might have been different had alternative rules been adopted.
Part II is designed to bring in expertise from a broader array of programs, including programs focusing on health care financing, employment and training, and selfsufficiency initiatives for welfare recipients. While the experience of these other programs may not directly apply to the Ticket program and its target population, important broader lessons from this literature might prove fruitful in addressing Ticket program issues. In particular,methodological and/or practical lessons related to (1) the potential difficulties of aligning government objectives and provider incentives, and (2) the effect of program design on access and services among HTS groups (however defined in any given program context) may be particularly illuminating. We encouraged the authors and discussants here to focus on broad analytic implications for the Ticket program, rather than simply providing an overview of their respective fields or drawing narrow inferences concerning services to clients with the most severe disabilities.
The interplay of client characteristics and provider incentives is also an issue weighty enough for its own section. Part III looks at how clients' characteristics affect access to programs and services and what that means for provider incentives and adequacy. The interest here is how the specific challenges facing various segments of the target population—defined by physical disabilities, mental health issues, mental retardation, severity of impairments, educational attainment, and labor market experience—interact with Ticket provider incentives.
Additional experts provided commentary on each section, reacting to the chapters but often extending beyond them as well.We especially encouraged commentators to elaborate on creative ideas or important concerns that cross the boundaries defined by the three sections, but appear productive and important in terms of our broader agenda. In some cases, therefore, the discussants focus their creative energies on the narrower section subject, while in other cases, they move beyond. In our judgment, some of the most creative contributions in this volume arose from thinking "outside the box."
The remainder of this chapter provides an overview of the three parts of the volume. The chapters speak for themselves, and we do not attempt to summarize each of them in any comprehensive way. Rather,we strive to orient the reader to what lies ahead, and highlight some issues raised by the authors that we found particularly productive or intriguing.
TICKET'S ORIGIN AND POLICY CONTEXT
Monroe Berkowitz, widely regarded as the intellectual "father" of the Ticket program, authored chapter 2. This chapter provides a broad perspective on the evolution of the Ticket concept—modestly described as a simple idea—into a program that turned out to be fairly complex to implement and raised a multitude of passionate intellectual and political arguments. Berkowitz and other members of the National Academy of Social Insurance (NASI) panel, who formally recommended the Ticket program before its enactment, started out with the premise that the status quo vocational rehabilitation system for SSA disability beneficiaries was a clear failure. The Ticket program was to be a simple, market-oriented approach directly tying provider payments to government savings arising from beneficiaries' return to work. Berkowitz identifies Carolyn Weaver's initial voucher proposal and the "contingent fee method of payment" used to pay lawyers in the disability adjudication system as the key antecedents. Berkowitz conveys skepticism regarding the equity concerns of certain advocates who worry that only some disabled individuals will benefit from Ticket. His notion, instead, is that all disability beneficiaries are rather disadvantaged, and that the modest social objective of the Ticket program—helping some of these people to return to work—will produce an unambiguous Pareto improvement in economic terms: some disadvantaged beneficiariesmade better-off without hurting the others.
In chapter 3, Chad Newcomb, Suzanne Payne, and Mikki Waid present useful background information and baseline data on the work activities of disability beneficiaries and the historical record of SSA's work incentive programs. They note that although a large portion of disability beneficiaries express an interest in returning to work, these intentions do not seem to translate into active engagement—even in prior demonstrations with intensive outreach.At the same time, a small group of individuals do leave the rolls for work, and seem to use existing incentives and demonstration opportunities to best effect.The chapter compiles the best currently available evidence providing a broad baseline of the status quo pre-Ticket, data that should be useful to anyone interested in making broad—and fair—generalizations about the new program. The authors document substantial heterogeneity within the disability beneficiary population, and caution that any future assessment of the adequacy of EN incentives to serve HTS beneficiaries—however defined—should distinguish beneficiary self-selection from screening by program operators.
Chapter 4 was written by David Stapleton and Gina Livermore, the researchers most responsible for developing SSA's complex, comprehensive multiyear evaluation plans for the Ticket program. The chapter is a good introduction to an important, but difficult, planned study—dealing with a multitude of methodological challenges arising in evaluating systemic change in a nonexperimental setting. It does much more, however, by tying evaluation questions to AOI concerns and tackling some fundamental conceptual problems. Stapleton and Livermore provide a conceptual framework for the Ticket to Work program from the beneficiary, provider, and government perspectives.While the volume as a whole focuses on provider incentives, a good understanding of beneficiary incentives is important to an appropriate analysis. This chapter goes a long way in this regard. Importantly, the authors point out that the Ticket can be used as a stipend for beneficiaries, and they provide useful insights concerning this potential strategy by ENs. The chapter also attempts in an intriguing and fairly specific way to operationalize the HTS criteria specified by Congress. While this is far from being the only sensible approach possible to address the problem, it is clearly useful and original.
Chapter 5, by Minh Huynh and Paul O'Leary, provides background on the structure of the Ticket to Work program, considers how service providers are likely to respond to the program, presents some preliminary data on Ticket program activity, and outlines several alternative approaches to the design of provider incentives that might be considered if Ticket is reformed. The chapter fills in the details of the administrative complexity to which Berkowitz alludes; some details, while unanticipated by the idea's creators, nevertheless may turn out to be important in determining the outcomes of the actual Ticket legislation. Huynh and O'Leary offer an excellent discussion of the Ticket program's major payment options. In particular, they present an original analysis comparing the potential attractiveness of the outcomes-only (OO) and milestones-plus-outcomes (MO) payment options for ENs. In light of concerns about the "backloading" of payments under the OO system, the authors explore how ENs can be expected to decide which system to use. The central variable in their analysis is the provider rate of time preference. The authors' analysis suggests that the MO option is likely to dominate for small providers, while the OO option might be more attractive to large institutional providers that do not need quick payments to stay financially viable, providers that expect quick success in moving beneficiaries off the SSA rolls, and providers that expect high overall success rates.
Robert Weathers, Robert Moffitt,William Kiernan, and Eugene Steuerle offer discussion and commentary on part I from their perspectives as academic and government researchers and former vocational rehabilitation providers.
LESSONS FROM OTHER SETTINGS
Chapter 6, by Richard Frank and Thomas McGuire, is a fitting start for part II, which includes three chapters focusing on what can be learned from other program areas about Ticket's potential incentive effects. The authors provide an analysis informed by their expertise in health care financing, an area of public policy that probably has been influenced by the economic analysis of provider behavior more than any other. The chapter would be a useful contribution even if it were limited to the cautionary tale of the Medicare health maintenance organization (HMO) risk program, where the government hoped to save 5 percent of per capita Medicare outlays by setting HMO payments at 95 percent of the fee-for-service average in the enrollee's county of residence. As the authors point out, favorable risk selection by HMOs made such government savings illusory, a problem that has not been resolved to date despite various attempts to attack the selection problem through risk adjustment. Chapter 6 goes much farther than a valuable review of lessons learned, however. Frank and McGuire attack the Ticket to Work incentive problems directly through an optimization model for government rule-setting in the face of profit-maximizing behavior on the part of providers. The authors use simple price theoretic concepts to derive the rules for a socially efficient Ticket program—with three major conclusions. First, the optimal payment level, or "price," should ideally reflect successes attributable to EN services, not those that would have occurred anyway. This theme—and the implication that Ticket operates in a "second-best" world where payments are keyed to gross outcomes rather than net impacts—echoes in other chapters in the volume. Second, the price should reflect a broader set of social benefits than just SSA savings. Third, the optimal price should vary by beneficiary characteristics; in actuality, Ticket payments for qualifying months are affected only by the title—SSI or SSDI—of the benefit and not by any other individual differences, either on the social benefit or the cost side of the equation.
Chapter 7, by Burt Barnow and Jeffrey Smith, brings in another body of research to help tackle the Ticket to Work provider incentive issue—the research on employment and training (E&T) programs generally. The issue of selection, or "selection bias," in who is served, is as central to this literature as it is to the health care financing field, but with a fundamental difference. In the health care financing literature, favorable risk selection has always been addressed in the context of provider incentives and pricing, whereas in the E&T field, it has risen as a measurement problem when evaluating program effectiveness by comparing the subsequent labor market outcomes of self-selected participants with those of fundamentally different nonparticipants. Barnow and Smith go beyond this measurement focus by addressing provider incentives created by performance standards in the decentralized E&T system. They point out the need to clarify the government's objectives between maximizing net impacts and serving the most "needy"—a theme hauntingly similar to Ticket's dual concern for government savings and serving the HTS. The chapter summarizes a number of E&T's lessons for Ticket, the most important of which is the enormous analytical difficulty in distinguishing outcomes attributable to a program intervention from results that would have occurred anyway and—in the ideal world—would not be rewarded with provider payments.
Chapter 8, by Fredrica Kramer, David Wittenburg, Pamela Holcomb, and Demetra Nightingale, completes lessons from other program contexts by considering what the Ticket program can learn from the use of performance-based contracting in welfare-to-work service provision. The chapter neatly complements chapters 6 and 7 by focusing on the implementation of performance-based contracting under the Temporary Assistance for Needy Families (TANF) program and the practical implications this holds for the Ticket program. The chapter covers a wide range of contracting mechanisms that have evolved in state welfare agencies over the past several years, mechanisms involving a degree of micromanagement, trial and error, and flexible negotiation that may appear as inconceivable to those schooled in the centralized and highly procedural world of Social Security program management. This situation raises the intriguing question of whether the need for well-established payment system principles and procedures at the national level can be reconciled with what some see as the need for a more customized approach for HTS groups.Another tension for Ticket suggested by the welfare-to-work experience is the difficulty SSA may face in getting beneficiaries to take part in employment-focused services without dramatically altering the incentive structures that they face. Even in mandatory welfare-to-work programs, where benefits can be cut off if individuals fail to participate in employment-focused activities,"no-shows"pose a substantial challenge to many providers. Finally, regarding the potential involvement of small providers in the Ticket program, the authors reach a conclusion strikingly similar to results reached in chapter 5 and part III: Some sort of immediate revenue flow to providers following their initial investment in services to beneficiaries may be vital.
Larry Orr, Howard Rolston, Craig Thornton, and Randall Bovbjerg offer discussion and commentary on the chapters included in part II, extending the cross-context examination to look at further ways health, E∓T, and welfare applications parallel or part from one another and—in the process—adding predictions and perspectives on the translation to Ticket.
SPECIAL ISSUES FOR SUBGROUPS OF BENEFICIARIES
Part III includes three chapters providing a subgroup perspective. Chapter 9, by Kalman Rupp and Stephen Bell, examines client selection and simulates expected Ticket payments based on SSA's actual experience offering enhanced employment services to disability beneficiaries. The Project NetWork field experiment tracks client participation and selection at the micro level and incorporates a randomly assigned "control" group of individuals who want enhanced services but do not receive them. Random assignment helps to separate the effects of client selection—where participants do better than nonparticipants in terms of long-run outcomes because of preexisting advantages—from service impacts per se, where better outcomes are the result of provider contributions. The incentive for providers to engage in "favorable risk selection"—serving those who will do well on their own—as opposed to effective service provision appears considerable. Both voluntary selfselection and potentially selective provider intake are expected to increase Ticket payments, creating "deadweight"—SSA payments for gross outcomes that would have occurred anyway, rather than net impacts. The use of a uniform 40 percent payment multiplier in Ticket (provider payments equal 40 percent of the average monthly SSDI or SSI benefit nationally under the OO system) protects against deadweight somewhat, but at the expense of underpayments for efficient services. The authors also note how the shift from an individualized payment scheme advocated by the NASI panel to a national–average-based payment approach reduces the already tenuous link between benefit savings and provider payments.
Chapter 10, by David Salkever, assesses the potential barriers to the provision of rehabilitation services to SSDI and SSI beneficiaries with mental health disorders. This subgroup of beneficiaries has dramatically increased in size during the past 20 years—to more than one-third of the SSI and about one-quarter of the SSDI caseload—and thus will play a major role in the success or failure of Ticket to Work. Beneficiaries with mental disorders may be seen as hard to serve because of the nature of their underlying disabilities and the way these interact with labor markets. This, plus the relatively high cost of state-of-the-art vocational interventions for this group, creates potential disincentives to serve these beneficiaries effectively. Salkever argues that under the MO and OO payment systems, providers face a low probability of receiving any payments for beneficiaries with serious mental disorders, and that providers'willingness to serve beneficiaries with serious mental illness will depend on the availability of supplemental funding streams. He believes that the Ticket payment system does not sufficiently recognize the social benefits arising from modest increases in earnings, particularly those for SSI recipients. This relates to a fundamental difference in the benefit formula for the SSDI and SSI programs. In the SSDI program, work activities can never result in benefit reduction other than a reduction to zero—the suspension or termination of benefits. SSI, in contrast, is a means-tested program. The SSI benefit formula incorporates a 50 percent benefit offset rate for earnings increases beyond a small disregard; thus, SSI benefits are gradually phased out as earnings increase. The Ticket payment scheme gives no credit to providers for benefit reduction other than the complete cessation of benefits. Clearly, the initiators of the Ticket payment mechanism focused their attention on the way the SSDI program works. As Salkever and others point out, the relationship between SSI rules and the Ticket payment mechanism clearly warrants additional attention.
Chapter 11, by Paul Wehman and Grant Revell, summarizes lessons learned from the provision and funding of employment services for the mentally retarded/developmentally disabled (MR/DD) population and draws inferences concerning the adequacy of incentives to serve this population in the Ticket to Work program. Unlike the other contributors, Wehman and Revell start with the service and support needs of the target population and move from there to the likely costs of services given the goal of benefit exit. This is a subtle but crucial distinction, since it takes the desirability of providing services as given, rather than as conditional on providers' ability to produce benefit savings (as in the original NASI proposal). Other authors in this volume implicitly acknowledge the theoretical possibility—not a prediction—that the optimal size of the Ticket program might be zero, or at least that the costs of Ticket services may outweigh benefits from employment gains in some instances. Based on the cost structure of potential providers,Wehman and Revell conclude that performance-based funding systems must allow service agencies to recoup lost revenue—losses arising from the cost of services to participants who fail to achieve Ticket's payment milestones and outcomes in the labor market. This conclusion leads to proposals for frontloading Ticket payments to reward employment below the current threshold level, a suggestion not inconsistent with the benefit-savings rationale for Ticket reform in the case of SSI recipients.
Leo McManus, Judith Cook, Andrew Batavia, and Joshua Wiener provide discussion and commentary on the chapters in part III at the conclusion of the volume. This collection of commentaries provides more than the usual opportunity to reflect broadly on the Ticket philosophy and its implementation challenges, and suggests some nonfinancial norms by which the Ticket program may be judged a success or failure.
CONCLUDING THOUGHTS
The contributions in this volume suggest a range of intriguing possibilities for the potential success and possible improvement of the Ticket to Work program. Our objective in drawing together these experts was to provide a variety of informed technical perspectives on the complex issues involved in designing an outcome-oriented payment system that is intended to align provider incentives with government goals of equity and efficiency. The volume is not meant to provide definitive conclusions about the merits of the Ticket to Work reforms. Rather, it is our hope that the ideas and reactions presented here will stimulate further discussion and debate about the key policy and technical issues posed by Ticket to Work and its adequacy of incentives agenda. If the volume contributes to the better framing and assessment of key trade-offs as Ticket moves ahead toward full implementation, maturation, and potential reform, we will have achieved our objectives.
NOTE
The editors are jointly responsible for the chapter and any errors it may contain. They wish to thank Virginia McCaskey and Chad Newcomb for useful comments and suggestions on an earlier draft and Suellen Wenz for her excellent editorial assistance. All views and opinions expressed represent the authors' technical assessment and do not represent the views, opinions, or policy positions of the U.S. Social Security Administration, the Urban Institute, or any other entity.
Note: The essay below appears in Paying for Results in Vocational Rehabilitation (2002, Urban Institute), edited by Kalman Rupp and Stephen H. Bell. To order the full report, please visit the Urban Institute Press' online bookstore.
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