Does Inclusion of Both Partial and Complete Does Inclusion of Both Partial and Complete Interviews from the Source Sampling Frame Have an Interviews from the Source Sampling Frame Have an Effect on Nonresponse Error and Measurement Error Effect on Nonresponse Error and Measurement Error

in a National Health Survey?in a National Health Survey?

Trena M. Ezzati-Rice, Frederick Rohde, Steven B. Cohen Trena M. Ezzati-Rice, Frederick Rohde, Steven B. Cohen

International Total Survey Error Workshop 2010 Stowe, VT

June 13-16, 2010

Motivation for researchMotivation for research

Large observed differences in Large observed differences in response rates between two types response rates between two types of previously interviewed cases of previously interviewed cases included in the Medical included in the Medical Expenditure Panel Survey (MEPS) Expenditure Panel Survey (MEPS) sample as a result of its integration sample as a result of its integration with another national health survey with another national health survey

MEPS survey backgroundMEPS survey background

Annual survey since 1996; nationally representative Annual survey since 1996; nationally representative sample of householdssample of households

5 rounds of data collection covering 2 calendar years5 rounds of data collection covering 2 calendar years

Used to estimate medical care utilization, access to Used to estimate medical care utilization, access to care, and health care expenses for the U.S. civilian care, and health care expenses for the U.S. civilian noninstitutionalized populationnoninstitutionalized population

Widely used to inform health care policyWidely used to inform health care policy

Integrated survey designIntegrated survey design

– Each annual panel of households is a subsample of Each annual panel of households is a subsample of responding households (from prior year) from another large responding households (from prior year) from another large ongoing U.S. health survey, the National Health Interview ongoing U.S. health survey, the National Health Interview Survey (NHIS)Survey (NHIS)

Integration of NHIS and MEPSIntegration of NHIS and MEPS

MEPS inherits the NHIS complex sample design with its MEPS inherits the NHIS complex sample design with its oversampling of selected minority populationsoversampling of selected minority populations

Reduces household screening costs for MEPS Reduces household screening costs for MEPS

Provides valuable sampling frame information to adjust for Provides valuable sampling frame information to adjust for survey nonresponsesurvey nonresponse

Provides enhanced analytical potential (NHIS and MEPS linked Provides enhanced analytical potential (NHIS and MEPS linked analyses)analyses)

MEPS response rate is conditioned on the NHIS response rateMEPS response rate is conditioned on the NHIS response rate

MEPS inherits the composition of the NHIS interviewed sampleMEPS inherits the composition of the NHIS interviewed sample

– Completed household interviewsCompleted household interviews

– ““Partially Completed” household interviewsPartially Completed” household interviews

Definition of an NHIS Definition of an NHIS “partially completed” interview“partially completed” interview

All questionnaire modules are not completedAll questionnaire modules are not completed

NHIS questionnaire composed of 5 major sectionsNHIS questionnaire composed of 5 major sections

1. Household composition (demographic information)1. Household composition (demographic information)

2. Family core (basic health and sociodemographic data)2. Family core (basic health and sociodemographic data)

Family relationships, marital statusFamily relationships, marital status

Health status, activity limitations, injury, poisoningHealth status, activity limitations, injury, poisoning

Access and utilization and citizenshipAccess and utilization and citizenship

Health insuranceHealth insurance

Educational attainment Educational attainment STOPSTOP

Employment, earnings, or income data for partials Employment, earnings, or income data for partials NO DataNO Data

– 3. Sample adult qx. 3. Sample adult qx. NO DataNO Data

– 4. Sample child qx. 4. Sample child qx. NO DataNO Data

– 5. Immunization section 5. Immunization section NO DataNO Data

Data Matrix: NHIS and MEPS Data Matrix: NHIS and MEPS sample integrationsample integration

NH

IS c

ompl

ete

Int

ervi

ews

MEPS Respondents

MEPS Nonrespondents

MEPS Respondents

MEPS Nonrespondents

NHIS partially completed interviews

NH

IS S

ampl

e F

ram

e

(NH

IS R

espo

nden

ts

elig

ible

for

ME

PS

)

Background for this researchBackground for this research

Previously conducted research (Chiu et al, 2001) Previously conducted research (Chiu et al, 2001) indicated that “late”/difficult” NHIS interviews were indicated that “late”/difficult” NHIS interviews were more likely to be partial completes.more likely to be partial completes.

Partially completed NHIS cases in the MEPS sample Partially completed NHIS cases in the MEPS sample observed to: observed to:

require more field effort require more field effort

have lower response rates compared to the NHIS complete have lower response rates compared to the NHIS complete casescases

Research questionsResearch questions Do the NHIS partially completed cases as included in the MEPSDo the NHIS partially completed cases as included in the MEPS

– Have lower response propensity at Round 1 and subsequent rounds?Have lower response propensity at Round 1 and subsequent rounds?

– Adversely affect data collection burden?Adversely affect data collection burden?

Are there differences in the demographic and socioeconomic Are there differences in the demographic and socioeconomic characteristics of the MEPS respondents when stratified by their characteristics of the MEPS respondents when stratified by their NHIS interview status (partial versus complete)?NHIS interview status (partial versus complete)?

Do the NHIS partially completed cases as carried over to MEPS Do the NHIS partially completed cases as carried over to MEPS affect survey data quality?affect survey data quality?

– Do they have higher item nonresponse rates on MEPS variables?Do they have higher item nonresponse rates on MEPS variables?

– Do MEPS survey estimates differ when stratified by partial vs. complete Do MEPS survey estimates differ when stratified by partial vs. complete NHIS interview status?NHIS interview status?

Source of Data Source of Data

MEPS MEPS

– Historical data for examining response rate trendsHistorical data for examining response rate trends

– Panels 11 & 12 for detailed analyses Panels 11 & 12 for detailed analyses

– Paradata (survey burden assessment)Paradata (survey burden assessment)

– Survey data (item nonresponse and weighted Survey data (item nonresponse and weighted survey estimates)survey estimates)

NHISNHIS

– Paradata (NHIS interview status and other data)Paradata (NHIS interview status and other data)

– Survey data (response propensity modelingSurvey data (response propensity modeling) )

Percentage of MEPS reporting units Percentage of MEPS reporting units with a previous NHIS partially with a previous NHIS partially completed interview: MEPS Panels 3-14completed interview: MEPS Panels 3-14

Year MEPS Year MEPS Panel StartedPanel Started

PanelPanel NHIS “partially NHIS “partially completed” completed”

interview (%)interview (%)19981998 33 101019991999 44 212120002000 55 242420012001 66 222220022002 77 171720032003 88 202020042004 99 191920052005 1010 161620062006 1111 232320072007 1212 191920082008 1313 252520092009 1414 2626

0102030405060708090

100

2004 2005 2006 2007 2008 2009

Year

(%)

un

wei

gh

ted

res

po

nse

Completes

Partials

MEPS Round 1 response rates MEPS Round 1 response rates (reporting unit level) by NHIS interview (reporting unit level) by NHIS interview completion status: 2004-2009completion status: 2004-2009

Percent refused MEPS interview (at the Percent refused MEPS interview (at the RU level) by round and NHIS interview RU level) by round and NHIS interview status, MEPS Panel 12status, MEPS Panel 12

RoundRound NHIS PartialNHIS Partial

(%)(%)

NHIS CompleteNHIS Complete

(%)(%)

11 28.7*28.7* 15.915.9

22 10.3*10.3* 5.55.5

33 4.74.7 3.63.6

44 3.23.2 2.62.6

55 1.81.8 1.11.1

*p<.001*p<.001

0

5

10

15

20

25

30

35

40

R1* R2* R3* R4 R5

Round

Per

cen

t

Partials

Completes

Percent ever refused (reluctant respondent or final Percent ever refused (reluctant respondent or final refusal) by Round and NHIS interview completion refusal) by Round and NHIS interview completion status: RU level MEPS Panel 12status: RU level MEPS Panel 12

Percent of noncontacts and true contacts by Percent of noncontacts and true contacts by NHIS interview status: MEPS Panel 12, Round 1NHIS interview status: MEPS Panel 12, Round 1

ParadataParadata

NHISNHIS

partialpartialNHIS NHIS

completecomplete SignifSignif

Round 1 noncontactsRound 1 noncontacts

4+4+ 34.734.7 26.926.9 p<.001p<.001

Round 1 “true” contacts Round 1 “true” contacts

11

2-32-3

4-54-5

6-106-10

11-1411-14

15+15+

11.111.1

42.142.1

21.521.5

18.518.5

3.73.7

3.03.0

13.313.3

51.251.2

17.517.5

13.813.8

2.52.5

1.61.6

p<.001p<.001

Other paradata measures by NHIS Other paradata measures by NHIS interview status: MEPS Panel 12, Round 1interview status: MEPS Panel 12, Round 1

ParadataParadata NHIS NHIS partialpartial

NHIS NHIS completecomplete

SignifSignif

Reluctant respondent (%)Reluctant respondent (%) 14.314.3 8.48.4 p<.001p<.001

Not located (%)Not located (%) 6.16.1 3.33.3 p<.001p<.001

MEPS interview typeMEPS interview type

In person (%)In person (%)

Phone (%)Phone (%)90.290.2

9.89.8

93.893.8

6.26.2

p<.001p<.001

Mean interview time Mean interview time (minutes)(minutes)

110.3110.3 107.3107.3 p=.232p=.232

Any break-offs during the Any break-offs during the interview (%)interview (%)

10.710.7 9.29.2 p=.006p=.006

Bivariate analysis of R1 respondent Bivariate analysis of R1 respondent characteristics (reference person) by NHIS characteristics (reference person) by NHIS interview completion status: MEPS Panels 11 & interview completion status: MEPS Panels 11 & 12 combined12 combined

CharacteristicCharacteristic Overall (%)Overall (%) Partial (%)Partial (%) Complete(%)Complete(%)

Age of Reference person*Age of Reference person* 65+65+ 18.118.1 13.013.0 19.219.2

Race/ethnicity *Race/ethnicity * HispanicHispanic Non-Hispanic BlackNon-Hispanic Black Non-Hispanic AsianNon-Hispanic Asian Non-Hispanic OtherNon-Hispanic Other

19.719.717.417.44.64.6

58.358.3

26.526.517.917.9 6.76.748.948.9

18.218.217.217.2 4.24.260.460.4

Marital Status*Marital Status* MarriedMarried Widowed/separated/divorcedWidowed/separated/divorced Never marriedNever married

49.849.828.328.321.821.8

56.956.923.423.419.619.6

48.248.229.429.422.322.3

Year 1 Poverty Status*Year 1 Poverty Status* In/near povertyIn/near poverty Low incomeLow income Middle incomeMiddle income High incomeHigh income MissingMissing

23.523.514.214.225.125.126.226.211.011.0

22.822.813.113.124.324.324.524.515.315.3

23.723.714.514.525.325.326.626.610.010.0

**significant at alpha = 0.05significant at alpha = 0.05

Bivariate analysis (cont.) of R1 respondent characteristics Bivariate analysis (cont.) of R1 respondent characteristics (MEPS reference person) by NHIS interview completion (MEPS reference person) by NHIS interview completion status: MEPS Panels 11 & 12 combined status: MEPS Panels 11 & 12 combined (* = significant at alpha = .05) (* = significant at alpha = .05)

CharacteristicCharacteristic Overall (%)Overall (%) Partial (%)Partial (%) Complete (%)Complete (%)

Size of RU*Size of RU* 11 22 33 44 5+5+

28.928.928.528.515.815.814.314.312.412.4

19.119.125.425.419.219.218.518.517.817.8

31.131.129.229.215.115.113.413.411.211.2

Employment status*Employment status* Employed Employed 65.365.3 69.469.4 64.464.4

Region*Region* NortheastNortheast MidwestMidwest SouthSouth WestWest

16.316.321.221.238.038.024.524.5

17.317.318.118.135.835.828.828.8

16.016.021.921.938.538.523.623.6

MSA status*MSA status* MSAMSA Non MSANon MSA

83.783.716.316.3

87.987.912.112.1

82.782.717.317.3

Logistic regression analysis of Round 1 (RU) Logistic regression analysis of Round 1 (RU) respondent (reference person charac) being a respondent (reference person charac) being a prior NHIS partial complete: MEPS Panels 11 & prior NHIS partial complete: MEPS Panels 11 & 1212

EffectEffect DFDF Wald XWald X22 Pr > Pr > XX22

Race/ethnicityRace/ethnicity 33 52.152.1 <.0001<.0001Yr1 poverty statusYr1 poverty status 55 41.941.9 <.0001<.0001No. of people in RUNo. of people in RU 44 21.821.8 .0002 .0002Family structureFamily structure 55 28.528.5 <.0001<.0001Employment statusEmployment status 22 15.015.0 .0006 .0006RegionRegion 33 10.210.2

.0167 .0167MSA statusMSA status 11 15.315.3 <.0001<.0001

Odds ratios of logistic model predicting a Odds ratios of logistic model predicting a “NHIS Partial Complete” respondent at “NHIS Partial Complete” respondent at MEPS Round 1, Panels 11 & 12MEPS Round 1, Panels 11 & 12

Race/ethnicityRace/ethnicity MSA MSA AsianAsian 1.61* 1.61* MSA MSA 1.31*1.31* BlackBlack 1.31*1.31* Non-MSA Non-MSA 1.001.00 HispanicHispanic 1.45*1.45* White/OtherWhite/Other 1.001.00

Reporting Unit SizeReporting Unit Size Poverty StatusPoverty Status 11 0.26*0.26* In poverty In poverty 1.011.01 22 0.57*0.57* Low income Low income 0.950.95 33 0.77*0.77* Middle income Middle income 1.011.01

44 0.900.90 Missing income Missing income 1.52* 1.52* 5+5+ 1.001.00 Near poverty Near poverty 1.101.10

High incomeHigh income 1.001.00RegionRegion MidwestMidwest 0.84*0.84* Employment StatusEmployment Status NortheastNortheast 0.950.95 Employed Employed 1.14*1.14* SouthSouth 0.85*0.85* Missing/<16 yr Missing/<16 yr 2.42*2.42* WestWest 1.001.00 Unemployed Unemployed 1.001.00

Predicting Round 1 dwelling unit level response Predicting Round 1 dwelling unit level response propensity -- 29 potential (NHIS) covariates as propensity -- 29 potential (NHIS) covariates as used in MEPS weights productionused in MEPS weights production

DemographicDemographic Household Household CharacteristicsCharacteristics

Socio-Socio-Economic Economic StatusStatus

GeographicGeographic Health-Health-related related

Age ref. personAge ref. person DU sizeDU size Poverty statusPoverty status Census regionCensus region Health Health statusstatus

Race/ethnicityRace/ethnicity Has phoneHas phone EducationEducation MSA sizeMSA size Need helpNeed help

Marital statusMarital status Working or not Working or not IncomeIncome MSA/nonMSAMSA/nonMSA # nts. in # nts. in hospitalhospital

GenderGender Type of PSUType of PSU Employment Employment statusstatus

Urban/RuralUrban/Rural Healthcare Healthcare coveragecoverage

Any AsianAny Asian Type of home – Type of home – house, apt., etc.house, apt., etc.

Home Home ownershipownership

Medical Medical expenses expenses categorycategory

Any BlackAny Black Time w/ no phoneTime w/ no phone

Interview Interview languagelanguage

U.S. citizenU.S. citizen

U.S. bornU.S. born

Additional NHIS para data included in logit Additional NHIS para data included in logit regression (predicting round 1 response regression (predicting round 1 response propensity) -- * available for MEPS panel 12 onlypropensity) -- * available for MEPS panel 12 only

NHIS interview completion status (partial vs. complete)NHIS interview completion status (partial vs. complete)

– Panels 11 and 12Panels 11 and 12

Household cooperativeness*Household cooperativeness*

How likely respond to later linked survey*How likely respond to later linked survey*

# of contacts and # of non-contacts*# of contacts and # of non-contacts*

Language problem*Language problem*

Health problem*Health problem*

Time constraints*Time constraints*

Content/privacy concerns*Content/privacy concerns*

Hostility mentioned*Hostility mentioned*

Results of logistic regression predicting round 1 Results of logistic regression predicting round 1 DU level response propensity -- MEPS Panel 11DU level response propensity -- MEPS Panel 11

EffectEffect DFDF Wald X Wald X22 Pr > XPr > X22

Predicted povertyPredicted poverty 11 12.6 12.6 .0004 .0004AgeAge 44 10.4 10.4 .0338 .0338Race/ethnicity Race/ethnicity 33 24.6 24.6 <.0001<.0001Marital statusMarital status 11 6.3 6.3 .0121 .0121IncomeIncome 44 48.3 48.3 <.0001<.0001DU sizeDU size 44 36.5 36.5 <.0001<.0001MSA statusMSA status 22 21.0 21.0 <.0001<.0001RegionRegion 33 18.7 18.7 .0003 .0003Has phoneHas phone 33 27.0 27.0 <.0001<.0001Home typeHome type 11 7.8 7.8 .0053 .0053Interview languageInterview language 22 6.9 6.9 .0325 .0325U.S. born U.S. born 22 11.8 11.8 .0028 .0028NHIS interview completion statusNHIS interview completion status 11 105.4105.4 <.0001<.0001

Results of logistic regression predicting round 1 Results of logistic regression predicting round 1 response propensity -- MEPS Panel 12response propensity -- MEPS Panel 12(additional NHIS paradata available)(additional NHIS paradata available)

EffectEffect DFDF Wald XWald X22 Pr > XPr > X22

Race/ethnicity Race/ethnicity 33 33.9 <.000133.9 <.0001Marital statusMarital status 11 4.2 .0405 4.2 .0405IncomeIncome 44 15.3 .004115.3 .0041DU sizeDU size 44 21.3 .000321.3 .0003MSA statusMSA status 22 6.0 .0496 6.0 .0496RegionRegion 33 21.0 .000121.0 .0001Has phoneHas phone 33 19.6 .000219.6 .0002PSU typePSU type 11 4.5 .0340 4.5 .0340Interview languageInterview language 22 12.3 .002112.3 .0021Health statusHealth status 22 11.2 .003711.2 .0037NHIS interview completion statusNHIS interview completion status 11 3.9 .0500 3.9 .0500Med expend categoryMed expend category 44 1.4 .0343 1.4 .0343HH cooperativenessHH cooperativeness 44 28.3 <.000128.3 <.0001Likely to respond to later surveyLikely to respond to later survey 11 10.6 .001110.6 .0011# contacts w/ sample unit# contacts w/ sample unit 66 35.5 <.000135.5 <.0001# noncontacts# noncontacts 55 30.7 <.000130.7 <.0001Privacy concernsPrivacy concerns 11 20.6 <.000120.6 <.0001Hostility mentionedHostility mentioned 11 5.5 .0194 5.5 .0194

RU level item nonresponse rates, MEPS Panel 12RU level item nonresponse rates, MEPS Panel 12(if any respondent in the RU had a missing value (if any respondent in the RU had a missing value in year 1) in year 1)

VariableVariable NHIS NHIS

Partial (%)Partial (%)

NHIS NHIS Complete (%)Complete (%)

SignifSignif

Yr1 poverty statusYr1 poverty status 15.815.8 10.310.3 p<.001p<.001

EducationEducation 3.93.9 2.12.1 p=.002p=.002

High blood pressure (>17)High blood pressure (>17) 2.42.4 0.90.9 p<.001p<.001

High cholesterol (>17)High cholesterol (>17) 2.32.3 1.21.2 p=.025p=.025

Diabetes diagnosisDiabetes diagnosis 1.51.5 0.80.8 p=.059p=.059

How often dental check upHow often dental check up 5.35.3 2.52.5 p<.001p<.001

How long last routine check up How long last routine check up (>17)(>17)

10.710.7 6.46.4 p<.001p<.001

How long last flu shot (>17)How long last flu shot (>17) 9.69.6 4.94.9 p<.001p<.001

How long since mammogram (>29)How long since mammogram (>29) 8.68.6 4.54.5 p<.001p<.001

How long since last PSA (>39, M)How long since last PSA (>39, M) 17.017.0 10.510.5 p<.001p<.001

Usual source of careUsual source of care 5.25.2 2.22.2 p<.001p<.001

Employment statusEmployment status 3.73.7 2.32.3 p=.014p=.014

Mental health statusMental health status 2.12.1 1.11.1 p=.014p=.014

Health statusHealth status 1.61.6 0.90.9 p=.059p=.059

Comparison of selected Year 1 estimates Comparison of selected Year 1 estimates (percents) according to NHIS interview completion (percents) according to NHIS interview completion status: MEPS Panels 11 & 12 status: MEPS Panels 11 & 12 (* = signif p <.05)(* = signif p <.05)

Person level Person level healthhealth

Panel 11Panel 11 Panel 12Panel 12

measuremeasure Partial Partial CompleteComplete PartialPartial CompleteComplete

Insurance (<65)Insurance (<65)

Any privateAny private 68.368.3 71.4*71.4* 65.065.0 68.968.9

Public onlyPublic only 15.215.2 15.315.3 17.417.4 15.915.9

UninsuredUninsured 16.516.5 13.313.3 17.617.6 15.215.2

Any activity Any activity limitation*limitation*

7.37.3 10.410.4 6.16.1 9.59.5

High cholesterol High cholesterol dx (>17)*dx (>17)*

20.720.7 25.525.5 24.424.4 30.530.5

Office based Office based provider visit*provider visit*

68.068.0 75.275.2 65.765.7 72.672.6

Rx (including Rx (including refills)*refills)*

58.658.6 65.265.2 55.155.1 63.463.4

Total mean Total mean expenditures*expenditures*

$2,760$2,760 $3,815$3,815 $3,171$3,171 $3,943$3,943

5+ contacts5+ contacts $2,484$2,484 $3,390*$3,390* $3,021$3,021 $3,823$3,823

MEPS Year 1 estimates (in percent) for All MEPS MEPS Year 1 estimates (in percent) for All MEPS respondents versus excluding NHIS partial cases respondents versus excluding NHIS partial cases (person weights for NHIS completes re-calculated treating partials (person weights for NHIS completes re-calculated treating partials as nonrespondents) as nonrespondents) (* = signif p<.05)(* = signif p<.05)

Person level Person level healthhealth

Panel 11Panel 11 Panel 12Panel 12

measuremeasure AllAll CompletesCompletes

Only (rewt)Only (rewt)

AllAll Completes Completes Only (rewt)Only (rewt)

Insurance (<65)Insurance (<65)

Any privateAny private 70.770.7 71.171.1 68.168.1 68.668.6

Public onlyPublic only 15.315.3 15.515.5 16.216.2 16.016.0

UninsuredUninsured 14.014.0 13.513.5 15.715.7 15.315.3

Any activity Any activity limitationlimitation

9.89.8 10.0*10.0* 8.98.9 9.19.1

High cholesterol High cholesterol dx (>17)*dx (>17)*

24.524.5 25.125.1 29.529.5 30.030.0

Office based Office based provider visit*provider visit*

73.773.7 74.774.7 71.471.4 72.172.1

Rx (including Rx (including refills)*refills)*

63.863.8 64.464.4 61.961.9 62.662.6

Total mean Total mean expendituresexpenditures

$3,593$3,593 $3,723*$3,723* $3,802$3,802 $3,836$3,836

5+ contacts5+ contacts $3,162$3,162 $3,313*$3,313* $3,647$3,647 $3,702$3,702

SummarySummary

We examined the impact of the carry-over of two types We examined the impact of the carry-over of two types of prior interview cases in the MEPS as a result of its of prior interview cases in the MEPS as a result of its integration with the NHIS.integration with the NHIS.

In particular, we wanted to examine if the partially In particular, we wanted to examine if the partially completed NHIS cases may bias MEPS survey completed NHIS cases may bias MEPS survey estimates and impact survey burden.estimates and impact survey burden.

NHIS partial cases had significantly higher ever refused NHIS partial cases had significantly higher ever refused rates, higher contact rates, lower response rates at rates, higher contact rates, lower response rates at MEPS Round 1, and higher attrition rates.MEPS Round 1, and higher attrition rates.

Partial versus complete was a significant predictor of Partial versus complete was a significant predictor of MEPS Round 1 response propensity controlling for MEPS Round 1 response propensity controlling for other variables.other variables.

Summary (cont.)Summary (cont.)

Item nonresponse rates were higher for the Item nonresponse rates were higher for the partially completed cases relative to the NHIS partially completed cases relative to the NHIS completes for a number of MEPS key variables.completes for a number of MEPS key variables.

Estimates for several selected health items were Estimates for several selected health items were different between the NHIS partials and different between the NHIS partials and completes as carried over in the MEPS sample.completes as carried over in the MEPS sample.

Excluding the NHIS partial cases from the MEPS Excluding the NHIS partial cases from the MEPS survey estimates (and re-weighting) resulted in survey estimates (and re-weighting) resulted in slightly higher estimates of selected conditions, slightly higher estimates of selected conditions, medical events, and expenditures.medical events, and expenditures.

Thanks Thanks

DiscussionDiscussion

Initial exploratory analysisInitial exploratory analysis

– What additional analyses can be carried out to What additional analyses can be carried out to assess potential nonresponse bias and assess potential nonresponse bias and measurement error bias related to the two types of measurement error bias related to the two types of interview cases in the MEPS?interview cases in the MEPS?

– What approaches could be explored to correct for What approaches could be explored to correct for nonresponse or measurement error bias?nonresponse or measurement error bias?

Should MEPS consider excluding or subsampling the Should MEPS consider excluding or subsampling the NHIS partials in future panels of the MEPS?NHIS partials in future panels of the MEPS?

Ideas/suggestions for future research?Ideas/suggestions for future research?

Logistic regression analysis of the insured (<65 years) Logistic regression analysis of the insured (<65 years) reference person: testing for NHIS interview status reference person: testing for NHIS interview status effect, MEPS, Panels 11 and 12 (RU level analysis)effect, MEPS, Panels 11 and 12 (RU level analysis)

Panel 11Panel 11 Panel 12Panel 12 Panel 11 + 12Panel 11 + 12

DFDF Wald FWald F p-valuep-value DFDF Wald FWald F P-valueP-value DFDF Wald FWald F p-valuep-value

AgeAge 33 9.139.13 .0276.0276 11 4.754.75 .0029.0029 33 21.8121.81 <.0001<.0001

SexSex 11 10.9210.92 .0009.0009 11 7.677.67 .0056.0056 11 18.6118.61 <.0001<.0001

Race/ethnicityRace/ethnicity 33 99.3999.39 <.0001<.0001 11 111.99111.99 <.0001<.0001 33 206.47206.47 <.0001<.0001

Highest year of Highest year of educationeducation 44 69.7869.78 <.0001<.0001 44 52.7552.75 <.0001<.0001 44 122.32122.32 <.0001<.0001

Poverty status (Y1)Poverty status (Y1) 55 237.16237.16 <.0001<.0001 55 174.76174.76 <.0001<.0001 55 406.38406.38 <.0001<.0001

RegionRegion 33 39.0139.01 <.0001<.0001 33 53.0253.02 <.0001<.0001 33 86.5186.51 <.0001<.0001

Total health careTotal health care

ExpendituresExpenditures 66 233.63233.63 <.0001<.0001 66 194.35194.35 <.0001<.0001 66 417.21417.21 <.0001<.0001

NHIS InterviewNHIS Interview

Completion StatusCompletion Status 11 0.360.36 .5477.5477 11 4.754.75 .0293.0293 11 2.932.93 .0868.0868