Medical Expenditure Panel SurveyMedical Expenditure Panel Survey

Karen BeauregardKaren BeauregardSteve MachlinSteve Machlin

Jeffrey RhoadesJeffrey Rhoades

Medical Expenditure Panel SurveyMedical Expenditure Panel Survey

SURVEY OVERVIEWSURVEY OVERVIEW

MEPS HistoryMEPS History

1977 National Medical Care Expenditure 1977 National Medical Care Expenditure SurveySurvey

1987 National Medical Expenditure Survey1987 National Medical Expenditure Survey

1996 Medical Expenditure Panel Survey1996 Medical Expenditure Panel Survey

Medical Expenditure Panel Medical Expenditure Panel Survey (MEPS)Survey (MEPS)

Annual Survey of 15,000 households:Annual Survey of 15,000 households: provides national estimates of health care use, provides national estimates of health care use, expenditures, insurance coverage, sources of payment, expenditures, insurance coverage, sources of payment, access to care and health care qualityaccess to care and health care quality

Permits studies of:Permits studies of: Distribution of expenditures and sources of paymentDistribution of expenditures and sources of payment Role of demographics, family structure, insuranceRole of demographics, family structure, insurance Expenditures for specific conditionsExpenditures for specific conditions Trends over timeTrends over time

MEPS Survey ComponentsMEPS Survey Components

Household Component (HC)Household Component (HC)

– Medical Provider Component (MPC)Medical Provider Component (MPC)

– Insurance Component (IC)– Link SampleInsurance Component (IC)– Link Sample

Insurance Component (IC) – List SampleInsurance Component (IC) – List Sample

MEPS-Household Component(HC) Survey Design

Sub-sample of household respondents Sub-sample of household respondents from the previous year’s National Health from the previous year’s National Health Interview Survey (NHIS), sponsored by Interview Survey (NHIS), sponsored by NCHSNCHS

Representative of the civilian non-Representative of the civilian non-institutionalized population of the USinstitutionalized population of the US

5 in-person interviews (CAPI) over 2 ½ year 5 in-person interviews (CAPI) over 2 ½ year periodperiod

Person and family level data collectedPerson and family level data collected

Oversampling in MEPSOversampling in MEPS

Every year: Blacks and Hispanics– Carryover from NHIS

1997: Selected subpopulations– Functionally impaired adults– Children with activity limitations– Adults 18-64 predicted to have high medical expenditures– Low income– Adults with other impairments

2002 and beyond:– Asians – Low income– Additional over sampling of blacks in 2004

MEPS-HC Sample SizesMEPS-HC Sample Sizes

YearYear HouseholdsHouseholds PersonsPersons

19961996 9,400 9,400 23,500 23,500

19971997 13,500 33,00013,500 33,000

1998-20001998-2000 10,00010,000 24,000 24,000

20012001 13,50013,500 32,000 32,000

20022002 ++ 15,00015,000 37,000 37,000

MEPS-HC MEPS-HC Core Interview ContentCore Interview Content

DemographicsDemographics Charges and PaymentsCharges and Payments Health StatusHealth Status ConditionsConditions Utilization Utilization EmploymentEmployment Health InsuranceHealth Insurance

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Panel 5

Round 3

Round 4

Round 5

Panel 6

Round 1

Round 2

Round 3

Round 4

Round 5

Panel 7

Round 1

Round 2

Round 3

Round 4

Round 5

Panel 8

Round 1

Round 2

Round 3

Round 4

Round 5

Panel 9

Round 1

Round 2

Round 3

Sample Size

2001 2002 2003 2004

N= 32,122 N=37,418 N=32,681 N=32,737

MEPS Panel Design: Data Reference Periods

N is equal to the number of people with a positive person weight on the file.

MEPS Overlapping PanelsMEPS Overlapping Panels(Panels 8 and 9)(Panels 8 and 9)

MEPS Household Component MEPS Panel 8

2003-2004

Round 2

Round 3 Round 4 Round 5

Round 1 Round 2 Round 3

MEPS Panel 92004-2005

1/1/2003 1/1/2004

Round 1

NHISNHIS20022002

NHISNHIS20032003 Round 4 Round 5

MEPS-HC PurposeMEPS-HC Purpose

Estimates annual health care use and Estimates annual health care use and expendituresexpenditures

Supports distributional estimatesSupports distributional estimates Tracks changes in insurance Tracks changes in insurance

coverage and employmentcoverage and employment Longitudinal design; linkage to NHISLongitudinal design; linkage to NHIS

MEPS-HC Utilization DataMEPS-HC Utilization Data

Hospital staysHospital stays Other hospital careOther hospital care Office based Office based

physician carephysician care Other medical Other medical

providersproviders

Dental servicesDental services Home healthHome health Prescribed Prescribed

medicationsmedications Medical equipment Medical equipment

and suppliesand supplies

MEPS- HC Periodic MEPS- HC Periodic SupplementsSupplements

Access to careAccess to care Satisfaction with health Satisfaction with health

plans & providersplans & providers Health statusHealth status Income Income

New SupplementsNew Supplements

Adult SAQAdult SAQ Preventive CarePreventive Care Enhanced Access to Care Enhanced Access to Care

SectionSection Children’s Health Children’s Health

Supplement Supplement

Condition SupplementsCondition Supplements

Priority ConditionsPriority Conditions– DiabetesDiabetes– AsthmaAsthma– HypertensionHypertension– Ischemic Heart DiseaseIschemic Heart Disease– ArthritisArthritis– StrokeStroke– COPDCOPD

Diabetes Care SAQ (DCS)Diabetes Care SAQ (DCS)

MEPS-HC Caveats and MEPS-HC Caveats and LimitationsLimitations

Sample size limitations preclude some analysesSample size limitations preclude some analyses Household respondents may not be able to report Household respondents may not be able to report

accurately certain types of informationaccurately certain types of information– type of health plantype of health plan– detailed event informationdetailed event information– diagnosesdiagnoses– limited capacity to produce state level estimateslimited capacity to produce state level estimates

Types of MEPS-HC FilesTypes of MEPS-HC Files

Full-year Files - calendar year dataFull-year Files - calendar year data

Point-in-time Files - snap shot first Point-in-time Files - snap shot first part of yearpart of year

Levels of MEPS-HC Public Levels of MEPS-HC Public Use FilesUse Files

Person Level - detailed person Person Level - detailed person informationinformation

Event Level - detailed event level Event Level - detailed event level informationinformation

Condition Level - detailed condition Condition Level - detailed condition informationinformation

Job Level - detailed job informationJob Level - detailed job information

Sub-national AnalysisSub-national Analysis

Supports state estimates: Direct state level estimates of cost, coverage and use for the largest states.

Supports metro area estimates: Direct MSA level estimates of cost, coverage and use for the largest metropolitan areas.

Medical Expenditure Panel SurveyMedical Expenditure Panel Survey

DISSEMINATION OF DISSEMINATION OF INFORMATION AND DATA INFORMATION AND DATA

PRODUCTSPRODUCTS

MEPS Web-site RedesignMEPS Web-site Redesign

More User FriendlyMore User Friendly Additional Content AddedAdditional Content Added More Powerful Databases and Search More Powerful Databases and Search

EnginesEngines Upgraded to Meet Federal, HHS, and Upgraded to Meet Federal, HHS, and

AHRQ Web StandardsAHRQ Web Standards

Medical Expenditure Panel Survey Medical Expenditure Panel Survey Methods of Dissemination Methods of Dissemination

MEPS Website at MEPS Website at www.meps.ahrq.govwww.meps.ahrq.gov

MEPS e-mail address - MEPS e-mail address - MEPSPD@ahrq.govMEPSPD@ahrq.gov

AHRQ clearinghouse AHRQ clearinghouse 800-358-9295800-358-9295– for CD-ROMs and print publicationsfor CD-ROMs and print publications

MEPS Website MEPS Website www.meps.ahrq.govwww.meps.ahrq.gov

Overview of MEPS and Frequently Asked Questions (FAQs)Overview of MEPS and Frequently Asked Questions (FAQs) Staff Reports using MEPS Staff Reports using MEPS

Findings/Statistical Briefs/Chart booksFindings/Statistical Briefs/Chart books Data Tables of EstimatesData Tables of Estimates Public Use Files (microdata) Public Use Files (microdata) MEPSnet Interactive Query ToolMEPSnet Interactive Query Tool Survey Methodology Reports Survey Methodology Reports Survey Questionnaires and Other Collection MaterialsSurvey Questionnaires and Other Collection Materials Data product availability and ordering informationData product availability and ordering information MEPS data workshop information and schedule MEPS data workshop information and schedule Mailing list and List serverMailing list and List server Data Center InformationData Center Information

Data User WorkshopsData User Workshops

Hands-on Workshops planned for May and Hands-on Workshops planned for May and September in Rockville, MDSeptember in Rockville, MD

Information will be posted on Workshops and Information will be posted on Workshops and Events section of web siteEvents section of web site

For inquiries please e-mail: For inquiries please e-mail: Workshop06@ahrq.hhs.govWorkshop06@ahrq.hhs.gov

MEPS Mailing List/List MEPS Mailing List/List ServerServer

Mailing List/List ServerMailing List/List Server Click on “Mail List/List Server” from Web Click on “Mail List/List Server” from Web

site site Both receive e-mail notices of data and Both receive e-mail notices of data and

publications released on the Webpublications released on the Web List Server allows for interactive exchange List Server allows for interactive exchange

of ideas and informationof ideas and information

Micro Data FilesMicro Data Files

Public Use Files (Microdata) – Available for Public Use Files (Microdata) – Available for downloading from web site (Household survey downloading from web site (Household survey only)only)

Restricted Access Files (Microdata) Restricted Access Files (Microdata) – MEPS-HC – Available for Use at AHRQ Data CenterMEPS-HC – Available for Use at AHRQ Data Center– MEPS-IC – Available for Use at Census Research Data MEPS-IC – Available for Use at Census Research Data

CentersCentersFor more information go to www.ces.census.govFor more information go to www.ces.census.gov

Recent Data ReleasesRecent Data Releases

2004 Utilization and Quality of Care2004 Utilization and Quality of Care– (new variables include K6 and PH2 mental health assessment tools)(new variables include K6 and PH2 mental health assessment tools)

2004 Jobs File2004 Jobs File

1996-2001 Risk Adjustment File1996-2001 Risk Adjustment File

Link to 2003 NHIS FileLink to 2003 NHIS File

Recent Data ReleasesRecent Data Releases

2005 First Part of Year File 2005 First Part of Year File

2004 Event Files 2004 Event Files

1996-2004 Pooling File 1996-2004 Pooling File

Upcoming Data ReleasesUpcoming Data Releases

2004 Consolidated File (Use and 2004 Consolidated File (Use and Expenditures)-NovemberExpenditures)-November

2004 Condition file -November2004 Condition file -November

2002-2004 Risk adjustment File - December2002-2004 Risk adjustment File - December

AHRQ Data Center (ADC)AHRQ Data Center (ADC)

Provides researchers access to non-public use Provides researchers access to non-public use MEPS data (except directly identifiable information);MEPS data (except directly identifiable information);

Mode of data analysis Mode of data analysis

– on secure LAN at AHRQ - Rockville, Maryland on secure LAN at AHRQ - Rockville, Maryland

– task order agreement with data contractor task order agreement with data contractor

– combinations of bothcombinations of both

ADC ProceduresADC Procedures

Researcher may bring data in, but not outResearcher may bring data in, but not out Researcher has access only to data needed for approved Researcher has access only to data needed for approved

projectproject All tabular data will be reviewed for confidentiality before All tabular data will be reviewed for confidentiality before

release from Centerrelease from Center Only approved tables can leave the CenterOnly approved tables can leave the Center Center will store data files, foreign merge files, and all Center will store data files, foreign merge files, and all

outputs needed for replicationoutputs needed for replication

ADC FacilitiesADC Facilities Secure roomSecure room Terminal connected to secure LANTerminal connected to secure LAN SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep,

EQS software available, and others upon request EQS software available, and others upon request Limited staff support by people who know:Limited staff support by people who know:

– the datathe data– the confidentiality issuesthe confidentiality issues– the softwarethe software

ADC Application ADC Application And Review ProcessAnd Review Process

Application procedures are on the Application procedures are on the MEPS web siteMEPS web site

Submit proposal to data center Submit proposal to data center coordinatorcoordinator

Review within 1 week for feasibility, Review within 1 week for feasibility, and data availabilityand data availability

Institutional Review Board (IRB) Institutional Review Board (IRB) review requiredreview required

ADC FeesADC Fees

User fee of $150.00 for approved projects to User fee of $150.00 for approved projects to cover technical assistance, simple file cover technical assistance, simple file construction, and/or up 2 hours of construction, and/or up 2 hours of programming support from data contractorprogramming support from data contractor

Additional programming support available Additional programming support available from an AHRQ contractor at a cost of $80.00/hrfrom an AHRQ contractor at a cost of $80.00/hr

User fee waived for full-time studentsUser fee waived for full-time students

ADC Limited Remote ADC Limited Remote AccessAccess

Once you have an established data Once you have an established data center project, and have worked on site center project, and have worked on site to develop and debug programs, jobs to develop and debug programs, jobs may be submitted to our Data Center may be submitted to our Data Center Supervisor to run. Out-put will be Supervisor to run. Out-put will be reviewed for confidentiality and mailed reviewed for confidentiality and mailed to you.to you.

Confidential Data Confidential Data Available for ADC ProjectsAvailable for ADC Projects

Linked MEPS-HC and Secondary Data (full Linked MEPS-HC and Secondary Data (full geo-coding for 1996, 1997 and 2000-2004, geo-coding for 1996, 1997 and 2000-2004, FIPS codes for other years)FIPS codes for other years)

Selected Medical Provider Component DataSelected Medical Provider Component Data

Selected State and MSA identifiers and Selected State and MSA identifiers and estimation variablesestimation variables– 29 largest states and 10 largest MSA’s29 largest states and 10 largest MSA’s

Confidential Data Available for Confidential Data Available for Data Projects in ADCData Projects in ADC

Fully specified industry/occupation codesFully specified industry/occupation codes

Fully specified condition codesFully specified condition codes

Continuous poverty measure Continuous poverty measure

Linked MEPS Household Component (HC) and Linked MEPS Household Component (HC) and Insurance Component (IC) data ( 96-98, 2001-Insurance Component (IC) data ( 96-98, 2001-excluding federal workers )excluding federal workers )