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Record Use in the Medical Expenditure Panel Survey Jeffrey Rhoades, PhD AHRQ/CFACT/DSO [email protected]

Record Use in the Medical Expenditure Panel Survey · Medical Expenditure Panel Survey (MEPS) Insurance Component (IC) • Utilization • Expenditure Data • Expenditure Data. Medical

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  • Record Use in the Medical Expenditure Panel Survey

    Jeffrey Rhoades, PhDAHRQ/CFACT/DSO

    [email protected]

  • Introduction

    Medical Expenditure Panel Survey (MEPS) design MEPS components Utilization and expenditures Medical Events Measurement error Record use Interviewer and respondent training Results

  • MEPS-HC Survey Design

    Annual Survey of 15,000 Households Sub-sample of respondents from the previous year’s National

    Health Interview Survey (NHIS), sponsored by NCHS Representative of the civilian non-institutionalized population of

    the US Collects data for 2 years of healthcare usage from each panel 5 in-person interviews over 2 ½ year period using Computer

    Assisted Personal Interview (CAPI) One respondent per household Person and family level data collected Interviews average 90 minutes with a range of one to four hours

  • Medical Expenditure Panel Survey –Household Component

    Purpose and Uses Estimates and tracks annual health care use,

    expenditures and insurance coverage Provides estimates of expenditures and sources of

    payment by selected demographic variables Access to care and health care quality Used for policy-related and behavioral research on the

    determinants of health care use, spending, and insurance coverage

    Used in microsimulation models to analyze alternative health care delivery proposals

    Trends over time

  • Household Component


    Medical Expenditure Panel Survey (MEPS)



    • Demographics• Income• Health Conditions• Health Status• Health Insurance• Utilization• Expenditure Data

    • Expenditure Data

    Medical Provider Component


    MEPS components


  • Household Component


    Medical Expenditure Panel Survey (MEPS)



    • Utilization• Expenditure Data • Expenditure Data

    Medical Provider Component


    Sources of expenditure data

    2 1

    3 Imputation


  • Health care utilization

    MEPS household respondents asked to report all health care use for family members during reference period

    Utilization is called an ‘event’ in MEPS

    Event type categories: ‘Event’ definition Hospital inpatient stays (IP) . . . . . . . . . . . . . . . stay Office-based medical provider visits (OB) . . Outpatient department visits (OP) . . . . . . . Emergency room visits (ER) . . . . . . . . . . . . . Dental visits (DN) . . . . . . . . . . . . . . . . . . . . . ------------------------------------------------------ Prescription medicine purchases (RX) . . . . . . . original script or refill Home health care (HH) . . . . . . . . . . . . . . . . . . . month of care Other medical expenses (OM) . . . . . . . . . . . . . purchase [e.g. glasses, hearing aids]



  • Collected at the event level

    Represent payments to providers of the health care

    Payments are reported by source e.g. out-of-pocket, private insurance

    Total expenditure is the sum of payments across all sources of payment

    Health care expenditures


  • Out of Pocket► SF – self or family

    Public► MR – Medicare ► MD – Medicaid ► VA – VA/CHAMPVA

    Private insurance► PV – private insurance► TR – TRICARE

    Other► OF – other federal government ► SL – state or local government► WC – worker’s comp ► OT – other insurance► OR – other private► OU – other public

    Total Expenditures (XP) =Sum of payments from all 12 sources

    Sources of payment


  • Event type HC MPCOffice-based: physician Office-based: non-physician Inpatient Outpatient ER Dental RX Home health: agency Home health: paid independent Other medical

    Sources of expenditure data by event type

  • Household respondent – one person report for all

    Recall periods of 4 – 10 months (avg. 6 months)

    Saliency of a health care event not equal across all events –but expected to report all events

    Some concepts are not easily understood (e.g, source of payment)

    MEPS Design and Measurement Error


  • Training on respondent-centered interviewing

    Interviewer monitoring and feedback

    Respondent materials

    Preparing for the interview

    During the interview

    For the next interview

    Approaches for improving record use


  • Training to increase record use

    Active listening

    Recognize barriers to complete response

    Tailor approach to promote use of recordsCase management tool identifies records used last round

    Coach and mentor respondents on record keeping

    Most knowledgeable respondent - includes someone who can work with records for household

  • Interviewer Monitoring and Feedback on records

    Weekly reports by interviewer Number of interviews with No records used Number of interviews with no “key” records used

    Feedback given each week Notes if improved Trouble-shoots barriers to records at a case level

  • Key► Bill/Statement from


    ► Doctor’s Card/Appt Slip

    ► Calendar

    ► Electronic Records

    ► Explanation of Benefits

    Other► Checkbook

    ► Medicine Bottle/Receipt

    ► Insurance Cards

    ► Telephone Book

    ► Magnetic Basket

    ► Pharmacy Patient Profile

    ► Tax Form

    Record indicators in Computer Assisted Personal Interview


  • Preparing for the interview

  • Preparing for Your Interview (con’t)

  • Materials at start/during interview

  • Materials to help maintain records for next interview

  • Materials to help maintain records

  • Metric Panel 17, 2012

    Round 1

    Panel 19, 2014 Round 1

    Count of completes 6,301 7,114

    Percent using no records 27.6 13.5

    Percent using one or more “key” records

    54.9 74.8

    Record Use in Interviews

  • Summary

    MEPS survey design and components

    Capture of health care events

    Measurement error

    Strategies to reduce error Respondent centered interviewing Tailored approach Interviewer monitoring Preparing for the interview Emphasis on record keeping


  • Acknowledgement

    I want to thank Wendy HicksWestatDeputy Project DirectorMEPS Household Component for her contributions to this presentation.

    Record Use in the �Medical Expenditure Panel SurveyIntroductionMEPS-HC Survey DesignMedical Expenditure Panel Survey – Household Component MEPS componentsSlide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Training to increase record useInterviewer Monitoring and �Feedback on recordsSlide Number 15Preparing for the interviewPreparing for Your Interview (con’t)Materials at �start/during interviewMaterials to help maintain records for next interviewMaterials to help maintain recordsSlide Number 21SummaryAcknowledgement