The Medical Expenditure Panel Survey: Data Resources to

Inform Research & Policy

Jeffrey Rhoades, Ph.D.

MEPS History

1977 National Medical Care Expenditure Survey

1987 National Medical Expenditure Survey

1996 Medical Expenditure Panel Survey (annual)

MEPS Survey Components

MEPS-HC -- Household Component

MEPS-MPC -- Medical Provider Component

MEPS-IC -- Insurance Component

Medical Expenditure Panel Survey – Household Component

Annual Survey of 14,000 households: provides national estimates of health care use, expenditures, insurance coverage, sources of payment, access to care and health care quality

Permits studies of: Distribution of expenditures and sources of

payment Role of demographics, family structure,

insurance Expenditures for specific conditions Trends over time

MEPS-Household ComponentSurvey Design

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 CAPI technology

Person and family level data collected Interviews average 90 minutes with a range of

one to four hours

MEPS Panel Design: Data Reference Periods

2008 2009 2010

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

Panel 12 Round 3 Round 4 Round 5

Panel 13 Round 1 Round 2 Round 3 Round 4 Round 5

Panel 14 Round 1 Round 2 Round 3 Round 4 Round 5

Panel 15 Round 1 Round 2 Round 3

Sample Size

N = 31,262 N = 34,920 N = 31,228

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

MEPS-HC Core Interview Content

Demographics Charges and Payments Health Status Conditions Utilization Employment Health Insurance

MEPS- HC Supplemental CAPI Sections

Sections asked in rounds 2 and 4: Access to care Child preventive health Satisfaction with health plans &

providersSections asked in rounds 3 and 5: Assets (round 5 only) Income Preventive Care Priority conditions

MEPS-HC Supplemental Paper Questionnaires

Diabetes Care Survey (DCS)• Given once a year to each adult identified as

having diabetes

Adult SAQ• Given once a year to each adult 18 years old

and older

Cancer SAQ– Given only in Panel 15 round 5 and Panel 16

round 3 to each person identified as having cancer

Levels of MEPS-HC Public Use Files

Person Level - detailed person information

Event Level - detailed event level information

Condition Level - detailed condition information

Job Level - detailed job information

MEPS-HC Caveats and Limitations

Sample size limitations preclude some analyses

Typically, one respondent provides data for the entire household

Household respondents may not be able to report accurately certain types of information– type of health plan– detailed event information– diagnoses

MEPS Medical Provider Component (MPC) - Purpose

Compensate for household item non-response

Accuracy and detail

Imputation source

Methodological studies

MEPS-MPC (Medical Provider Component)

Survey of medical providers linked to respondents of the HC

Collects data that household respondents cannot accurately provide, such as dates of visit, diagnosis and procedure codes, charges and payments

The Pharmacy Component (PC), a subcomponent of the MPC, collects drug detail information, including National Drug Code (NDC) and medicine name, date filled and sources and amounts of payment

The MPC is not designed to yield national estimates.  It is primarily used as an imputation source to supplement household reported expenditure information.

Medical Provider Component (MEPS) Data

Collected for:– Physician Office Visits– Outpatient Department Visits– Hospital Inpatient Stays– Emergency Room Visits– Prescribed Medicines (Pharmacy Component)– Home Health Agency Care

Not collected for:– Non-physician Office Visits– Dental Visits– Home Health - Independent Providers– Other Medical Expenses

MEPS-IC Survey

Nationwide, annual survey of both private and public sector establishments

Funded by the Agency for Healthcare Research and Quality (AHRQ)

Conducted by the U.S. Census Bureau Survey data available for 1996 through

2010 (except 2007)

MEPS-IC (Insurance Component)

An independent survey of employers and unions not linked to the household survey

The sample contains information from about 44,000 establishments and supports national and state-level estimates for all 50 states.

Employer-sponsored health insurance measures:– Availability– Enrollment– Benefit and payment provisions– Cost

MEPS-IC Sample Design

Sample of private establishments drawn from the Census Bureau’s Business Register– Approximately 42,000 establishments sampled

Sample of state and local governments drawn from the Census Bureau’s Census of Governments– Approximately 2,000 governmental units

sampled (No longer collected) Sample of employers

directly linked to the MEPS Household Survey – Last year available is 2001

MEPS-IC Sample Design

Designed to make National, State, and some Metro area estimates

Designed to make year-to-year estimates

Data is Census Bureau Confidential - Public Use Files are not available

Methodology Reports available on website

Types of Information Collected

Establishment-level (location) characteristics

Health insurance plan characteristics

Firm-level (company) characteristics

Medical Expenditure Panel Survey

Medical Conditions

MEPS Condition Roster

One roster per person Cumulates medical conditions reported across MEPS interviews Source of conditions

–Following 4 sections: Condition Enumeration Priority Conditions Medical Events Disability

General File Structure

Each record represents a unique condition or procedure reported by a household respondent

Depending on the number of conditions reported, persons may be represented on the file– once– several times – not at all

Condition Enumeration

We're interested in learning about health problems that may have bothered (PERSON) {since (START DATE)/between (START DATE) and (END DATE)}. – Health problems include physical conditions,

accidents, or injuries that affect any part of the body as well as mental or emotional health conditions, such as feeling sad, blue, or anxious about something.

Condition Enumeration

Asked in every round

Has a time frame (since last interview until today)– Responses recorded verbatim and coded into 5

digit ICD9 codes– Responses directly linked to conditions roster– Chronic/priority conditions appear only once on

the roster– Acute conditions can have many records– Responses aggregated across rounds for the

annual responses

Priority Conditions

New section since Panel 12 Separate section of questionnaire Series of questions asking if “ever” had

condition– “yes/no” responses, no ICD9 coding– responses of “yes” with a current utilization

record will appear on person’s condition roster Factors used in determining priority

conditions– Prevalence– Expenditures– Policy relevance

Priority Conditions List

Heart disease Heart attack Angina High cholesterol Cancer Stroke High blood pressure Diabetes Asthma Arthritis/Joint pain Emphysema Chronic bronchitis Attention deficit disorder

Medical Events

What conditions were discovered or led (PERSON) to make this visit? PROBE: Any other condition? IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?– Types of visits

Inpatient Outpatient Emergency Room Office Based Home Health

Conditions associated with Prescribed Medicine purchases:– What health problem is (MEDICINE) prescribed for?

PROBE: Any other health problems?

Disability Days

Missed school or work– What are the health problems that caused

(PERSON) to miss work/school on those days? PROBE: Any other health problems?

Bed days– What are the health problems that caused

(PERSON) to spend half day or more in bed on those days? PROBE: Any other health problems?

Reporting and Recording Conditions

Respondents may report having the same condition more than once– Interviewer verifies that these are

different occurrences of the condition– each unique episode of a condition is

recorded only once person may have more than one cold in a

year each cold has a separate record

Condition Coding

Coding and Editing

– Text strings coded into fully specified ICD-9 CM codes (up to 5 digits)

– Collapsed into 3 digits to maintain confidentiality

– Approximately 10% of condition codes are collapsed further by combining 2 or more 3-digit codes

Clinical Classification System (CCS codes) - ICD-9 codes aggregated into clinically meaningful categories

Limitations: clustering of ICD-9 codes in NEC (not elsewhere classified) and one respondent provides information for the entire household

Medical Expenditure Panel Survey

Health Care Utilization and Expenditures

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:

– Office-Based Medical Provider Visits (OB)– Hospital Inpatient Stays (IP)– Outpatient Department Visits (OP)– Emergency Room Visits (ER)– Dental Visits (DN)– Prescription Medicine Purchases (RX)– Home Health Care (HH)– Other Medical Expenses (OM)

Health Care Expenditures 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, public program)

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

Source of Payment Categories

Self or family Medicare Medicaid Private

insurance VA

TRICARE Other federal

gov’t State or local

gov’t Worker’s comp Other insurance

Sources of Expenditure Data

Expenditures derived from two survey components:– Household Component (HC)– Medical Provider Component (MPC)

MPC data used to replace and/or supplement household-reported expenditures

Incomplete data on expenditures for an event is imputed - no missing values

Sources of Expenditure Data by Event Type

Event type HC MPCOB: Physician yes yesOB: Non-Physician yes noIP yes yesOP yes yesER yes yesDN yes noRX no yesHH: Agency no yesHH: Paid independent yes noOM yes no

Annual Expenditure Data

Annual data cumulated across approx 2 ½ rounds of data collection

Event level files– Separate by type of service– Unique record for each reported event

Some persons have no events Some persons have multiple events

Person-level file (full year consolidated) Variables derived from event level

Event Level File Record Units

EVENT TYPE RECORD UNIT

OB visit

OP visit

ER visit

IP stay

DN visit

HH month

RX original script or refill

Flat Fees

What is a Flat Fee?– A fixed dollar amount paid for a group of

health care services– Common examples: orthodontic,

prenatal care Flat Fee ID: FFEEIDX Flat fee structure (FFevTYPE)

– Stem - Initial medical visit - expenditures– Leaf - subsequent medical visits - zero

expenditures

Zero Dollar Events

Reasons for $0 total expenditures– Leaf event in flat fee bundle from prior

year– Follow-up visit without extra charge– Free care – Bad debt

Medical Expenditure Panel Survey

DISSEMINATION OF INFORMATION AND DATA

PRODUCTS

MEPS Website www.meps.ahrq.gov

Overview of MEPS and Frequently Asked Questions (FAQs)

Staff Reports using MEPS Findings/Statistical Briefs/Chart books

Data Tables of Estimates Public Use Files (microdata) MEPSnet Interactive Query Tool Survey Methodology Reports Survey Questionnaires and Other Collection Materials Data product availability and ordering information MEPS data workshop information and schedule Mailing list, List server and e-mail for technical

assistance Data Center Information

Data User Workshops

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

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

MEPS Publications Statistical Briefs: Easy-to-read, concise graphical

summaries of MEPS data Research Findings and Highlights: Tables and

summaries of descriptive statistics Methodology Reports: Detailed information on MEPS

sample design and survey methods Chartbooks: Policy-sensitive topics in an accessible

question-and-answer format Working Papers: Preliminary analyses of methodological

and technical issues by AHRQ staff Research in Action: Analyses using research results from

AHRQ-sponsored studies, including MEPS data

Micro Data Files

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

Restricted Access Files (Microdata) – MEPS-HC – Available for Use at AHRQ

Data Center– MEPS-IC – Available for Use at Census

Research Data CentersFor more information go to www.ces.census.gov

Contact Information

MEPS e-mail address - MEPSPD@ahrq.gov

MEPS Information Coordinator:– (301) 427-1406

AHRQ Data Center

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

Located in Rockville, MD Applications/procedures on MEPS web site User fee of $300.00 includes up to 2 hours

of programming (fee waived for full-time students)

AHRQ Data Center Facilities

Secure room Terminal connected to secure LAN SAS, STATA, GAUSS, Stat Transfer,

SUDAAN, Limdep, EQS software available, and others upon request

Limited staff support by people who know:– the data– the confidentiality issues– the software

ADC Guidelines

Researcher may bring data in, but not out Researcher has access only to data

needed for approved project All tabular data will be reviewed for

confidentiality before release from Center Only approved tables can leave the

Center Center will store data files, foreign merge

files, and all outputs needed for replication

ADC Limited Remote Access

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

ADC Application Procedures

Application procedures are on the MEPS web site

Submit proposal to data center coordinator

Review within 1 week for feasibility, and data availability

Institutional Review Board (IRB) review required

Data Center Questions

Contact Data Center Administrator by e-mail at: CFACTDC@AHRQ.HHS.GOV

Census Bureau Research Data Centers (RDC)

Access to MEPS-IC data files and other files (including MEPS-HC)

All work takes place at a RDC operated by the Census Bureau’s Center for Economic Studies – University of Washington

(coming Summer 2012)– Texas (coming Fall 2012)

– Atlanta (Federal Reserve Bank)

– Boston (NBER)– UC-Berkeley – UCLA – Stanford– Washington DC (Census

HQ)– Chicago (Federal Reserve

Bank)– University of Michigan– University of Minnesota– Baruch School of Public

Affairs (New York City)– Cornell University– Duke University – Research Triangle (RTI)

Medical Expenditure Panel Survey

MEPS Web Analytical Tools

MEPS Web Analytical Tools

The MEPS web site contains two web analytical tools:

MEPSnet Query Tools

Customizable Summary Data Tables

MEPSnet Query Tools

MEPSnet is a collection of analytical tools offering online capability to generate MEPS estimates. The tools are divided into two sections:

MEPSnet/Household Component MEPSnet/HC

MEPSnet/Insurance Component MEPSnet/IC

Customizable Summary Data Tables

The following MEPS Summary Data Tables are customizable:

All of the Expenditures by Health Care Service Tables

All of the Expenditures by Medical Condition Tables

All of the Quality of Care Tables

Only Table 1, Usual Source of Health Care and Selected Population Characteristics, United States from the Access to Care Tables

Medical Expenditure Panel Survey

Considerations for Developing an Analytical File

Major Areas of Health Research Topics Using MEPS Data

Access Use Expenditures Health insurance Health status and conditions QualityFirst order of business is to define goals of analysis

using MEPS data as clearly as possible!

Sources of Useful Information

MEPS-HC Questionnaires Public Use File Documentation

– General information about MEPS– File-specific general information– File specific variable information

Person-level or Family-level Condition-level or Event-level MEPS supplement questions

Public Use File Codebooks– Good source of overview information– Formatted frequencies for all variables on file

Both weighted and unweighted

Variable Naming Conventions

Edited Variables end in an “X”– For example: RACEX

Names of year specific variables use last two digits of year– For example: TOTEXP09, PERWT09F, AGE09X

For round specific variables, round designation is indicated at the end of the variable or immediately before the “X” in the case of edited variables– For example: AGE31X, AGE42X, AGE53X– Certain questions or instrument sections are only asked

in certain rounds, e.g. the Self-Administered Questionnaire in rounds 2 and 4

General Tips

Clearly define research objectives Read the documentation Subset to only the variables you need for

your analysis Do not subset to specific populations prior

to running statistical analyses Compare program output with codebooks Use the correct weight, stratum and psu

variables (including supplement weights) Read the documentation!