Record Use in the Medical Expenditure Panel Survey
Jeffrey Rhoades, PhDAHRQ/CFACT/DSO
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
(HC)
Medical Expenditure Panel Survey (MEPS)
InsuranceComponent
(IC)
• Demographics• Income• Health Conditions• Health Status• Health Insurance• Utilization• Expenditure Data
• Expenditure Data
Medical Provider Component
(MPC)
MEPS components
5
Household Component
(HC)
Medical Expenditure Panel Survey (MEPS)
InsuranceComponent
(IC)
• Utilization• Expenditure Data • Expenditure Data
Medical Provider Component
(MPC)
Sources of expenditure data
2 1
3 Imputation
6
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]
visit
7
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
8
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
9
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
11
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
12
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
Provider
► 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
15
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
Results
Acknowledgement
I want to thank Wendy HicksWestatDeputy Project DirectorMEPS Household Component for her contributions to this presentation.
Recommended
