The Medical Expenditure Panel Survey (MEPS): Data Resources to Inform Research & Policy

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Slide 1

The Medical Expenditure Panel Survey: Data Resources to Inform Research & Policy

Jeffrey Rhoades, Ph.D.

Slide 2

MEPS History

• 1977 National Medical Care Expenditure Survey.
• 1987 National Medical Expenditure Survey.
• 1996 Medical Expenditure Panel Survey (annual).

Slide 3

MEPS Survey Components

• MEPS-HC — Household Component.
• MEPS-MPC — Medical Provider Component.
• MEPS-IC — Insurance Component.

Slide 4

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.

Slide 5

MEPS-Household Component Survey 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.

Slide 6

MEPS Panel Design: Data Reference Periods

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

Slide 7

MEPS-HC Core Interview Content

• Demographics.
• Charges and Payments.
• Health Status.
• Conditions.
• Utilization.
• Employment.
• Health Insurance.

Slide 8

MEPS- HC Supplemental CAPI Sections

Sections asked in rounds 2 and 4:

• Access to care.
• Child preventive health.
• Satisfaction with health plans & providers.

Sections asked in rounds 3 and 5:

• Assets (round 5 only).
• Income.
• Preventive Care.
• Priority conditions.

Slide 9

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.

Slide 10

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.

Slide 11

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.

Slide 12

MEPS Medical Provider Component (MPC)—Purpose

• Compensate for household item non-response.
• Accuracy and detail.
• Imputation source.
• Methodological studies.

Slide 13

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.

Slide 14

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.

Slide 15

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).

Slide 16

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.

Slide 17

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.

Slide 18

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 Web site.

Slide 19

Types of Information Collected

• Establishment-level (location) characteristics.
• Health insurance plan characteristics.
• Firm-level (company) characteristics.

Slide 20

Medical Expenditure Panel Survey

Medical Conditions

Slide 21

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.

Slide 22

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.

Slide 23

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.

Slide 24

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.

Slide 25

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.

Slide 26

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.

Slide 27

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?

Slide 28

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?

Slide 29

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.

Slide 30

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.

Slide 31

Medical Expenditure Panel Survey

Health Care Utilization and Expenditures

Slide 32

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).

Slide 33

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.

Slide 34

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.

Slide 35

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.

Slide 36

Sources of Expenditure Data by Event Type

Slide 37

Annual Expenditure Data

• Annual data cumulated across approx 2½ 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.

Slide 38

Event Level File Record Units

Slide 39

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.

Slide 40

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.

Slide 41

Medical Expenditure Panel Survey

Dissemination of information and data products.

Slide 42

MEPS Web site 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 Email for technical assistance.
• Data Center Information.

Slide 43

Image: A screen shot shows the MEPS Web site. The logo and title at the top of the page are circled in red.

Slide 44

Image: A screen shot shows the MEPS Web site. The menu bar at the left-hand side of the page is outlined in red.

Slide 45

Data User Workshops

• Information will be posted on Workshops and Events section of Web site.
• For inquiries please Email: Workshopinfo@ahrq.hhs.gov.

Slide 46

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.

Slide 47

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 Centers.
    • For more information go to www.ces.census.gov.

Slide 48

Contact Information

• MEPS Email address — MEPSPD@ahrq.gov
• MEPS Information Coordinator:
  • (301) 427-1406

Slide 49

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).

Slide 50

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.

Slide 51

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.

Slide 52

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.

Slide 53

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.

Slide 54

Data Center Questions

• Contact Data Center Administrator by Email at: CFACTDC@AHRQ.HHS.GOV.

Slide 55

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).

Slide 56

Medical Expenditure Panel Survey

MEPS Web Analytical Tools

Slide 57

MEPS Web Analytical Tools

The MEPS Web site contains two Web analytical tools:

• MEPSnet Query Tools.
• Customizable Summary Data Tables.

Slide 58

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.

Slide 59

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.

Slide 60

Medical Expenditure Panel Survey

Considerations for Developing an Analytical File

Slide 61

Major Areas of Health Research Topics Using MEPS Data

• Access.
• Use.
• Expenditures.
• Health insurance.
• Health status and conditions.
• Quality.

First order of business is to define goals of analysis using MEPS data as clearly as possible!

Slide 62

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.

Slide 63

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.

Slide 64

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!