AHRQ 2010 Annual Conference AHRQ Data Resources to Inform Health Policy Research: The Medical Expenditure Panel Survey (MEPS) Jeffrey Rhoades, Ph.D.

AHRQ 2010 Annual Conference

AHRQ Data Resources to Inform Health Policy Research:

The Medical Expenditure Panel Survey (MEPS)

Jeffrey Rhoades, Ph.D.

Medical Expenditure Panel Survey

MEPS OVERVIEW

MEPS Overview

History & Purpose Survey Components & Design Sample Core Content Supplemental CAPI sections &

Questionnaires Public Use Files Dissemination of Data

MEPS History

1977 National Medical Care Expenditure Survey

1987 National Medical Expenditure Survey

1996 Medical Expenditure Panel Survey

MEPS-HC Purpose & Uses

Estimates and tracks annual health care use, expenditures and insurance coverage

Provides estimates of expenditures and sources of payment by selected demographic variables

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

MEPS Survey Components

MEPS-HC -- Household Component

MEPS-MPC -- Medical Provider Component

MEPS-IC -- Insurance Component

MEPS-HC Survey Design

Sub-sample of respondents from the previous year’s National Health Interview Survey (NHIS)

Representative of the civilian non-institutionalized population of the US

Five in-person interviews over 2 ½ year period using Computer Assisted Personal Interview (CAPI)

Interviews average 90 minutes with a range of one to four hours

Oversampling in MEPS Panels 7-14 (2002-2009)

Carryover from NHIS– Blacks– Hispanics– Asians (panels 12-14 after 2006 NHIS redesign)

Additional MEPS Oversampling– Asians – Low income (panels 7-13)– Blacks (panels 9-11, 13-14)– Hispanics (panels 13-14)

9

MEPS Panel Design: Data Reference Periods

2006 2007 2008

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

Panel 10 Round 3 Round 4 Round 5

Panel 11 Round 1 Round 2 Round 3 Round 4 Round 5

Panel 12 Round 1 Round 2 Round 3 Round 4 Round 5

Panel 13 Round 1 Round 2 Round 3

Sample Size N = 32,577 N = 29,370 N =31,262

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

MEPS-HC Sample Sizes

Year Families Persons

1996 8,655 21,5711997 13,087 32,6361998 9,023 22,9531999 9,345 23,5652000 9,515 23,8392001 12,852 32,1222002 14,828 37,4182003 12,860 32,6812004 13,018 32,7372005 12,810 32,3202006 12,811 32,5772007 11,615 29,3702008 12,957 31,262

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 &

providers

Sections asked in rounds 3 and 5: Assets (round 5 only) Income Preventive Care

MEPS-HC Supplemental Paper Questionnaires

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

having diabetes• Includes questions about diabetes related tests

and managing diabetes

Adult Self-Administered Questionnaire (SAQ)• Given once a year to each adult 18 years old and

older• Focuses on self-reported information such as

opinions about health care issues and quality of care measures, assessment of own health, and height /weight.

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 Public Use Files

Levels of MEPS-HC Public Use Files

Person Level - detailed person information

Event Level - detailed event information

Condition Level - detailed condition information

Job Level - detailed job information

Types of MEPS-HC Files

Full-year Files – Contain expenditure and utilization data for the calendar year from several rounds of data collection.

– Full Year Consolidated Data File – Event File– Medical Conditions File – Jobs File – Person Round Plan Public Use File

Point-in-time Files - Data for the beginning of the year providing early glimpses of what full-year estimates will likely be.

MEPS/NHIS Link Files - Cross-walk files that allow merging of Household Component files and NHIS files.

Details on MEPS PUFs

Documentation Files– Contain general information about MEPS– Contain survey information specific to each file– Contain variable-source crosswalk to link back to

questionnaire items

File Codebooks– Contains names and location of all variables – List both weighted and unweighted estimates

Data files and related documentation are available for downloading on MEPS Web site: www.meps.ahrq.gov/mepsweb

http://www.meps.ahrq.gov/mepsweb


DISSEMINATION OF INFORMATION AND DATA

PRODUCTS

MEPS Web Site

Materials on the MEPS Web site: – Questionnaires

Core and Supplemental– Summary data tables

Expenditures by Health Care Service Expenditures by Medical Condition Health Insurance Quality of Care Prescription Drugs State-Level Medical Expenditures Access to Care

– Interactive MEPS query tool – MEPSnet– Publications

Statistical Briefs Methodology Reports Research Findings

Data User Workshops

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

For inquiries please e-mail: [email protected]

mailto:[email protected]

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

AHRQ Data Center (ADC) Provides researchers access to non-

public use MEPS data (except directly identifiable information);

Location of data analysis – on secure LAN at AHRQ– Census Remote Data Center (RDC)

ADC Application And Procedures

Application procedures are on the MEPS web site

Submit proposal to Data Center coordinator

Review within 2 weeks for feasibility, and data availability

Institutional Review Board (IRB) review required

ADC Fees

User fee of $300 for approved projects to cover technical assistance, simple file construction, and/or up to 4 hours of programming support from data contractor

Additional programming support available from an AHRQ contractor at a cost of $105.00/hr

User fee waived for full-time students

No fee if you use a RDC

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


MEDICAL CONDITIONS DATA

MEPS Condition Roster

One roster per person Cumulates medical conditions reported across MEPS interviews Interviewer records verbatim responses to questions in the following 3 sections:

– Condition Enumeration– Medical Events – Disability

Condition Enumeration Question

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.

Medical Events Condition Questions

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 Condition Questions

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 probes whether occurrence

of condition already reported– Each unique episode of a condition

recorded only once person may have multiple colds in year each cold has separate record

Accidents and Injury Questions

Following items asked if relevant to reported condition:– date of accident– place (work, home, school, etc.)– cause (gun, vehicle, fall, fire, etc.)– whether or not the person has recovered

from the injury

Medical Conditions File Structure

Each record represents unique condition or procedure for a person

Persons may be represented on file once, several times or not at all

Can be linked to person and event files for analysis

Condition Coding and Editing

Fully specified ICD-9 CM codes (up to 5 digits)

ICD-9 condition codes collapsed to 3 digits to maintain confidentiality

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

Procedure Coding and Editing

Only obtained from Medical Events Questions

Fully specified ICD-9 CM codes (up to 4 digits)– Collapsed to 2-digit codes– Approximately 3% collapsed further by

combining 2 or more 2-digit codes

Clinical Classification Codes (CCC)

ICD-9 codes aggregated into broad clinically meaningful categories

Edited to preserve confidentiality Crosswalk included in documentation Formerly Clinical Classification for

Health Policy Research (CCHPR)

Condition-Event Link Files

Used to link conditions to:– Persons on person files

all reported conditions or just those associated with events

– Events on event files most conditions associated with events

already included on event files

Separate link file for prescribed medicines

National Estimates of Conditions

Most appropriate to estimate “treated prevalence”– MEPS website summary data tables on

Expenditures by Medical Condition Condition more likely to be

underreported if:– respondent/person not aware– not salient or bothersome– no medical care received

Condition Data Limitations/Caveats

Household-reported – One respondent usually providing

information for all household members Many recorded text strings not easily

classifiable into ICD-9 codes Limited information on procedures Not suitable for prevalence estimates More salient conditions tend to be

better reported

Priority Conditions Section

Separate section of questionnaire

Series of questions asking if “ever” had condition– “yes/no” responses, no ICD9 coding– responses not directly linked to conditions

roster

Factors used in determining priority conditions– Prevalence– Expenditures– Policy relevance

Priority Conditions List (Panel 12 and beyond)

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

Priority Condition Section Revisions

Revised section in Panel 12– Priority Conditions Enumeration (PE) section

replaced PC section in prior panels

Primary differences between PE and PC– Questions asked all rounds rather than 3/5 only– PE section substantially earlier in CAPI– Follow-up question on cancer remission added– Age of diagnosis collected for more conditions

Revisions may increase reporting of conditions and associated medical events


Health Care Utilization And Expenditures Data

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 sum of payments across all sources of payment

Source of Payment Categories in CAPI

Self or family Medicare Medicaid/SCHIP 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:– Medical Provider Component (MPC)– Household Component (HC)

MPC data used when available HC data used when no MPC data

available Events with no MPC or HC data on

expenditures are imputed– results in no missing values

Sources of Expenditure Data by Event Type

Event type HC MPCOB: Physician yes yesOB: Non-Physician yes noIP/OP/ER (hospital events) yes yesDN yes noRX no* yesHH: Agency no yes

HH: Paid independent yes noOM yes no

*Except for self-filers

Annual Utilization and 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

Event File Expenditure Variables:OB, DN and OM

12 expenditure by source of payment variables

A total expenditure variable – sum of 12 source of payment

variables

A total charge variable– provider’s charge before

adjustment or discount

Hospital Event Files Expenditure Variables: IP, OP, and ER

Facility Expenditure Variables – 12 expenditure by source of payment variables– A total facility expenditure variable– A total facility charge variable

Separately Billing Doctor Expenditure (SBD) Variables– 12 SBD expenditure by source of payment variables– A total SBD expenditure variable – A total SBD charge variable

Total Expenditures for the event– Sum of facility and SBD expenditures

Total charges for the event– Sum of facility and SBD charges

Common Variables in Event Files

Person/event ID Date(s) of care (not RX) Services/procedures Type of provider (not

RX,ER,IP) Expenditure variables Full year person weight Variance estimation variables Imputation flag

Event Files: Medical Conditions

IP – Up to 4 per event

OB, OP, ER & RX– Up to 3 per event

HH – Need to obtain from condition file

DN & OME – No medical conditions

IP variables

Have operation? Stay begin with ER visit? Number of nights in hospital Reason for stay (5 broad reasons) Stay related to specific condition (yes

or no); if yes, provide condition(s) VA facility?

Diagnostic Tests/Services Received During OB, OP, or ER Visit

Laboratory tests Sonogram/

Ultrasound X-ray Mammogram MRI/CAT SCAN

EKG/ECG EEG Vaccination Surgery Anesthesia Other tests or

exams

Main Medical ProviderOB and OP Visits

Specialty if a physician– 33 specialties plus “other”

Type of provider if not a physician– 17 types plus “other”

Category of Care Received During an OB or OP Visit

General checkup Diagnosis or

treatment Emergency Well child exam Follow-up or

post-op visit

Psychotherapy or mental health counseling

Maternity care Immunizations or

shots Laser eye

surgery

Treatments During an OB or OP Visit

Physical therapy Occupational

therapy Speech therapy Chemotherapy Radiation

therapy

Kidney dialysis IV therapy Treatment for

drug or alcohol Received allergy

shot Psychotherapy

or counseling

Prescribed Medicines (PMED) Event File

Each record represents an original RX script or refill – Includes diabetic supply/equipment and

insulin purchases– Contains drug characteristic and

expenditure variables

PMED File Expenditure Variables

Source – Nearly all MPC (pharmacy) data– Some source of payment information

collected from households filing their own insurance claims

Variables– 12 expenditure by source of payment– Total expenditure variable – No total charge variable

Variables in the PMED File

Household Component (HC) variables collected in each round– Medicine name– Number of times purchased– Used to treat a condition– Date first used – Pharmacy information– Names of free samples– Who files prescribed drug insurance claims

Drug characteristics

Drug characteristics included for each prescribed medicine event – Medication name– National drug code (NDC)– Quantity dispensed (e.g., 50)– Form (e.g., suspension)– Strength (e.g., 10)– Unit of measurement of form (e.g., cc) and strength

(e.g., mg)– Brand/generic designation (from Multum Lexicon)– Therapeutic class, sub-class, and sub sub-class (from

Multum Lexicon) – Pregnancy category (from Multum Lexicon)

Home Health (HH) Event File

Three broad categories – Agency care (including hospitals

and nursing homes)– Paid independent providers– Informal providers (e.g., family and

friends) Each record in file represents

monthly aggregate for specific type of care

HH File Expenditure Variables

Agency care– 12 expenditure by source of payment

variables – A total expenditure variable – A total charge variable

Paid independent providers– Same expenditure variables as Agency

care

Informal care – No expenditure variables

Home Health Variables

Type of worker(s) provided– Agency care only

Type of care

Amount of care– (frequency and length of visits)

Dental Event FileType of Provider Seen

General dentist

Dental Hygienist

Dental Technician

Dental Surgeon

Orthodontist

Endodontist

Periodontist

Other

Dental Services and Procedures

Diagnostic or preventative Restorative or endodontic Periodontic (gum treatment) Oral surgery Prosthetics Orthodontics Other procedures

OTHER MEDICAL EXPENDITURES FILE

TYPE (OMTYPEX) RECORD UNITGlasses or contacts roundAmbulance services annual

Orthopedic items annualHearing devices annual

Prosthesis annualBathroom aids annual

Medical equipment annualDisposable supplies annual

Alterations/modifications annualOther annual

Flat Fees

What is a Flat Fee?– 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– Flat fee leaf event from prior year– Follow-up visit without extra charge– Free care – Bad debt

Annual Person-Level File with Expenditure Data

Full Year Consolidated File– One record for each person in MEPS– Summary of all events and expenditures

Appendix 1 of documentation contains naming conventions for use and expenditure variables

– No detail on expenditures or characteristics of individual events


HEALTH INSURANCE DATA

Health InsurancePublic Use Files, 2007-2008

MEPS HC-117 : 2009 P13R3/P14R1, Point-in-Time Population Characteristics

MEPS HC-115: 2008 Full Year Population Characteristics Data File

MEPS HC-111: 2007 Person Round Plan Public Use File

2009 Point-in-TimePublic Health Insurance Variables

TRINW31X COV BY TRICARE AT INTERVIEW – EDITED

MCARE31X COV BY MEDICARE – EDITED

MCAID31X COV BY MEDICAID – EDITED

OTPUBA31 COV BY/PAYS OTH GOV MCAID HMO

OTPUBB31 COV BY OTH PUBLIC NOT MCAID HMO

STPRG31 COV BY STATE SPECIFIC PROGRAM

PUB31X COV BY PUBLIC INS - EDITED

2009 Point-in-TimePrivate Health Insurance Variables

PRIEU31 COV BY PRIV EMPL/UNION PLAN

PRIDK31 COV BY PRIV DK PLAN PRING31 COV BY NONGROUP PLAN PRIOG31 COV BY OTH GROUP PLAN PRIS31 COV BY SELF-EMP-1 INS PRIOUT31 COV BY HOLDER OUTSIDE

RU PRIV31 COV BY PRIVATE INS INSRD31X INSURED - EDITED

2009 Point-in-TimePolicy Holder Insurance Variables

HPRIEU31 HOLDER OF PRIV EMPL/UNION PLAN

HPRIDK31 HOLDER OF PRIV DK PLAN HPRING31 HOLDER OF NONGROUP

PLAN HPRIOG31 HOLDER OF OTH GROUP

PLAN HPRIS31 HOLDER OF SELF-EMP-1

INS HPRIV31 HOLDER OF PRIV INS

PLAN

2008 Full Year Population Characteristics Data File

Public Insurance

Month by month indicators

TRIJA08X-TRIDE08X - TRICARE MCRJA08X-MCRDE08X - Medicare MCDJA08X-MCDDE08X - Medicaid/SCHIP OPAJA08-OPADE08 - managed care, other public

insurance OPBJA08-OPBDE08 - not managed care, other

public insurance STAJA08-STADE08 - state-specific program

participation PUBJA08X-PUBDE08X - indicates public insurance

in month


Private Insurance


PEGJA08-PEGDE08 - employer/union group insurance

PNGJA08-PNGDE08 - non-group private insurance POGJA08-POGDE08 - other group private insurance PDKJA08-PDKDE08 - don't know source of insurance POUJA08-POUDE08 - policy holder is outside the

household PRSJA08-PRSDE08 - self-employed with firm size of 1 PRIJA08-PRIDE08 - indicates private insurance in

month Policy Holders (repeat of Private) "H"


Summary Variables


PUBJA08X-PUBDE08X - indicates public insurance in month

PRIJA08-PRIDE08 - indicates private insurance in month

INSJA08X-INSDE08X - indicates any insurance in month


Summary Variables (continued)

UNINS08 – uninsured all of 08 INSCOV08 – health insurance

indicator 08– 1 = Any Private during 2008

– 2 = Public Only during 2008

– 3 = Uninsured all of 2008


Managed Care

Public insurance

Medicare Managed Care Plan

Medicaid or SCHIP HMO

Medicaid/SCHIP Gatekeeper Plans


Managed Care

Private insurance

Private HMOs Private HMO Plans that Pay for Visits to Non-Plan

Doctors Private Gatekeeper Plans Private Gatekeeper Plans that Pay for Visits to

Non-Plan Doctors Private Plan that has a Book or List of Doctors Private Plan that has a Book or List of Doctors

that Pays for Non-Plan Visits


Ever Covered During the Year

TRIEV08 - by TRICARE MCREV08 - by Medicare MCDEV08 - by Medicaid OPAEV08 - managed care, other public insurance OPBEV08 - not managed care, other public insurance PRVEV08 - by private health insurance


Medicare Part D

MCRPD31X– Medicare prescription drug benefit

(Part D), Rounds 3 and 1 MCRPD42X

– Medicare prescription drug benefit (Part D), Rounds 4 and 2

MCRPD08X– Medicare prescription drug benefit

(Part D), end of year


DENTIN31/42/53 – round specific variables– Covered by a private health insurance plan

that included at least some dental coverage

PMEDIN31/42/53 – round specific variables– Covered by a private health insurance plan

that included at least some prescribed medicine coverage

Person Round Plan Public Use File (PRPL)

Reflects complex and dynamic relationships between people and their private insurance.

Contains records for persons with – Hospital/physician coverage – Medigap – Dental, vision, or prescription medication

coverage

Contains variables pertaining to managed care and satisfaction with plan.

Out-of-pocket premiums (starting in 2001).

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

2008 (not 2007)

Types of Information Collected

Establishment-level (location) characteristics

Health insurance plan characteristics

Firm-level (company) characteristics

Establishment-level (Location) Characteristics

Number of active employees Whether or not establishment offers

health insurance Number of plans offered Number of employees eligible for

health insurance and number enrolled (full-time and part-time employees separately).

Workforce characteristics

Health Insurance Plan Characteristics

Premiums (single, employee-plus-one, family)

Contributions Plan types (by type of provider

arrangement) Self-Insured / Fully-Insured Enrollments (single, employee-plus-one,

family coverage) Deductibles / Copayments

Firm (Company) Characteristics

Size

Industry

Age of firm

Retiree offerings

Employee characteristics

MEPS-IC Sample Design

Private establishments from the Census Bureau’s Business Register– Approximately 42,000 establishments sampled

State and local governments from the Census of Governments– Approximately 2,500 governmental units

sampled

MEPS-IC Sample Design

Annual estimates– National– State– some Metro areas

Data Census Bureau Confidential - Public Use Files not available

Methodology Reports available on MEPS website

AHRQ 2010 Annual Conference AHRQ Data Resources to Inform Health Policy Research: The Medical Expenditure Panel Survey (MEPS) Jeffrey Rhoades, Ph.D.

Documents

meps panels

mepshc caveats

meps panel design

health care issues

annual health care use

household component

kind of care

health policy research