Medical Expenditure Panel Survey

1. Medical Expenditure Panel Survey Karen Beauregard Steve Machlin Jeffrey Rhoades

2. Medical Expenditure Panel Survey SURVEY OVERVIEW

3. MEPS History • 1977 National Medical Care Expenditure Survey • 1987 National Medical Expenditure Survey • 1996 Medical Expenditure Panel Survey

4. Medical Expenditure Panel Survey (MEPS) Annual Survey of 15,000 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

5. MEPS Survey Components • Household Component (HC) • Medical Provider Component (MPC) • Insurance Component (IC)– Link Sample • Insurance Component (IC) – List Sample

6. MEPS-Household Component(HC) Survey Design • Sub-sample of household respondents from the previous year’s National Health Interview Survey (NHIS), sponsored by NCHS • Representative of the civilian non-institutionalized population of the US • 5 in-person interviews (CAPI) over 2 ½ year period • Person and family level data collected

7. Oversampling in MEPS • Every year: Blacks and Hispanics • Carryover from NHIS • 1997: Selected subpopulations • Functionally impaired adults • Children with activity limitations • Adults 18-64 predicted to have high medical expenditures • Low income • Adults with other impairments • 2002 and beyond: • Asians • Low income • Additional over sampling of blacks in 2004

8. MEPS-HC Sample Sizes YearHouseholdsPersons 1996 9,400 23,500 1997 13,500 33,000 1998-2000 10,000 24,000 2001 13,500 32,000 2002 + 15,000 37,000

9. MEPS-HC Core Interview Content • Demographics • Charges and Payments • Health Status • Conditions • Utilization • Employment • Health Insurance

11. MEPS Overlapping Panels(Panels 8 and 9) MEPS Household Component MEPS Panel 8 2003-2004 1/1/2003 1/1/2004 NHIS 2002 Round 1 Round 2 Round 3 Round 4 Round 5 NHIS 2003 Round 1 Round 2 Round 3 Round 4 Round 5 MEPS Panel 9 2004-2005

12. MEPS-HC Purpose • Estimates annual health care use and expenditures • Supports distributional estimates • Tracks changes in insurance coverage and employment • Longitudinal design; linkage to NHIS

13. Hospital stays Other hospital care Office based physician care Other medical providers Dental services Home health Prescribed medications Medical equipment and supplies MEPS-HC Utilization Data

14. MEPS- HC Periodic Supplements • Access to care • Satisfaction with health plans & providers • Health status • Income

15. New Supplements • Adult SAQ • Preventive Care • Enhanced Access to Care Section • Children’s Health Supplement

16. Condition Supplements • Priority Conditions • Diabetes • Asthma • Hypertension • Ischemic Heart Disease • Arthritis • Stroke • COPD • Diabetes Care SAQ (DCS)

17. MEPS-HC Caveats and Limitations • Sample size limitations preclude some analyses • Household respondents may not be able to report accurately certain types of information • type of health plan • detailed event information • diagnoses • limited capacity to produce state level estimates

18. Types of MEPS-HC Files • Full-year Files - calendar year data • Point-in-time Files - snap shot first part of year

19. 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

20. Sub-national Analysis • Supports state estimates: Direct state level estimates of cost, coverage and use for the largest states. • Supports metro area estimates: Direct MSA level estimates of cost, coverage and use for the largest metropolitan areas.

21. Medical Expenditure Panel Survey DISSEMINATION OF INFORMATION AND DATA PRODUCTS

22. MEPS Web-site Redesign • More User Friendly • Additional Content Added • More Powerful Databases and Search Engines • Upgraded to Meet Federal, HHS, and AHRQ Web Standards

23. Medical Expenditure Panel Survey Methods of Dissemination • MEPS Website at www.meps.ahrq.gov • MEPS e-mail address - MEPSPD@ahrq.gov • AHRQ clearinghouse 800-358-9295 • for CD-ROMs and print publications

25. 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 and List server • Data Center Information

26. Data User Workshops • Hands-on Workshops planned for May and September in Rockville, MD • Information will be posted on Workshops and Events section of web site • For inquiries please e-mail: Workshop06@ahrq.hhs.gov

27. MEPS Mailing List/List Server • Mailing List/List Server • Click on “Mail List/List Server” from Web site • Both receive e-mail notices of data and publications released on the Web • List Server allows for interactive exchange of ideas and information

28. 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

29. Recent Data Releases • 2004 Utilization and Quality of Care • (new variables include K6 and PH2 mental health assessment tools) • 2004 Jobs File • 1996-2001 Risk Adjustment File • Link to 2003 NHIS File

30. Recent Data Releases • 2005 First Part of Year File • 2004 Event Files • 1996-2004 Pooling File

31. Upcoming Data Releases • 2004 Consolidated File (Use and Expenditures)-November • 2004 Condition file -November • 2002-2004 Risk adjustment File - December

32. AHRQ Data Center (ADC) • Provides researchers access to non-public use MEPS data (except directly identifiable information); • Mode of data analysis • on secure LAN at AHRQ - Rockville, Maryland • task order agreement with data contractor • combinations of both

33. ADC Procedures • 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

34. ADC 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

35. ADC Application And Review Process • 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

36. ADC Fees • User fee of $150.00 for approved projects to cover technical assistance, simple file construction, and/or up 2 hours of programming support from data contractor • Additional programming support available from an AHRQ contractor at a cost of $80.00/hr • User fee waived for full-time students

37. 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. Out-put will be reviewed for confidentiality and mailed to you.

38. Confidential Data Available for ADC Projects • Linked MEPS-HC and Secondary Data (full geo-coding for 1996, 1997 and 2000-2004, FIPS codes for other years) • Selected Medical Provider Component Data • Selected State and MSA identifiers and estimation variables • 29 largest states and 10 largest MSA’s

39. Confidential Data Available for Data Projects in ADC • Fully specified industry/occupation codes • Fully specified condition codes • Continuous poverty measure • Linked MEPS Household Component (HC) and Insurance Component (IC) data ( 96-98, 2001-excluding federal workers )