AHRQ 2010 Annual Conference AHRQ Data Resources to Inform Health Policy Research: The Medical Expenditure Panel Survey

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

2. Medical Expenditure Panel Survey MEPS OVERVIEW

3. MEPS Overview • History & Purpose • Survey Components & Design • Sample • Core Content • Supplemental CAPI sections & Questionnaires • Public Use Files • Dissemination of Data

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

5. 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

6. MEPS Survey Components • MEPS-HC -- Household Component • MEPS-MPC -- Medical Provider Component • MEPS-IC -- Insurance Component

7. 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

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

10. MEPS-HC Sample Sizes Year Families Persons 1996 8,655 21,571 1997 13,087 32,636 1998 9,023 22,953 1999 9,345 23,565 2000 9,515 23,839 2001 12,852 32,122 2002 14,828 37,418 2003 12,860 32,681 2004 13,018 32,737 2005 12,810 32,320 2006 12,811 32,577 2007 11,615 29,370 2008 12,957 31,262

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

12. 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

13. 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.

14. 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

15. MEPS Public Use Files

16. 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

17. 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.

18. 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

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

21. 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

22. Data User Workshops • Information will be posted on Workshops and Events section of web site • For inquiries please e-mail: Workshopinfo@ahrq.hhs.gov

23. 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

24. 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)

25. 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

26. 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

27. 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

28. MedicalExpenditure Panel Survey MEDICAL CONDITIONS DATA

29. 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

30. 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.

31. 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?

32. 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?

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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)

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. Medical Expenditure Panel Survey Health Care Utilization And Expenditures Data

46. 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)

47. 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

48. Self or family Medicare Medicaid/SCHIP Private insurance VA TRICARE Other federal gov’t State or local gov’t Worker’s comp Other insurance Source of Payment Categories in CAPI

49. 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

50. Sources of Expenditure Data by Event Type