Center for Financing, Access, and Cost Trends (CFACT): Publications by Staff

Steven R. Machlin

Authors: Machlin S, Carper K, Kashihara D
Title: Health care expenditures for non-melanoma skin cancer among adults, 2005-2008 (average annual)
Publication: MEPS Statistical Brief No. 345. Available on the MEPS Web site.
Date: November 2011
Abstract: An average of about 3.72 million adults were treated for non-melanoma skin cancer each year from 2005–08, a notably larger number of persons than were treated for other common but generally more serious cancers such as breast, prostate, colon, and lung. Elderly adults age 65 and older were by far the most likely to be treated for non-melanoma skin cancer (annual average of 6.0 percent) followed by middle aged adults ages 45–64 (1.6 percent).

Authors: Machlin S, Chevan J, Yu W, Zodet M
Title: Determinants of utilization and expenditures for episodes of ambulatory physical therapy among adults
Publication: Physical Therapy; 91(7):1018-1029
Date: July 2011
Abstract: Available on PubMed®.

Authors: Chowdhury S, Machlin S
Title: Variance estimation from MEPS event files
Publication: MEPS Methodology Report No. 26. Available on the MEPS Web site.
Date: September 2011
Abstract: This Methodology Report looks into the issue of variance estimation from the MEPS event files and evaluates the impact of not doing a proper domain analysis on variance estimates.

Authors: Machlin S, Cohen S, Yu W
Title: Health care access and expenditures among non-elderly adults with multiple chronic conditions: Variations by insurance coverage status, 2007-08 (Average Annual)
Publication: MEPS Statistical Brief No. 320. Available on the MEPS Web site.
Date: April 2011
Abstract: Health insurance helps people get timely access to medical care and protects them against the risk of unanticipated costly medical events. This Statistical Brief provides baseline pre-Patient Protection and Affordable Care Act estimates of health care access, utilization, and expenditures for uninsured high risk non-elderly adults and their counterparts with insurance coverage.

Authors: Machlin S, Chowdhury S
Title: Expenses and characteristics of physician visits in different ambulatory care settings, 2008
Publication: MEPS Statistical Brief No. 318. Available on the MEPS Web site.
Date: March 2011
Abstract: This Statistical Brief presents descriptive estimates from the 2008 Medical Expenditure Panel Survey (MEPS) that illustrate variation in expenses and characteristics of physician visits across the three different MEPS ambulatory care setting categories: office-based (OB), hospital outpatient department (OP), and hospital emergency room (ER).

Authors: Machlin S, Mutter R
Title: Estimating total emergency department visits: A comparison of two data sources
Publication: JSM Proceedings of the Section on Health Policy Statistics 2866-2876.
Date: 2010

Authors: Rhoades J, Cohen J, Machlin S
Title: Methodological comparison of estimates of ambulatory health care use from the Medical Expenditure Panel Survey and other data sources
Publication: JSM Proceedings of the Section on Health Policy Statistics 2828-2837.
Date: 2010

Authors: Machlin S, Chowdhury S, Ezzati-Rice T, DiGaetano R, Goksel H, Wun L, Yu, W, Kashihara D
Title: Estimation procedures for the Medical Expenditure Panel Survey Household Component
Publication: MEPS Methodology Report No. 24. Available on the MEPS Web site.
Date: September 2010
Abstract: The primary purposes of this report are to describe the procedures used to develop the various MEPS analytic weights and provide an overview of appropriate variance estimation procedures.

Authors: Carper K, Machlin S
Title: Variations in perceived need and access to specialist care among adults in the U.S. civilian noninstitutionalized population, 2007
Publication: MEPS Statistical Brief No. 274. Available on the MEPS Web site.
Date: December 2009
Abstract: In 2006, more than half of the physicians in the United States were specialists, such as allergists, cardiologists, dermatologists, neurologists, oncologists, and surgeons (U.S. Census Bureau 2009). Using data from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC), this Statistical Brief examines variations in the perceptions of adults age 18 and over about their need for and access to physician specialists in 2007. These variations are examined across several characteristics including age, insurance coverage, the presence of selected chronic conditions (or not) and having a usual source of care (or not).

Author: Machlin S
Title: Trends in health care expenditures for the elderly age 65 and over: 2006 versus 1996
Publication: MEPS Statistical Brief No. 256. Available on the MEPS Web site.
Date: August 2009
Abstract: This statistical brief compares summary statistics on health care expenditures and expenditure distributions by type of service and source of payment for the elderly (age 65 and over) in 2006 relative to the elderly in 1996. The $333.3 billion in total health care expenses for the elderly in 2006 was over $100 billion higher than inflation-adjusted expenses for 1996. In each year, over 95 percent of the elderly had some expenses, but the average annual expense per person with an expense was about 30 percent higher in 2006 ($9,080 versus $6,989 in 1996 after adjusting for inflation).

Authors: Machlin S, Kress M
Title: Trends in health care expenditures for adults ages 45-64: 2006 versus 1996
Publication: MEPS Statistical Brief No. 255. Available on the MEPS Web site.
Date: August 2009
Abstract: This statistical brief compares summary statistics on health care expenditures and expenditure distributions by type of service and source of payment for adults ages 45-64 in 2006 relative to the same age group in 1996. The $370 billion in total health care expenses for adults ages 45-64 in 2006 was $183 billion higher than inflation-adjusted expenses for 1996. About 90 percent of adults ages 45-64 in each year had some expenses but the average annual expense per person with an expense was markedly higher in 2006 ($5,455 versus $3,849 in 1996 after adjusting for inflation).

Author: Machlin S
Title: Trends in health care expenditures for adults ages 18-44: 2006 versus 1996
Publication: MEPS Statistical Brief No. 254. Available on the MEPS Web site.
Date: August 2009
Abstract: This statistical brief compares summary statistics on health care expenditures and expenditure distributions by type of service and source of payment for adults ages 18-44 in 2006 relative to this age group in 1996. The $230.9 billion in total health care expenses for adults age 18-44 in 2006 was about $40 billion higher than spending in 1996 (adjusted to 2006 dollars). Although a smaller proportion of this age group had some expenses for health care in 2006 than in 1996 (76.9 percent versus 80.5 percent, respectively), the average annual expense among those with an expense was significantly higher in 2006 ($2,703 versus $2,177 in 1996 after adjusting for inflation).

Author: Machlin S
Title: Trends in health care expenditures for children under age 18: 2006 versus 1996
Publication: MEPS Statistical Brief No. 253. Available on the MEPS Web site.
Date: August 2009
Abstract: This statistical brief compares summary statistics on health care expenditures and expenditure distributions by type of service and source of payment for children under age 18 in 2006 relative to children in 1996. The $98.8 billion in total health care expenses for children in 2006 was about $23 billion higher than spending in 1996 (adjusted to 2006 dollars). Although a similar proportion of children had some expenses for health care in each year, about 85 percent, the average annual expense per child with an expense was somewhat higher in 2006 ($1,560 versus $1,257 in 1996 after adjusting for inflation).

Authors: Machlin S, Cohen J, Elixhauser A, Beauregard K, Steiner C
Title: Sensitivity of household reported medical conditions in the Medical Expenditure Panel Survey
Publication: Medical Care 47(6):618-25
Date: June 2009
Abstract: Available on PubMed®.

Authors: Machlin S, Woodwell D
Title: Healthcare expenses for chronic conditions among non-elderly adults: Variations by insurance coverage, 2005-06 (Average Annual Estimates)
Publication: MEPS Statistical Brief No. 243. Available on the MEPS Web site.
Date: April 2009
Abstract: This statistical brief presents estimates on medical expenditures and their variations by insurance coverage for chronic conditions among non-elderly adults. Adults ages 18-64 with public insurance only were much more likely to be reported in fair or poor health (34.1 percent) than those with private insurance (7.6 percent) or no insurance coverage (12.6 percent). The uninsured were less likely to be near-elderly (ages 55-64) than persons with private or public insurance only coverage.

Authors: Machlin S, Cohen J
Title: Persons with high health care expenditures: Proportions by age and insurance coverage, 2005
Publication: MEPS Statistical Brief No. 217. Available on the MEPS Web site
Date: August 2008
Abstract: This brief provides estimates from the 2005 Medical Expenditure Panel Survey (MEPS) of proportions of the population with high medical expenditures by age and insurance coverage. Estimates are provided separately for total and out-of-pocket expenses.

Authors: Machlin S, Cohen J, Beauregard K
Title: Health care expenses for adults with chronic conditions, 2005
Publication: MEPS Statistical Brief No. 203. Available on the MEPS Web site
Date: May 2008
Abstract: Using data from the Household Component of the 2005 MEPS (MEPS-HC), this statistical brief presents overall expenditures among adults for chronic conditions and acute care expenses for adults. These expenses are presented by type of service and age.

Authors: Kashihara D, Machlin S, Carper K
Title: National health care expenses in the U.S. civilian noninstitutionalized population, 2005
Publication: MEPS Statistical Brief No. 193. Available on the MEPS Web site
Date: December 2007
Abstract: Using data from the MEPS-HC and Medical Provider Component (MEPS-MPC), this Statistical Brief presents estimates of health care expenses by type of service and distributions by payment sources for the U.S. civilian noninstitutionalized population in 2005. Health care expenses represent payments to hospitals, physicians, and other health care providers for services reported by respondents in the MEPS-HC. These expenses are defined as direct payments by individuals, private insurance, Medicare, Medicaid, and other payment sources.

Authors: Machlin S, Rohde F
Title: Health care expenditures for uncomplicated pregnancies
Publication: Research Findings No. 27. Available on the MEPS Web site
Date: August 2007
Abstract: This report uses data pooled from three panels (2001-02, 2002-03, 2003-04) of the MEPS-HC to estimate medical expenditures (in 2004 dollars) associated with an uncomplicated pregnancy and in-hospital delivery.

Authors: Machlin S, Carper K
Title: Expenses for office-based physician visits by specialty, 2004
Publication: MEPS Statistical Brief No. 166. Available on the MEPS Web site
Date: March 20, 2007
Abstract: This statistical brief presents data from the MEPS-HC on expenses by provider specialty type for office-based physician visits in 2004 among persons in the U.S. civilian noninstitutionalized population. Data are shown for the eight most common types of office-based physician specialties, including primary care (defined in this brief as general practice, family practice, and internal medicine); pediatrics; obstetrics/gynecology; ophthalmology; orthopedics; psychiatry; cardiology; and dermatology; as well as a ninth catchall category that includes all other physician specialty types. Descriptive data on aggregate expenses, expenses per visit, and out-of-pocket payments for these physician specialty categories are presented.

Authors: Zodet M, Wobus D, Machlin, S, Kashihara D, Dougherty D
Title: Class variables for MEPS expenditure imputations
Publication: MEPS Methodology Report No. 20. Available on the MEPS Web site
Date: March 15, 2007
Abstract: MEPS collects data on health care utilization, expenditures, sources of payment, insurance coverage, and health care quality measures. The survey was designed to produce national and regional estimates for the U.S. civilian noninstitutionalized population. The data on medical expenses are collected from both household respondents in the Household Component and from a sample of their health care providers in the Medical Provider Component. In the absence of payment information from either component, expenditure data are derived for sample persons through an imputation process. Missing expense data are imputed at the event level for each medical event type using a weighted hot-deck procedure. This process utilizes individual- and event-level data collected in MEPS that are correlated with medical expenditures. Bivariate analyses and linear regression models were utilized to assess the current class variables used for imputation. This paper details the methodology used to select, prioritize, and categorize the class variables used to impute missing expenditures for two event types: doctor visits and inpatients hospitalizations. (Previously published as Working Paper #4005, December 2004.)

Authors: Machlin S, Dougherty D
Title: Overview of methodology for imputing missing expenditure data in the Medical Expenditure Panel Survey
Publication: MEPS Methodology Report No. 19. Available on the MEPS Web site
Date: March 15, 2007
Abstract: In MEPS, expenditures are defined as payments from all sources (including individuals, private insurance, Medicare, Medicaid, and other sources) for health care services during the year. Data on expenditures are collected for sample persons in the Household Component of the survey and from a sample of their health care providers responding to the Medical Provider Component of the survey. In the absence of payment information from either component, expenditure data are completed through weighted hot-deck imputation procedures. The MEPS collects a wide variety of data about individuals and health care events that are correlated with expenditures and, for each event type (e.g., doctor visits, hospitalizations, etc.), a selected set of these variables is used in the imputation processes. Several hot-deck iterations are run for each medical event type category based on factors such as whether partial payment information was reported and whether payments for the event covered multiple visits. This paper provides an overview of the methodological approach to impute MEPS expenditure data and how class variables for the hot-deck procedures were determined. (Previously published as Working Paper #4003, December 2004.)

Authors: Machlin S, Carper K
Title: Expenses for hospital inpatient stays, 2004
Publication: MEPS Statistical Brief No. 164. Available on the MEPS Web site
Date: March 12, 2007
Abstract: This statistical brief presents data from the MEPS-HC on payments for hospital inpatient stays among persons in the U.S. civilian noninstitutionalized population in 2004. Descriptive data on aggregate expenses, payment sources, variations by age and gender, as well as information on expenses per stay and per diem, are presented.

Author: Machlin S, Wobus D
Title: Completeness of household reported medical expenditure data for physician office visits in the Medical Expenditure Panel Survey
Publication: American Statistical Association, Joint Statistical Meetings—Section on Survey Research Methods, pp. 3375-9 (CD-ROM), Alexandria, VA
Date: 2006

Authors: Machlin S, Carper K
Title: National health care expenses in the U.S. civilian noninstitutionalized population, 2004
Publication: MEPS Statistical Brief No. 149. Available on the MEPS Web site
Date: November 30, 2006
Abstract: Using data from the MEPS-HC and MEPS-MPC, this statistical brief presents estimates of health care expenses by type of service and distributions by payment sources for the U.S. civilian noninstitutionalized population in 2004. Health care expenses represent payments to hospitals, physicians, and other health care providers for services reported by respondents in the MEPS-HC. These expenses are defined as direct payments by individuals, private insurance, Medicare, Medicaid, and other payment sources.

Authors: Machlin S, Hill S, Liang L
Title: Children living with adult smokers, United States, 2004
Publication: MEPS Statistical Brief No. 147. Available on the MEPS Web site MEPS Web site
Date: November 2006
Abstract: Using data from the MEPS-HC, this statistical brief presents estimates of the percentage of children under age 18 at the end of 2004 who lived in families containing at least one adult who smoked. Variations are examined by selected characteristics of the child (asthma status, age, race/ethnicity) and co-residing family (number of adults, poverty status, geographic location of residence, highest adult education level).

Authors: Machlin S, Carper K
Title: Treatment of sore throats: Antibiotic prescriptions and throat cultures for children under 18 years of age, 2002-2004 (Average Annual)
Publication: MEPS Statistical Brief No. 137. Available on the MEPS Web site
Date: August 2006
Abstract: This statistical brief uses data from the MEPS-HC to examine the percentages of children under 18 years of age for whom, within the past 12 months: 1) contact was made with a doctor or other health professional primarily regarding a serious sore throat, 2) an antibiotic was prescribed for those who contacted a health professional, and 3) a throat swab was administered before prescribing an antibiotic. Variations in these three measures are examined by selected demographic characteristics and insurance status.

Authors: Machlin S, Zodet M
Title: Out-of-pocket health care expenses by age and insurance coverage, 2003
Publication: MEPS Statistical Brief No. 126. Available on the MEPS Web site
Date: May 2006
Abstract: This statistical brief uses data from MEPS-HC for 2003 to examine levels of out-of-pocket payments for individuals in the U.S. civilian noninstitutionalized population with expenses for health care. Estimates are shown according to age and insurance coverage, since levels of out-of-pocket expenses differ substantially according to these characteristics.

Authors: Machlin S, Miller E
Title: Health service use and expenses for migraines and other headaches
Publication: MEPS Statistical Brief No. 115. Available on the MEPS Web site
Date: February 2006
Abstract: This statistical brief presents estimates based on data from the MEPS-HC on health care use and expenditures to treat headaches among adults age 18 and over in the U.S. civilian noninstitutionalized population. Average annual estimates for the period from 2002-03 are shown for two categories of headaches: migraines and other headaches (facial pain, nonspecific reported pain in head, and tension headaches) as well as by age and sex.

Authors: Greenblatt J, Machlin, S, Wun L
Title: Evaluation of panel in-time effects on utilization estimates
Publication: American Statistical Association, Joint Statistical Meetings—Section on Health Policy Statistics, pp. 1542-1546 (CD-ROM), Alexandria, VA
Date: 2005

Authors: Machlin S, Gorrell P
Title: Using the Medical Expenditure Panel Survey to estimate health care expenses associated with accidents/injuries
Publication: American Statistical Association, Joint Statistical Meetings—Section on Health Policy Statistics, pp. 1560-1564 (CD-ROM), Alexandria, VA
Date: 2005

Authors: Yu W, Machlin S
Title: An examination of skewed health expenditure data from the Medical Expenditure Panel Survey (MEPS)
Publication: J Econ Social Measurem 30(2,3):127-34
Date: 2005

Author: Machlin S
Title: Expenses for a hospital emergency room visit, 2003
Publication: MEPS Statistical Brief No. 111. Available on the MEPS Web site
Date: January 2006
Abstract: This statistical brief presents estimates based on data from the MEPS-HC on payments for hospital emergency room visits (excluding those resulting in a hospital admission) among persons in the U.S. civilian noninstitutionalized population in 2003. Variations in expenses for emergency room visits are illustrated according to services that were reported to be provided as well as selected demographic characteristics of patients. In addition, average expenses are compared to those for visits to other ambulatory settings.

Authors: Carper K, Machlin S
Title: Variations in smoking by selected demographic, socioeconomic, insurance, and health characteristics, United States, 2003
Publication: MEPS Statistical Brief No. 101. Available on the MEPS Web site
Date: October 2005
Abstract: Using data from the 2003 MEPS-HC, this statistical brief presents estimates on the smoking status of adults, age 18 or older, in the U.S. civilian noninstitutionalized (community) population in 2003 by selected characteristics, including age, race/ethnicity, sex, education, insurance coverage, and health conditions. Additional estimates are provided on routine check-ups and smoking cessation counseling.

Authors: Machlin S
Title: Health care expenditures for injury-related conditions, 2002
Publication: MEPS Statistical Brief No. 93. Available on the MEPS Web site
Date: September 2005
Abstract: Using data from the 2002 MEPS-HC, this statistical brief presents estimates of spending for direct medical care for health conditions resulting from accidents and injuries (excluding dental care and other miscellaneous expenses). These expenses for injury-related care are presented by type of service and source of payment categories, and distributions are compared to those for non-injury-related care. Expenses for injury-related care are also presented for broad categories of injury cause.

Authors: Carper K, Machlin S
Title: Attitude regarding need for help from medical professionals: adults age 18 and over, 1987 and 2002
Publication: MEPS Statistical Brief No. 92. Available on the MEPS Web site
Date: July 2005
Abstract: Using data from the 1987 National Medical Expenditure Survey (NMES) and the 2002 MEPS, this statistical brief highlights variation in attitude regarding need for help from medical professionals across various demographic and socioeconomic characteristics (age, race/ethnicity, sex, insurance status, education, and family income) and also examines differences in attitude between 1987 and 2002.

Authors: Machlin S, Carper K
Title: Attitudes toward health insurance among adults age 18 and over
Publication: MEPS Statistical Brief No. 87. Available on the MEPS Web site
Date: July 2005
Abstract: Using data from the 1987 NMES and the 2002 MEPS, this statistical brief examines differences in the extent to which persons agreed with statements about health insurance in 2002 versus 1987, as well as the variation in agreement with these statements in 2002 by selected demographic and socioeconomic characteristics (age, race/ethnicity, sex, education, family income, and insurance status for adults under 65).

Authors: Machlin S, Dougherty D
Title: Overview of methodology for imputing missing expenditure data in the Medical Expenditure Panel Survey
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, 3948-53 (CD-ROM), Alexandria, VA
Date: 2004

Authors: Baskin R, Wun L, Sommers J, et al.
Title: Investigation of the impact of imputation on variance estimation in the Medical Expenditure Panel Survey (MEPS)
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, 3271-7 (CD-ROM), Alexandria, VA
Date: 2004

Authors: Zodet M, Wobus D, Machlin S, et al.
Title: Class variables for MEPS expenditure imputations
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, 4697-702 (CD-ROM), Alexandria, VA
Date: 2004

Authors: Machlin S, Sommers J
Title: Estimates of health care expenditures for the 10 largest states, 2002
Publication: MEPS Statistical Brief No. 69. Available on the MEPS Web site
Date: February 2005
Abstract: This statistical brief presents variations from the national average in health care expenses for the 10 most populous States in 2002, the most recent year of expenditure data from the MEPS-HC. The brief specifically examines selected measures for the U.S. community population, including 1) the proportion of the population with selected types of expenses, 2) the average amount of expenses, and 3) the distribution of payments for health care across various sources.

Authors: Machlin S, Zodet M
Title: Family health care expenses, by income level, 2002
Publication: MEPS Statistical Brief No. 64. Available on the MEPS Web site
Date: January 2005
Abstract: Using data from the 2002 MEPS-HC, this statistical brief provides descriptive statistics on total and out-of-pocket health care expenses in 2002 for families, by income level.

Authors: Machlin S, Zodet M
Title: Family health care expenses, by size of family, 2002
Publication: MEPS Statistical Brief No. 63. Available on the MEPS Web site
Date: January 2005
Abstract: Using data from the 2002 MEPS-HC, this statistical brief provides descriptive statistics on total and out-of-pocket health care expenses in 2002 for families, by size of family.

Authors: Larson S, Machlin S, Nixon A, Zodet M
Title: Health care in urban and rural areas, combined years 1998-2000
Publication: MEPS Chartbook No. 13. AHRQ Pub. No. 04-0001. Available on the MEPS Web site
Date: 2004
Abstract: This chartbook examines the differences in health care access, use, and expenses between urban and rural areas. Counties are classified along the urban-rural continuum according to whether they are metropolitan statistical areas (MSAs) and, if not, their proximity to an MSA.

Authors: Ezzati-Rice T, Kashihara D, Machlin, S.
Title: Health care expenses in the United States, 2000.
Publication: MEPS Research Findings No. 21. AHRQ Pub. No. 04-0022. Available on the MEPS Web site
Date: 2004
Abstract: This report presents descriptive data on health care spending in the United States. Estimates are based on data from the 2000 MEPS and cover the civilian noninstitutionalized U.S. population. Estimates of total health care expenses and expenses for hospital inpatient services, ambulatory services (including office-based, hospital outpatient, and emergency room visits), prescription medicines, dental services, home health services, and other medical equipment and supplies are provided.

Authors: Machlin S, Nixon A, Sommers J
Title: Health care expenditures and percentage uninsured in 10 large metropolitan areas, 2000
Publication: MEPS Statistical Brief No. 38. Available on the MEPS Web site
Date: 2004
Abstract: Based on data from the 2000 MEPS-HC, this report compares estimates of health care expenses and uninsured rates for the U.S. community population under 65 years of age in 10 large metropolitan areas to national averages. These 10 areas are defined by metropolitan statistical areas (MSA) and include Chicago, Dallas, Detroit, Houston, Los Angeles, Miami, New York City, Philadelphia, San Francisco, and Washington DC.

Authors: Wun L, Ezzati-Rice T, Machlin S, Baskin R
Title: Investigation of alternative nonresponse adjustment methods in the Medical Expenditure Panel Survey (MEPS)
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, pp. 4612-8 (CD-ROM), Alexandria, VA
Date: 2003

Authors: Machlin S, Zodet M, Nixon A
Title: Estimates of medical expenditures from the Medical Expenditure Panel Survey: Gains in precision from combining consecutive years of data
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, pp. 2615-22 (CD-ROM), Alexandria, VA
Date: 2003

Authors: Olin G, Machlin S
Title: Health care expenses in the community population, 1999
Publication: MEPS Chartbook No. 11. AHRQ Pub. No. 03-0038. Available on the MEPS Web site
Date: 2003
Abstract: This chartbook shows health care spending for the civilian noninstitutionalized (community) population in 1999. It presents data from the MEPS. The chartbook is organized into four sections. Section 1 is a summary of national expenses for the community population by amount, type of service, and source of payment. Section 2 presents information on non-elderly (under age 65) and elderly people living in the community, two groups that have quite different health care expenses. Section 3 shows average health care expenses for persons categorized by age, insurance status, income, and race/ethnicity. Section 4 shows the extent to which selected populations rely on different sources to pay for their health care.

Authors: Kirby J, Machlin S, Cohen J
Title: Has the increase in HMO enrollment within the Medicaid population changed the pattern of health service use and expenditures?
Publication: Med Care 41(7):III-24-34
Date: July 2003
Abstract: Available on PubMed®

Authors: Krauss N, Machlin S, Adams G
Title: Health care expenses for injuries: Estimates from the 1997 MEPS
Publication: MEPS Research Findings No. 19. AHRQ Pub. No. 04-0005. Available on the MEPS Web site
Date: 2003
Abstract: This report uses data from the 1997 MEPS Household Component to examine the health care costs of injury-related conditions. This report gives estimates of injury-related expenses for inpatient hospital services and ambulatory medical care services by age, sex, race, health insurance, and poverty level. Injury-related expenses as a proportion of total medical expenses, and mean and median expenses are also discussed. The proportion of expenses for injury and noninjury medical care paid by various sources, including out-of-pocket, Medicare, Medicaid, private insurance, and Workers' Compensation, are also compared.

Authors: Elixhauser A, Machlin S, Zodet M, et al.
Title: Health care for children and youth in the United States: 2001 annual report on access, utilization, quality, and expenditures
Publication: Ambul Pediatr 2(6):419-37
Date: 2002
Abstract: Available on PubMed®

Authors: Machlin S, Yu W, Thorpe J
Title: Correlation between 1996 and 1997 annual medical expenditures in the U.S. civilian non-institutionalized population
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods (CD-ROM), Alexandria, VA
Date: August 2001

Authors: Machlin S, Valluzzi J, Chevarley F, Thorpe J
Title: Measuring ambulatory health care use in the United States: a comparison of 1996 estimates across four federal surveys
Publication: J Econ Soc Measurement 27(1-2):57-69. AHRQ Pub. No. 03-R020
Date: 2001
Abstract: The U.S. Department of Health and Human Services currently sponsors a number of national surveys that have different primary objectives and methodologies, but all can be used in different ways to produce general estimates of the use of ambulatory care in the United States. Among these surveys are MEPS, the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). Through a comparison of 1996 survey estimates, this paper describes important methodological considerations when using these different data sources for measuring ambulatory use. This paper complements a previous article comparing estimates of hospital inpatient utilization across several federal data sources.

Authors: Thorpe J, Machlin S
Title: Health care expenses in the U.S. civilian noninstitutionalized population, 1997
Publication: AHRQ Pub. No. 01-R086. MEPS. Agency for Healthcare Research and Quality, Rockville, MD
Date: 2001
Abstract: These tables present descriptive data from MEPS on spending in 1997 for hospital, office-based, home health, and other types of care by source of payment and characteristics of users. Data for all types of health care combined and for each type of service are presented.

Authors: Taylor A, Cohen J, Machlin S
Title: Being uninsured in 1996 compared to 1987: How has the experience of the uninsured changed over time?
Publication: Health Serv Res 2001;36(6)Part II:16-31. AHRQ Pub. No. 02-R038
Date: 2001
Abstract: The composition of the uninsured population changed somewhat between 1987 and 1996, with adults over age 18 and employed persons making up larger proportions of the uninsured in 1996, and the poor and those in fair or poor health making up smaller proportions. There were few changes in utilization of services by the uninsured over this period and no change in mean expenses, but there was an increase in receipt of at least one preventive service (mammograms) and a decline in the proportion of families with high out-of-pocket burden. Disparities in use and expenses that existed between the uninsured and the privately insured in 1987, however, remained in 1996.

Authors: Machlin S, Cohen J, Zuvekas S, et al
Title: Health care expenses in the community population, 1996
Publication: MEPS Chartbook No. 5. AHRQ Pub. No. 01-0027. Available on the MEPS Web site
Date: 2001
Abstract: This chartbook presents data from MEPS on spending in 1996 for medical services and supplies for the civilian noninstitutionalized (community) population.

Authors: Kirby J, Machlin S, Thorpe J
Title: Patterns of ambulatory care use: Changes from 1987 to 1996
Publication: MEPS Research Findings No. 16. AHRQ Pub. No. 01-0026. Available on the MEPS Web site
Date: 2001
Abstract: This report presents trends in the use of ambulatory care services by the U.S. population from 1987 to 1996. The authors examine the frequency with which people visit health care providers by setting of care (office, hospital outpatient, or emergency room) and reason for visit (prevention, diagnosis or treatment, or emergency), paying special attention to differences between 1987 and 1996. They also examine variation in trends across several variables, including age, race, sex, urban versus rural residence, region, income, insurance status, and health status. Data come from 1987 NMES and 1996 MEPS.

Authors: Machlin S, Taylor A
Title: Design, methods, and field results of the 1996 Medical Expenditure Panel Survey Medical Provider Component
Publication: MEPS Methodology Report No. 9. AHRQ Pub. No. 00-0028. Available on the MEPS Web site
Date: 2000
Abstract: MEPS comprises four component surveys. The Medical Provider Component (MPC) is a survey of medical professionals and institutions that provided care to sample persons in the MEPS-HC. The MPC's primary focus is to collect data on expenditures for medical services provided to MEPS respondents. MPC data are critical in the development of MEPS national medical expenditure estimates because household respondents are not always a reliable source of information on medical expenditures. This report describes the design of and methods used in the 1996 MEPS MPC. In addition, information is included on the MPC objectives, instruments and procedures for data collection, sample sizes, and response rates.

Authors: Cohen S, Machlin S, Branscome J
Title: Patterns of survey attrition and reluctant response in the 1996 Medical Expenditure Panel Survey
Publication: Health Services & Outcomes Research Methodology 2000;1(2):131-48. AHRQ Pub. No. 00-R052
Date: 2000
Abstract: In panel designs with multiple waves of data collection, the overall survey response rate is a multiplicative function of the wave-specific response rates. The 1996 MEPS follows this model, requiring five rounds of data collection with the same panel of sampled households, to acquire data on health care use, expenditures, insurance coverage, and sources of payment that cover two consecutive calendar years. Gaining an understanding of the factors that distinguish the cooperative respondents, the survey participants that require use of nonresponse conversion techniques to maintain their cooperation (reluctant respondents), and the initial participants that eventually drop out of the survey (part-year respondents) is essential from both an estimation and data-collection perspective. To inform the specification of nonresponse adjustment strategies in MEPS to correct for survey attrition, this study attempts to identify the characteristics that distinguish survey participants across rounds from the part-year respondents.

Authors: Machlin S
Title: The 1996 MEPS: plans for matching medical provider to household component data
Publication: American Statistical Association, Proceedings of the Section on Social Statistics, pp. 335-39
Date: 2000

Authors: Cohen S, Machlin S
Title: Characteristics of nonrespondents in the 1996 MEPS
Publication: American Statistical Association, Proceedings of the Section on Social Statistics, pp. 329-34
Date: 2000

Authors: Cohen S, Machlin S
Title: Survey attrition considerations in the Medical Expenditure Panel Survey
Publication: J Econ Social Measurem 2000;26:83-98. AHRQ Pub. No. 01-R057
Date: 2000
Abstract: In panel designs with multiple waves of data collection, the overall survey response rate is a multiplicative function of the wave-specific response rates. The 1996 MEPS-HC follows this model to acquire data on health care use, expenditures, insurance coverage, and sources of payment that cover two consecutive calendar years. An overlapping panel design was implemented, where data covering the second year of a panel are combined with data from the first year of a new panel. This study identifies the characteristics that distinguish survey participants across waves of the survey from those that only participate in initial rounds and then discontinue their survey participation. The results provide insights regarding the efficacy of the MEPS nonresponse adjustment strategies by comparing the survey estimates from the second year of the longitudinal panel with those from a new panel for the same time period.

Authors: Cohen J, Machlin S, Zuvekas S, et al
Title: Health care expenses in the United States, 1996
Publication: MEPS Research Findings No. 12. AHRQ Pub. No. 01-0009. Available on the MEPS Web site
Date: 2000
Abstract: This report presents descriptive data on health care spending in the United States. Data come from the 1996 MEPS and cover the civilian noninstitutionalized U.S. population. Information is given on total health care expenses combined and also for hospital inpatient services, ambulatory services, prescription medicines, dental services, home health services, and other medical equipment and supplies.

Authors: Winglee M, Valliant R, Brick M, Machlin S
Title: Probability matching of medical events
Publication: J Econ Social Measurem 1999;23:1-12
Date: 1999
Abstract: In this paper, the authors discuss the methods of probability record linkage and error estimation for the MEPS. MEPS collects medical expenditure data from both household respondents and their medical providers. The medical events reported by the two sources are subject to reporting differences, and probability linkage methods are used to determine if pairs of medical events belong to the same entities. Match weights are assigned to pairs of events based on the likelihood of being a match, and a decision made to declare pairs as matches or nonmatches. The linkage errors include false matches (false positive) when pairs selected are not true matches, and false nonmatches (false negative) when true pairs are omitted. This study used three approaches: manual reviews, cumulative weight curves, and simulation approaches to provide estimates of linkage errors.

Authors: Potter D, Machlin S
Title: Comparison of the survey estimates from the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey. Paper presented at the annual meeting of the American Statistical Association, Baltimore, MD, August, 1999
Publication: Proceedings of the American Statistical Association, Section on Survey Research Methods, pp. 701-6
Date: 1999
Abstract: The household survey (HS) of both the MEPS and the Medicare Current Beneficiary Survey (MCBS) were designed to produce annual estimates for a variety of measures related to health care use, expenses, sources of payment, health status, and insurance coverage. Both are nationally representative population-based samples; longitudinal, with rotation; and require multiple rounds of in-person computer-assisted personal interview data collection to produce an annual estimate. The surveys differ with respect to their target populations; in MEPS-HS, the U.S. civilian noninstitutionalized population, and in MCBS, the current U.S. Medicare beneficiary population. The purpose of this evaluation is to assess the compatibility of the survey estimates derived from these surveys as part of the effort to enhance the analytic utility of each survey. To the extent that the samples can be pooled for specific health care measures, the paper examines potential gains in precision for the composite estimates. The paper also includes a discussion of key analytic measures considered incompatible for pooling, given survey differences.

Authors: Machlin S, Cohen J, Thorpe J
Title: Measuring inpatient care use in the United States: A comparison across five federal data sources
Publication: J Econ Social Measurem 1999;23:1-11
Date: 1999
Abstract: Despite declines in recent years, inpatient care remains the largest component of national medical expenditures. The U.S. Department of Health and Human Services currently sponsors five data-collection efforts that can be used to estimate the utilization of inpatient hospital care in the United States. Through a comparison of 1996 inpatient utilization estimates, this paper describes important methodological considerations when using the different data sources for measuring inpatient use. The results show that surveys with similar target populations and methodologies produced similar estimates. In particular, estimates for the household-based surveys (NHIS and MEPS-HC) were comparable while those for the hospital discharge surveys (NHDS and HCUP-NIS) were not comparable. Hospital discharge surveys produced substantially higher estimates of total discharges than household surveys, which is partly attributable to differences in target populations. Also, data from the MCBS suggest that underreporting may be another explanation for lower estimates from the household surveys.

Authors: Machlin S, Cohen J, Zuvekas S, Thorpe J
Title: Accuracy of household reported payments for physician visits in the 1996 Medical Expenditure Panel Survey
Publication: Proceedings of the American Statistical Association
Date: 1999

Authors: Krauss N, Machlin S, Kass B
Title: Use of health care services, 1996
Publication: MEPS Research Findings No. 7. AHCPR Pub. No. 99-0018. Available on the MEPS Web site
Date: 1999
Abstract: This report presents estimates of health care use for the civilian noninstitutionalized population of the United States during calendar year 1996. Data are derived from the 1996 MEPS Household Component (HC). Aspects of health care use described in this report include the proportion of people receiving ambulatory medical care in office-based and hospital-based settings, dental care, inpatient hospital care, home health services, and prescription medicines. Specific comparisons are made by selected demographic characteristics—such as age, sex, and race/ethnicity—as well as by health insurance coverage, perceived health status, and whether or not people had a usual source of care.

Authors: Krauss N, Machlin S, Kass B
Title: Health care use in America—1996
Publication: MEPS Highlights No. 9. AHCPR Pub. No. 99-0029. Available on the MEPS Web site
Date: 1999
Abstract: This highlight examines variations in the use of health care services among selected subgroups of the U.S. civilian noninstitutionalized population.

Authors: Cohen S, Machlin S
Title: Nonresponse adjustment strategy in the household component of the 1996 Medical Expenditure Panel Survey
Publication: J Econ Social Measurem 1998;25:15-33. AHRQ Pub. No. 00-R006
Date: 1998
Abstract: The MEPS Household Component was designed to produce national and regional estimates of the health care utilization, expenditures, sources of payment, and insurance coverage of the U.S. civilian noninstitutionalized population for calendar year 1996. In this paper, the characteristics of the households that did not respond to the first round of data collection for the 1996 MEPS are identified and contrasted with those that participated in the survey. As a consequence of the 1996 MEPS sample linkage to the 1995 National Health Interview Survey (NHIS), detailed information on the sociodemographic and health characteristics of both responding and nonresponding households was available to inform the investigation. The results of this study informed the adjustments implemented to correct for survey nonresponse. The paper also includes a presentation of the household-level nonresponse adjustment estimation strategy that was implemented to improve the accuracy of MEPS survey estimates. Implications of study findings on strategies for reducing the overall level of survey nonresponse and for better targeting interviewer efforts are also discussed.

Authors: Avruch S, Machlin S, Bonin P, Ullman F
Title: The demographic characteristics of Medicaid-eligible uninsured children
Publication: Am J Pub Health 1998;88(3):445-7
Date: 1998
Abstract: Available on PubMed®

Authors: Krauss N, Machlin S, Carper K
Title: A comparison of survey methodologies and their effects on health care utilization estimates
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, pp.653-56
Date: 1998

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