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

Steven B. Cohen

Authors: Rhoades J, Cohen S
Title: The long-term uninsured in America, 2004-2007: Estimates for the U.S. civilian noninstitutionalized population under age 65
Publication: MEPS Statistical Brief No. 258. Available on the MEPS Web site.
Date: August 2009
Abstract: This statistical brief provides detailed estimates for the U.S. civilian noninstitutionalized non-elderly (under age 65) population that was uninsured for the entire 2004-2007 period and identifies groups most at risk of lacking any coverage over that four-year period.

Authors: Cohen J, Cohen S, Banthin J
Title: The Medical Expenditure Panel Survey: A national information resource to support healthcare cost research and inform policy and practice
Publication: Medical Care 47(7 Suppl 1):S44-50
Date: July 2009
Abstract: Available on PubMed®.

Authors: Cohen S, Rohde F
Title: The concentration in health expenditures over a two year time interval, estimates for the U.S. population, 2005-2006
Publication: MEPS Statistical Brief No. 244. Available on the MEPS Web site.
Date: April 2009
Abstract: Using information from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) for 2005 and 2006, this report provides detailed estimates of the concentration in the level of health care expenditures over time. Studies that examine the concentration of high levels of expenditures over time are essential to help discern the factors most likely to drive health care spending and the characteristics of the individuals who incur them.

Authors: Cohen S, Yu W
Title: The concentration and persistence in the level of health expenditures over time: Estimates for the U.S. population, 2005-2006
Publication: MEPS Statistical Brief No. 236. Available on the MEPS Web site
Date: February 2009
Abstract: In 2006, health care expenses among the U.S. community population totaled $1.034 trillion. Medical care expenses, however, are highly concentrated among a relatively small proportion of individuals in the community population. As previously reported in 1996, the top 1 percent of the U.S. population accounted for 28 percent of the total health care expenditures and the top 5 percent for more than half.

Authors: Cohen S, Yu W
Title: The utility of prediction models to oversample the long-term uninsured
Publication: Medical Care 47(1):80-7
Date: January 2009
Abstract: Available on Pub Med®.

Authors: Rhoades J, Cohen S
Title: The long-term uninsured in America, 2003-2006: Estimates for the U.S. population under age 65
Publication: MEPS Statistical Brief No. 220. Available on the MEPS Web site
Date: August 2008
Abstract: This statistical brief provides detailed estimates for the U.S. civilian noninstitutionalized non-elderly (under age 65) population that was uninsured for the entire 2003-2006 period and identifies groups most at risk of lacking any coverage over that four-year period.

Authors: Cohen S, Clancy C
Title: The Agency for Healthcare Research and Quality and Data Collection
Publication: Health Aff 27(2):586-7
Date: March-April 2008
Abstract: Available on Pub Med®.

Authors: Cohen S, Yu W
Title: The persistence in the level of health expenditures over time: Estimates for the U.S. population, 2004-2005
Publication: MEPS Statistical Brief No. 191. Available on the MEPS Web site
Date: November 2007
Abstract: Using information from the MEPS-HC for 2004 and 2005, this report provides detailed estimates of the persistence in the level of health care expenditures over time. Studies that examine the persistence of high levels of expenditures over time are essential to help discern the factors most likely to drive health care spending and the characteristics of the individuals who incur them.

Authors: Rhoades J, Cohen S
Title: The long-term uninsured in America, 2002-2005: estimates for the U.S. population under age 65
Publication: MEPS Statistical Brief No. 183. Available on the MEPS Web site
Date: August 2007
Abstract: Using information from the MEPS-HC for 2004 and 2005, this statistical brief provides detailed estimates for the U.S. civilian noninstitutionalized non-elderly (under age 65) population that was uninsured for the entire 2002-2005 period and identifies groups most at risk of lacking any coverage over that four-year period. The addition of questions in MEPS to determine health insurance coverage profiles for the period covering 2002 and 2003, in concert with information on health insurance profiles from the National Health Interview Survey for 2003, facilitated these analyses of extended longitudinal profiles.

Author: Cohen S
Title: Attitudes toward health insurance and their persistence over time, adults 2003-2004
Publication: MEPS Statistical Brief No. 161. Available on the MEPS Web site
Date: February 16, 2007
Abstract: Using data from MEPS-HC, this statistical brief provides a summary of the attitudes adults have regarding the need for health insurance coverage and its cost over the time period 2003-2004. A description of the variation in agreement levels with these attitudes for adults further distinguished by demographic and socioeconomic characteristics is also provided. In addition, the persistence in these attitudes toward health insurance coverage is examined.

Authors: Cohen S, Rhoades J
Title: Estimation of the long term uninsured in the Medical Expenditure Panel Survey
Publication: J Ec & Soc Meas 32(4):235-49
Date: 2007

Authors: Cohen S, Makuc D, Ezzati-Rice T
Title: Health insurance coverage during a 24-month period: A comparison of estimates from two national health surveys
Publication: Health Services and Outcomes Research Methodology 7:125-44
Date: 2007

Authors: Wun, L, Ezzati-Rice T, Cohen S, Yu W
Title: The impact of medical expenditure predictors in the Medical Expenditure Panel Survey (MEPS) nonresponse adjustment
Publication: American Statistical Association, Joint Statistical Meetings—Section on Survey Research Methods, pp. 3900-4 (CD-ROM), Alexandria, VA
Date: 2006

Authors: Rhoades J, Cohen S
Title: The long-term uninsured in America, 2001-2004: Estimates for the U.S. population under age 65
Publication: MEPS Statistical Brief No. 136. Available on the MEPS Web site
Date: August 2006
Abstract: This statistical brief provides detailed estimates for the U.S. civilian noninstitutionalized non-elderly (under age 65) population that was uninsured for the entire 2001-2004 period and identifies groups most at risk of lacking any coverage over that four-year period. Estimates are based on information from the MEPS-HC for 2003 and 2004, additional questions in MEPS to determine health insurance coverage for 2001 and 2002, and health insurance profiles from the National Health Interview Survey for 2002.

Authors: Cohen S, Yu W
Title: The persistence in the level of health expenditures over time: Estimates for the U.S. population, 2002-2003
Publication: MEPS Statistical Brief No. 124. Available on the MEPS Web site
Date: May 2006
Abstract: Using information from the MEPS-HC for 2002 and 2003, this report provides detailed estimates of the persistence in the level of health care expenditures over time. Studies that examine the persistence of high levels of expenditures over time are essential to help discern the factors most likely to drive health care spending and the characteristics of the individuals who incur them.

Authors: Cohen S, Buchmueller T
Title: Trends in medical care costs, coverage, use, and access: Research findings from the Medical Expenditure Panel Survey
Publication: Med Care 44(5 Suppl):I1-3
Date: May 2006
Abstract: Available on PubMed®

Authors: Cohen S, Ezzati-Rice T, Yu W
Title: The utility of extended longitudinal profiles in predicting future health care expenditures
Publication: Med Care 44(5 Suppl):I45-53
Date: May 2006
Abstract: Available on PubMed®

Authors: Cohen S, Rhoades J
Title: The long-term uninsured in America, 2000-2003: estimates for the U.S. population under age 65
Publication: MEPS Statistical Brief No. 123. Available on the MEPS Web site
Date: March 2006
Abstract: Using information from the MEPS-HC for 2002 and 2003, this statistical brief provides detailed estimates for the U.S. civilian noninstitutionalized non-elderly (under age 65) population that was uninsured for the entire 2000-2003 period and identifies groups most at risk of lacking any coverage over that four-year period. Additional questions in MEPS for the period covering 2000 and 2001 and information on health insurance profiles from the 2001 National Health Interview Survey facilitated these analyses of extended longitudinal profiles.

Authors: Cohen S, Ezzati-Rice T, Yu W
Title: The impact of survey attrition on health insurance coverage estimates in a national longitudinal health care survey
Publication: Health Services Outcomes Research Methodology 6:111-25
Date: 2006

Author: Cohen S
Title: Integrated survey designs: A framework for nonresponse bias reduction
Publication: J Econ Social Measurem 30(2,3):101-14
Date: 2005

Authors: Cohen S, Wun L
Title: A comparison of household and medical provider reported health care utilization and an estimation strategy to correct for response error
Publication: J Econ Social Measurem 30(2,3):115-26
Date: 2005

Authors: Madans J, Cohen S
Title: Health surveys: A resource to inform health policy and practice
Publication: In: D Friedman, E Hunter, R Parrish II, (Eds.), Health Statistics: Shaping Policy and Practice to Improve the Population's Health (pp.119-138). New York: Oxford University Press, Inc.
Date: 2005

Authors: Cohen S, Ezzati-Rice T, Yu W
Title: The utility of probabilistic models to identify individuals with future high medical expenditures
Publication: J Econ Social Measurem 30(2,3):135-44
Date: 2005

Authors: Cohen SB, Ezzati-Rice T
Title: Designing national health care surveys
Publication: In: Peck R, Casella G, Cobb G, Hoerl R, Nolan D, Starbuck R, Stern H, editors. Statistics: A Guide to the Unknown, Fourth Edition. Duxberry. Thompson Brooks/Cole; p. 89-101
Date: 2005

Authors: Cohen S, Ezzati-Rice T
Title: Design and estimation strategies in the Medical Expenditure Panel Survey for investigation of trends in health care expenditures
Publication: In Eighth Conference on Health Survey Research Methods, pp. 23-28. DHHS Publication No. (PHS) 04-1013. U.S. Department of Health and Human Services, Hyattsville, MD
Date: July 2004

Authors: Cohen S, Ezzati-Rice T
Title: Design and estimation strategies and innovations in the Medical Expenditure Panel Survey for the measurement of trends in health care expenditures
Publication: American Statistical Association, Proceedings of the Section on Health Policy Statistics, pp. 1014-20
Date: 2003

Authors: Moeller J, Cohen S, Mathiowetz N, Wun L
Title: Model-based sampling for persons with high health expenditures: evaluating accuracy and yield with the 1997 MEPS
Publication: Joint Statistical Meetings—Section on Health Policy Statistics, pp. 2367-72. AHRQ Pub. No. 03-R064
Date: 2003

Authors: Cohen S, Ayanian J, Clancy C
Title: Foreword: Health care costs, coverage, and access in the United States: Research Findings from the Medical Expenditure Panel Survey.
Publication: Med Care 41(7 Suppl):III-1-4. AHRQ Pub No. 03-R052.
Date: July 2003.

Author: Cohen S
Title: Design strategies and innovations in the Medical Expenditure Panel Survey
Publication: Med Care 41(7 Suppl):III-5-12. AHRQ Pub. No. 03-R053
Date: July 2003
Abstract: Available on PubMed®

Authors: Moeller J, Cohen S, Mathioiwetz N, Wun L
Title: Regression-based sampling for persons with high health expenditures: Evaluating accuracy and yield with the 1997 MEPS.
Publication: Med Care 41(7 Suppl):III-44-52. AHRQ Pub. No. 03-R059.
Date: July 2003
Abstract: Available on PubMed®

Authors: Wun L, Cohen S, Moeller J
Title: Refining the prediction models of low income status and future medical expenditures in the Medical Expenditure Panel Survey
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, pp. 3813-18 (CD-ROM), Alexandria, VA
Date: 2002

Author: Cohen S
Title: The Medical Expenditure Panel Survey: an overview
Publication: Effective Clinical Practice 5(3 Suppl):152
Date: May/June 2002
Abstract: Overview of MEPS. Subjects include national sample of the U.S. civilian noninstitutionalized population; supplemental information obtained from medical providers and payers. Available data include health care use and expenditures (e.g., inpatient, outpatient, and office-based care; dental care; and prescription medications), health insurance coverage, access to care, sources of payment, health status and disability, medical conditions, health care quality, and socioeconomic and demographic measures. Covers 1996 to present. Data are in public-use files and can be downloaded from the MEPS Web site; restricted data are available from the AHRQ Data Center.

Authors: Moeller J, Cohen S, Hock E, et al
Title: Projecting NMES Data: A Framework for MEPS Projections
Publication: MEPS Methodology Report No. 13. AHRQ Pub. No. 02-0009. Available on the MEPS Web site
Date: 2002
Abstract: This report describes the procedures used to project data from the 1987 NMES household survey to future years. This survey, sponsored by the National Center for Health Services Research, AHRQ's predecessor agency, provided extensive information on health expenditures by or on behalf of American families and individuals, the financing of these expenditures, and use of services. NMES data have been "aged" based on more recent household population estimates from government sources and data from the National Health Accounts of the Centers for Medicare & Medicaid Services. The NMES data were released in public use data sets projected to the years 1996 and 2005. This report describes the categories of expenditures and payment sources in the projected data, the population and expenditure reweighting procedures, and alignment of the 1987 NMES to the 1987 National Health Accounts.

Author: Cohen S
Title: Enhancements to the Medical Expenditure Panel Survey to improve health care expenditure and quality measurement
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods (CD-ROM), Alexandria, VA.
Date: August 2001

Authors: Wun L, Cohen S, Moeller J
Title: An evaluation of a model used to oversample low income households in the 1997 MEPS
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods (CD-ROM), Alexandria, VA
Date: August 2001

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

Author: Cohen S
Title: Methodological issues for the design of consumer and patient satisfaction surveys
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods
Date: 2000

Authors: Wun L, Cohen S
Title: An adjustment strategy for medical provider nonresponse to facilitate an examination of the accuracy of household reported utilization data
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, pp. 110-15
Date: 2000

Authors: Cohen S, Yu W
Title: The impact of alternative sample allocation schemes on the precision of survey estimates derived from the National MEPS
Publication: J Econ Social Measurem 26:111-28. AHRQ Pub. No. 01-R056
Date: 2000
Abstract: The 1996 MEPS Household Component (MEPS-HC) was designed as a continuous ongoing survey to permit annual estimates of health care utilization, expenditures, insurance coverage and sources of payment for the U.S. civilian noninstitutionalized population. Selected as a nationally representative subsample from the National Health Interview Survey, it is characterized by a multistage area probability design with an oversample of households with Hispanic persons and black persons. The 1996 MEPS sample consists of 195 primary sampling units (PSUs), which contained 10,597 responding NHIS households. In this paper, the precision of survey estimates derived from a 195 PSU design is compared with precision results for alternative sample allocation schemes that preserve the number of sample respondents and the oversampling of minorities, while varying the number of PSUs and segments. The results provide insights on the impact of alternative sample allocation schemes on the precision of national health care estimates.

Authors: Cohen S, Machlin S, Branscome J
Title: Patterns of survey attrition and reluctant response in the 1996 MEPS
Publication: Health Services & Outcomes Research Methodology 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: Cohen S, Machlin S
Title: Survey attrition considerations in the MEPS
Publication: J Econ Social Measurem 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 Household Component 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.

Author: Cohen S
Title: Sample design of the 1997 MEPS Household Component
Publication: MEPS Methodology Report No. 11. AHRQ Pub. No. 01-0001. Available on the MEPS Web site
Date: 2000
Abstract: MEPS, third in a series of nationally representative surveys of medical care use and expenditures, comprises four component surveys. The Household Component (HC) produces national and regional estimates of the health care use, expenditures, sources of payment, and insurance coverage of the U.S. civilian noninstitutionalized population. This report gives a detailed description of the 1997 HC. (The 1996 HC was described in an earlier report.) The survey's overlapping panel design is emphasized. The sample selection scheme implemented to oversample selected subgroups—functionally impaired adults, children with activity limitations, working-age adults predicted to incur high medical expenditures, and persons predicted to have low family income—is explained. The report also includes a summary of sample size specifications, survey response rates, and targeted precision levels for national population estimates and health care expenditure estimates for policy-relevant subgroups.

Authors: Cohen S, DiGaetano R, Goksel H
Title: Estimation procedures in the 1996 MEPS Household Component
Publication: MEPS Methodology Report No. 5. AHCPR Pub. No. 99-0027. Available on the MEPS Web site
Date: 1999
Abstract: The Household Component of MEPS produces national and regional estimates of the health care utilization, expenditures, sources of payment, and insurance coverage of the U.S. civilian noninstitutionalized population. The HC sample design is a stratified multistage area probability design with disproportionate sampling to facilitate the selection of an oversample of minorities. This report provides an overall summary of HC sample yields across the three rounds of data collection that cover calendar year 1996. It also provides an overview of the weighting strategies used to obtain national estimates of health care parameters for the population. Survey design complexities that require special consideration for variance estimation and analysis are discussed.

Authors: Ezzati-Rice T, Cohen S, Khare M, Moriarity C
Title: Using the National Health Interview Survey as a sampling frame for other health-related surveys
Publication: American Statistical Association, Proceedings of the Section on Survey Research Methods, pp. 121-30
Date: 1998

Author: Cohen S
Title: Small area estimation
Publication: Encyclopedia of Biostatistics 5:4128-32. AHCPR Pub No. 98-R073
Date: 1998

Authors: Cohen S, Machlin S
Title: Nonresponse adjustment strategy in the household component of the 1996 Medical Expenditure Panel Survey
Publication: J Econ Soc Measurement 25:15-33. AHCPR 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 non-institutionalized 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 socio-demographic 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: Cohen, S
Title: Sample Design of the 1996 MEPS Medical Provider Component
Publication: J Econ Social Measurem 24:25-53. AHCPR Pub. No. 98-R082
Date: 1998
Abstract: MEPS was established to provide an assessment of the health care utilization, expenditures, health insurance coverage, and sources of payment for the civilian noninstitutionalized population. The 1996 MEPS sample consists of approximately 10,500 nationally representative households that were survey participants in the 1995 National Health Interview Survey (NHIS). In the design of the survey, it was recognized that the household respondent was not always the best source of information on medical expenditures, particularly with the growth of managed care. Consequently, MEPS includes a Medical Provider Survey Component (MPC), to improve the accuracy of national estimates of health care expenditures that are derived from the survey. The sample design selectively targets those individuals that are most likely to misreport or not possess adequate knowledge about their medical expenditures, in addition to medical events that were expected to be associated with high levels of missing or poor-quality data. In addition, the design was specified to enrich the sample of health care events available as donors for imputation, and to support methodological analysis. This paper provides a summary of the analytical objectives of the MPC, in addition to a detailed discussion of the survey design that was implemented.

Author: Cohen S
Title: Sample design of the 1996 MEPS Household Component
Publication: MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027. Available on the MEPS Web site
Date: 1997
Abstract: MEPS sample specifications and new design efficiencies are discussed.

Author: Cohen S
Title: An evaluation of alternative PC-based software packages developed for the analysis of complex survey data
Publication: American Statistician 51(3):285-92. AHCPR Pub. No. 98-R001
Date: 1997
Abstract: Data from complex survey designs require special consideration with regard to variance and data analysis as a consequence of significant departures from simple random sampling assumptions. Using data from the NMES, which is characterized by a complex survey design, three programs developed for the analysis of complex survey data in a personal computing environment are compared: Stata, SUDAAN, and WesVarPC. The comparisons concentrate on user facility, computational efficiency, and program capabilities.

Authors: Cohen J, Monheit A, Beauregard K, et al
Title: The Medical Expenditure Panel Survey: A national health information resource
Publication: Inquiry 33:373-89. AHCPR Pub. No. 97-R043
Date: 1996-97
Abstract: Available on PubMed®

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