Medical Expenditure Panel Survey (MEPS)

Budget Estimates for Appropriations Committees, Fiscal Year 2011

Authorizing Legislation: Title III and IX and Section 937(c) of the Public Health Service Act
FY 2009 Authorization: Expired
Allocation Method: Contracts, and Other.

A. Program Description and Accomplishments

The Medical Expenditure Panel Survey (MEPS), first funded in 1995, is the only national source for annual data on how Americans use and pay for medical care. It supports all of AHRQ's research related strategic goal areas. The survey collects detailed information from families on access, use, expense, insurance coverage and quality. Data are disseminated to the public through printed and Web-based tabulations, microdata files and research reports/journal articles.

The MEPS is designed to provide annual estimates at the national level of the health care utilization, expenditures, sources of payment and health insurance coverage for the U.S. civilian non-institutionalized population. The MEPS consists of a family of interrelated surveys, which include a Household Component (HC), a Medical Provider Component (MPC), and an Insurance Component. In addition to collecting data to yield annual estimates for a variety of measures related to health care use and expenditures, MEPS provides estimates of measures related to health status, demographic characteristics, employment, access to health care and health care quality. Estimates can be provided for individuals, families and population subgroups of interest. The data collected in this ongoing longitudinal study also permit studies of the determinants of the use of services and expenditures, and changes in the provision of health care in relation to social and demographic factors such as employment or income; the health status and satisfaction with health care of individuals and families; and the health needs of specific population groups such as the elderly and children.

The data from the MEPS have become a linchpin for the public and private economic models projecting health care expenditures and utilization. This level of detail enables public and private sector economic models to develop national and regional estimates of the impact of changes in financing, coverage, and reimbursement policy, as well as estimates of who benefits and who bears the cost of a change in policy. No other surveys provide the foundation for estimating the impact of changes on different economic groups or special populations of interest, such as the poor, elderly, veterans, the uninsured, or racial/ethnic groups. Government and non-governmental entities rely upon these data to evaluate health policies, the effect of tax code changes on health expenditures and tax revenue, and proposed changes in government health programs such as Medicare. In the private sector (e.g., RAND, Heritage Foundation, Lewin-VHI, and the Urban Institute), these data are used by many private businesses, foundations, and academic institutions to develop economic projections. These data represent a major resource for the health services research community at large. Since 2000, data on premium costs from the MEPS Insurance Component have been used by the Bureau of Economic Analysis to produce estimates of the GDP for the Nation.

Because of the need for timely data, performance goals for MEPS have focused on providing data in a timely manner. The MEPS program has met or exceeded all of its data timeliness goals. These performance goals require the release of the MEPS Insurance Component tables within 6 months of data collection; the release of MEPS Use and Demographic Files within 11 months of data collection; the release of MEPS Full Year Expenditure data within 11 months of data collection. In addition, the program has expanded the depth and breadth of data products available to serve a wide range of users. To date, over 275 statistical briefs have been published. The MEPS data table series has expanded to include eight topic areas on the household component and nine topic areas on the Insurance Component. In addition, specific large State and metro area expenditure and coverage estimates have been produced, further increasing the utility of MEPS within the existing program costs.

Further advances in the timeliness of the MEPS Insurance Component data have been initiated through a change in the questionnaire to obtain employer sponsored coverage information that is in force at the time of data collection, rather than for a prior year retrospective reference period. Due to such changes in the Insurance Component survey design and processing, the calendar year 2008 estimates of employer-based health insurance costs and availability are now provided a full year earlier than in previous years. In FY 2009, this timely advance in the provision of national and state level health insurance premium estimates served to improve the accuracy of the cost implications associated with health initiatives. In addition, advances in data accessibility have also been achieved by expanding the number of Data Centers across the Nation to permit access to MEPS restricted data through collaboration with the Bureau of the Census to utilize nine additional Research Data Centers for approved projects. Since its inception in 1996, MEPS has been used in several hundred scientific publications, and many more unpublished reports to inform health policy decisions and practice.

• MEPS data on national and state estimates of the percentage of employees enrolled in high cost health insurance plans were used by the Senate Finance Committee to develop their legislation.
• MEPS data produced detailed estimates of children eligible for S-CHIP who were uninsured. The information provided on number of children who were eligible for such coverage but remained uninsured had a significant impact on the Reauthorization of the Child Health Insurance Program (CHIP).
• MEPS data on national estimates of gaps and trends in health insurance coverage over two year period was used by Secretary Sebelius in a speech on Insurance Insecurity and the related HHS Report.
• The MEPS data have been used extensively by the Congressional Budget Office, Congressional Research Service, Department of Treasury, Joint Taxation Committee, and Department of Labor to inform Congressional inquires related to health care expenditures, insurance coverage and sources of payment and to analyze potential tax and other implications of Federal Health Insurance Policies.
• MEPS data on health care quality, access, and health insurance coverage have been used extensively in the Department's two annual reports to Congress, the National Healthcare Disparities Report and the National Healthcare Quality Report.
• The MEPS was awarded the American Association for Public Opinion Research's 2008 Policy Impact Award in recognition of their extraordinary, long-term group effort in contributing timely data and research that has informed U.S. health care policy decisions.
• The MEPS has been used in Congressional testimony on the impact of health insurance coverage rate increases on small businesses.
• The MEPS data have informed studies of the value of health insurance in private markets and the effect of consumer payment on health care.
• The MEPS data have been extensively used to inform Congressional inquiries tied to State Children's Health Insurance Program (SCHIP) reauthorization, with particular emphasis on the change in take-up rates among Medicaid eligible children over the implementation period of SCHIP and the percent of all uninsured children who are eligible for Medicaid or SCHIP.
• The MEPS -IC has been used by a number of States in evaluating their own private insurance issues including eligibility and enrollment by the State of Connecticut and by the Maryland Health Care Commission; and community rating by the State of New York. As part of the Robert Wood Johnson Foundation's State Coverage Initiative, MEPS data was cited in 69 reports, representing 27 States.
• The MEPS data have been used extensively by the Government Accountability Office to determine trends in Employee Compensation, with a major focus on the percentage of employees at establishments that offer health insurance, the percentage of eligible employees who enroll in the health insurance plans, the average annual premium for employer-provided health insurance for single workers, and the employees' share of these premiums.
• MEPS data have been used in HHS Reports to Congress on expenditures by sources of payment for individuals afflicted by conditions that include acute respiratory distress syndrome, arthritis, cancer, chronic obstructive pulmonary disease, depression, diabetes, and heart disease.
• MEPS data are used to develop estimates provided in the Consumers Checkbook Guide to Health Plans, of expected out of pocket costs (premiums, deductibles and copayments) for Federal employees and retirees for their health care. The Checkbook is an annual publication that provides comparative information on the health insurance choices offered to Federal workers and retirees.
• The MEPS has been used to estimate the impact of the Medicare Modernization Act (MMA) by the Employee Benefit Research Institute (the effect of the MMA on availability of retiree coverage), by the Iowa Rural Policy Institute (effect of the MMA on rural elderly) and by researchers to examine levels of spending and co-payments.
• MEPS data have been used by CDC and others to evaluate the cost of common conditions including arthritis, injuries, diabetes, obesity and cancer. Before AHRQ reorganized research portfolios in 2007, MEPS was part of the Data Collection and Dissemination portfolio. This portfolio underwent a program assessment in 2002, and was found to be moderately effective. The review cited the Medical Expenditure Panel Survey (MEPS) as a strong attribute of the program. As a result of the program assessment, the program continues to take actions to reduce the number of months that MEPS data is made available after the date of completion of the survey, increase the number of MEPS data users, and increase the number of topical areas tables included in the MEPS Tables Compendia.

B. Funding History

Funding for the MEPS budget activity during the last five years has been as follows:

C. Budget Request

The FY 2011 Request level for the MEPS totals $59,300,000 in contracts and IAAs, which reflects an increase of $500,000 above the FY 2010 Appropriated level. The funding allocation in FY 2011 for the three core MEPS Component Surveys is provided below.

Prior to FY 2010, the MEPS budget received no funding increments for most of the decade while survey administration and data processing costs were rising. To meet these budget constraints over the past decade, the MEPS Household Component sample size had declined by approximately 10%, impacting the precision of survey estimates and analytic capacity. The FY 2011 Request for MEPS will be used to support the sample size and content of the MEPS Household and Medical Provider Surveys necessary to satisfy the congressional mandate to submit an annual report on national trends in health care quality and to prepare an annual report on health care disparities. The MEPS Household Component sample size is restored in 2011 to 14,500 households with full calendar year information. These sample size specifications for the MEPS permit detailed analyses of the health care expenditures, health insurance coverage, and the quality of care received by special populations meeting precision specifications for survey estimates. This design, in concert with the survey enhancements initiated in prior years, significantly enhances AHRQ's capacity to report on the quality of care Americans receive at the national and regional level, in terms of clinical quality, patient satisfaction, access, and health status both in managed care and fee-for-service settings.

The MEPS Household Component:
The FY 2011 Request will permit the continuation of an oversample in MEPS of Asian and Pacific Islanders, an over-sample of African Americans, and an oversample of Hispanics. These enhancements, in concert with the existing MEPS capacity to examine differences in the cost, quality and access to care for minorities, ethnic groups and low income individuals, will provide critical data for the National Healthcare Quality Report and the National Healthcare Disparities Report.

The MEPS Insurance Component:
The MEPS Insurance Component (IC) is a survey of private business establishments and governments designed to obtain information on health insurance availability and coverage derived from employers in the U.S. The sample for this survey is selected from the Census Bureau's Business Register for private employers and Census of Governments for public employers. The IC is an annual survey designed to provide both nationally and state representative data on the types of health insurance plans offered by employers, enrollment in plans by employees, the amounts paid by both employers and employees for those plans, and the characteristics of the employers.

Funds will also be allocated to the MEPS Insurance Component to improve the availability of data at both the national and the State level. The FY 2010 Appropriation level allowed for data on employer sponsored health insurance to be collected in order to support both national and separate estimates for all 50 States and the District of Columbia. The FY2011 Request will maintain this capacity and these funds would also be used to enhance the tabulations provided to the States to support their analysis of private, employer sponsored health insurance. This will include data tabulations of distributional estimates of premiums paid for employer sponsored coverage at the State level.

The Medical Provider Component:
The FY 2011 Request will support the MEPS Medical Provider Component, a survey of medical providers, facilities and pharmacies that collects detailed data on the expenditures and sources of payment for the medical services provided to individuals sampled for the MEPS. The MEPS Medical Provider Component sample size of office based physicians is restored in 2011, increasing the MEPS provider sub-sample of person-provider pairs to original specifications that obtain data for 20,000 person-provider pairs, to insure the accuracy of MEPS survey expenditure estimates. Such data are essential to improve the accuracy of the national medical expenditure estimates derived from the MEPS and to correct for the item non-response on expenditures by household sample participants.

Recent enhancements to the estimation capabilities of the MEPS Household Component have also been realized and permit the generation of health care utilization, expenditure, and health insurance coverage estimates for some large metropolitan areas and for the ten largest States. This has resulted in visible improvements in the analytic capacity of the survey without any additional increments to the sample size.

IT Expenditures within the MEPS Portfolio:
MEPS is the primary national source of annual and longitudinal data on how Americans use and pay for medical care. The survey collects detailed information from families on access, use, expense, insurance coverage and quality. It supports all of AHRQ's research related strategic goal areas. This data is vital to the public and private economic models projecting health care expenditures and utilization. The IT portion of this portfolio is a key to the success of data collection, synthesis and dissemination. Recent upgrades to the system allow AHRQ to provide more timely data - a crucial factor for the success of this program.

The Medical Provider Component is also having its data system revamped. This component is adapting existing software and components to collect information from hospitals, pharmacies and other medical providers. This conversion will facilitate the automation of a number of quality control procedures and reduce a step in data collection (copying information onto paper forms which were then entered into a database). As medical providers adopt electronic medical and billing practices, this will process assist in reducing their survey burden in the future. This modification will also result in an enhancement to survey efficiency.

Performance Targets
In terms of performance targets, measures 1.3.16 in FY 2011, and measure 1.3.17 in FY 2010 cannot be more ambitious than the prior year. The MEPS program recently re-engineered its interviewing system. At the same time, our sample design changed as a result of the new sample design of the National Health Interview Survey. Because of these changes, additional quality control measures are needed to insure the integrity of survey estimates. Once this process is stable, we will evaluate whether continued efficiencies are possible, and what resources would be required to attain them.

D. Outputs and Outcomes Tables

Program: Medical Expenditure Panel Survey (MEPS)
Long-Term Objective: Achieve a wider access to effective health care services and reduce health care costs.
Performance Trends: The MEPS Program has met or exceeded all program assessment data timeliness goals. In addition, due to modifications to the MEPS Insurance Component survey design and data processing, calendar year estimates of employer-based health insurance costs and availability were provided a full year earlier than in previous years

Please see AHRQ's On-Line Performance Appendix (available at http://www.ahrq.gov/about/cj2011/cj11opa.htm) for measures the portfolio will be retiring in FY 2011.

E. Mechanism Table for MEPS

Agency For Healthcare Research And Quality MEPS Mechanism Table (Dollars in Thousands)

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