Expenditure Panel Survey (MEPS)
The Medical Expenditure Panel
Survey (MEPS) is designed to provide nationally representative estimates of
health care use, expenditures, sources of payment, and insurance coverage for
civilian noninstitutionalized population. MEPS is
cosponsored by the Agency for Healthcare Research and Quality (AHRQ) and the National Center for Health Statistics (NCHS).
MEPS comprises three component surveys: the Household
Component (HC), the Medical Provider Component (MPC), and the Insurance
Component (IC). The HC is the core survey of MEPS.
The MEPS HC, a nationally
representative survey of the U.S.
civilian noninstitutionalized population, collects medical expenditure data at
both the person and household levels. The HC collects detailed data on
demographic characteristics, health conditions, health status including adult
disability status as measured by activity limitations, use of medical care
services, charges and payments, access to care, satisfaction with care, health
insurance coverage, income, and employment.
The HC uses an overlapping panel
design in which data are collected through a preliminary contact followed by a
series of five rounds of interviews over a 2½-year period. Through the use of
computer-assisted personal interviewing (CAPI) technology, data on medical
expenditures and use for 2 calendar years are collected from each household.
This series of data collection rounds is launched each year on a new sample of
households to provide overlapping panels of survey data and, when combined with
other ongoing panels, will provide continuous and current estimates of health
The sample of households selected
for the MEPS HC is drawn from respondents to the National Health Interview
Survey (NHIS), conducted
by NCHS. The NHIS provides a nationally representative sample of the U.S.
civilian noninstitutionalized population, with oversampling of Hispanics and
Blacks. In addition, MEPS oversamples Asians, Blacks, and poor people (individuals whose family income is less than 200% of the Federal poverty level).
detailed information about MEPS and the information discussed here, refer to http://meps.ahrq.gov/mepsweb/data_stats/more_info_download_data_files.jsp.
health care estimates from MEPS for the 2010 NHQR and NHDR were derived from
the 2007 MEPS HC survey, including the Self-Administered Questionnaire (SAQ),
the Child Health and Preventive Care section, and the Diabetes Care Survey
The SAQ is a supplement to the
MEPS HC and was completed in late 2007 (Panel 11, Round 4, and Panel 12, Round
2). It included health care quality
measures taken from the health plan version of CAHPS® (Consumer Assessment of Healthcare Providers and Systems), an AHRQ-sponsored family
of survey instruments designed to measure quality of care from the consumer's
perspective; general health questions; attitudes about health questions; and
health status questions as measured by the SF-12 and the EuroQol 5D.
The Child Health and Preventive
Care section was part of the regular MEPS HC interview that took
place in rounds 2 and 4. It included health care quality measures
taken from the health plan version of CAHPS®; Children With Special Health
Care Needs (CSHCN) Screener questions; children's general health status as
measured by several questions from the General Health Subscale of the Child
Health Questionnaire; Columbia Impairment Scale questions about possible child
behavioral problems; and child preventive care questions. Researchers should
note that the CAHPS® and CSHCN questions changed from a self-administered
parent questionnaire in 2000 to an interviewer-administered questionnaire
starting in 2001.
A third supplement to the MEPS
HC, the Diabetes Care Survey (DCS), was a self-administered questionnaire given
to people identified with diabetes. It asked about the care they received in
the treatment of their diabetes.
Estimates derived from MEPS are
presented at both an aggregate level and for select subpopulations.
Characteristics used to define subpopulations included age, gender, race,
ethnicity, poverty status, education, insurance coverage, proximity to
metropolitan areas, preferred language at home, employment status, perceived
health status, children with special health care needs, and adult disability
status as measured by activity limitations. A brief description of how each of
these population characteristics was defined is provided below.
Age—With the exception of analytic
variables associated with round-specific questions noted below, age was defined
as a person's age on December 31 of the data year.
For measures using analytic
variables associated with round-specific questions (e.g., questions from the
SAQ, the Child Health and Preventive Care supplement, and access-to-care
measures), corresponding round-specific age variables were used to determine
Gender—Male and female.
Race—MEPS tables are shown starting with
2002 data, the year MEPS transitioned to the Office of Management and Budget (OMB)
standards issued in 1997 for collecting racial and ethnicity data. The new standards allow
respondents to identify more than one racial group
(http://www.whitehouse.gov/omb/fedreg_1997standards/). In the MEPS tables, race is
classified in the following six categories: (1) White, single race; (2) Black, single race; (3) Asian, single race;
(4) Native Hawaiian or Other Pacific Islander, single race; (5) American Indian or Alaska Native, single race; (6) multiple races. MEPS estimates by race using 2002 and later
years' data are not directly comparable with estimates using data from years
prior to 2002.
Ethnicity—Ethnicity was determined to be either
Hispanic or non-Hispanic. Persons of Hispanic origin may be of any race. Estimates
were derived for both Hispanic and non-Hispanic subpopulations. In addition,
race was crossed with ethnicity and estimates were reported for persons
classified as non-Hispanic, White; non-Hispanic, Black; and non-Hispanic,
other. For 2002 and later years, non-Hispanic White and non-Hispanic
Black categories excluded multiple-race individuals; estimates are not
directly comparable with data from previous years.
Poverty status—MEPS includes a five-level categorical
variable for family income as a percentage of poverty. For construction of this
variable, definitions of income, family, and poverty are taken from the poverty
statistics developed by the Current Population Survey (CPS). For the purposes
of analysis and reporting in the NHDR, the near-poor and low-income categories
were combined. This resulted in a four-level categorical variable of poverty
status: (1) negative or poor refers to household incomes below the Federal
poverty level (FPL); (2) near poor/low income, from the FPL to just below 200
percent of the FPL; (3) middle income, 200 percent to just below 400
percent of the FPL; and (4) high income, 400 percent or more of the FPL. Beginning with the 2002 file, there were substantial revisions
made to the skip patterns in the Income section. These changes have increased
response rates, resulting in a small impact on income estimates for people under age 65, with a somewhat larger impact on people age 65 and over.
Education—In MEPS, a person's educational attainment
is indicated as the number of completed years of education. For the NHQR and NHDR, this continuous measure was grouped into three categories: (1) less than high
school refers to people with less than 12 completed years of education; (2) high school graduate, people with exactly 12 completed years of education; and (3) at least some college, people with greater than 12 completed years of
education. This variable was constructed only for people age 18 years and over and any measure presented for the education subpopulations includes only people in this age group.
Insurance coverage—The insurance coverage variable was
constructed in a hierarchical manner and in relation to a person's age. For people less than 65 years of age, those who were uninsured for the entire year
were classified as uninsured; those who had private coverage at any time during
the year (including CHAMPUS/VA) were classified as having had private
insurance; and those who had only public coverage (i.e., no private) at any time
during the year were classified as public only. People age 65 years and over were categorized as having Medicare only, Medicare and private, or
Medicare and other public assistance. A small number of people age 65 years and over were identified as having private only or being uninsured. This
residual group is not shown in the tables.
Residence location—The 2010 NHDR and NHQR use the 2006 NCHS Urban-Rural
Classification Scheme for Counties. NCHS based this classification scheme for counties on the OMB definitions of metropolitan and nonmetropolitan
counties; the Rural-Urban Continuum Codes and the Urban Influence Codes
developed by the Economic Research Service of the U.S. Department of Agriculture;
and county-level data from the Census 2000 and 2004 postcensal population
estimates. Urban-rural categories used in the NHQR and NHDR are as follows:
- Large central metro ("central" counties of
metropolitan areas of 1 million or more population).
- Large fringe metro ("fringe" counties of
a metropolitan areas of 1 million or more population).
- Medium metro (counties in
metropolitan areas of 250,000 to 999,999 population).
in metropolitan areas of 50,000 to 249,999 population).
- Micropolitan (counties with at least one urban cluster of at least 10,000 residents).
- Noncore (counties
without an urban cluster of at least 10,000 residents).
The two nonmetropolitan levels of the
NCHS classification, micropolitan and noncore, are derived directly from the
differentiation of nonmetropolitan territory specified in the 2003 OMB
standards for defining metropolitan and micropolitan counties.
information, visit http://www.cdc.gov/nchs/data_access/urban_rural.htm
includes four-level round-specific categorical variables for employment status
for people age 16 years and over. For the
MEPS tables, employment status variables were set for adults ages 18-64. Employed
included levels 1-3, e.g., adults who were currently employed, had a job to return
to, or had a job but did not work during the reference period. Unemployed
included those who were unemployed during the reference period.
includes five-level round-specific categorical variables for perceived health
status: excellent, very good, good, fair, and poor. For the NHQR and NHDR tables, the five levels were collapsed
to two levels: excellent/very good/good; and fair/poor.
Children with special
health care needs—The variable CSHCN42 identifies children with special health care needs based
on the CSHCN Screener instrument developed through a national collaborative
process as part of the Child and Adolescent Health Measurement Initiative
(CAHMI) under the coordination of the Foundation for Accountability. Children
whose "special health care needs" status could not be determined were
coded as "unknown." For the NHQR and NHDR tables, the "unknown" category is not shown.
Preferred language at
individual family member, the Access to Care section ascertained what language is
spoken most often at home (LANGHM42), using the categories English, Spanish, and Other. For
the tables, the categories were collapsed to two levels: English and Other (includes Spanish and other); the
"unknown" category is not shown.
Usual primary care provider—People are considered to have a
usual primary care provider if they have a usual source of care not located in
a hospital emergency room, to which they go for new health problems;
preventive health care such as general checkups, examinations, and
immunizaions; and referrals to other professionals when needed.
composite measure (adults and children)—People who had a doctor's office or clinic visit
in the last 12 months whose health providers listened carefully, explained
things clearly, showed respect for what they had to say, and spent enough time
with them. For adults (children) who had a doctor's office or clinic visit in the last 12 months, percent distribution of how often the response categories of Always,
Usually, and Sometimes or Never were selected for the four CAHPS questions
asking about health providers: (1) listening carefully; (2) explaining things
clearly; (3) showing respect for what they had to say; and (4) spending enough
time with them. For example, if a person
had responded "Always" for each of the four questions, the composite measure
would be 100% for Always, 0% for Usually, and 0% for Sometimes or
Never. If a person did not complete all
four questions, the percentage estimates were weighted by the percentage of
the four questions that they completed.
Adults age 65 and over who
received potentially inappropriate prescription medications in the calendar
medications received includes all prescribed medications initially purchased or
otherwise obtained during the calendar year, as well as any refills. Inappropriate medications are defined by the
implementation of the Beers criteria in MEPS.1
According to this definintion, the 11 drugs that should always be avoided for
older patients include barbiturates, flurazepam, meprobamate, chlorpropamide,
meperidine, pentazocine, trimethobenzamide, bellodonna alkaloids, dicyclomine,
hyoscyamine, and propantheline. The 22
drugs that should often be avoided for older patients include carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, amitriptyline, chlordiazepoxide, diazepam, doxepin, indomethacin, dipyridamole, ticlopidine, methyldopa, reserpine, disopyramide, oxybutynin, chlorpheniramine, cyproheptadine, diphenhydramine, hydroxyzine, promethazine, and propoxyphene.
Adult disability status as
measured by activity limitations—For the 2010 NHQR and NHDR, adults
with disability are defined to be those with physical, sensory, and/or mental
health conditions that can be associated with a decrease in functioning in such
day-to-day activities as bathing, walking, doing everyday chores, and/or
engaging in work or social activities. Two measures are used in displaying disability data for adults. The first measure, limitations in
basic activities, represents problems with mobility and other basic
functioning at the person level. The second measure, limitations in complex
activities, represents limitations encountered when the person, in
interaction with his or her environment, attempts to participate in community
life. Basic activities include mobility; self-care (activities of daily living); domestic life (instrumental activities of daily living); and activities
dependent on sensory functioning (limited to people who are blind or
deaf). Complex activities include
experiences in work; and in community, social, and civic
life. These two categories are not mutually exclusive; people may
have limitations in basic activities and in complex activities.
The residual category neither includes adults with neither basic nor complex
Financial burden of health care costs and
underinsurance—Financial burden of health care costs and underinsurance are defined for
people under age 65. Financial burden of
health care costs is defined when a person's family level out-of-pocket health
insurance premiums and medical expenditures are greater than 10 percent of
total family income. Underinsurance is
defined for people with private insurance when a person's family level out-of-pocket
medical expenditures (excluding premiums) are greater than 10 percent of total
The following family
level variables are defined for these measures:
Family. The definition of family is based on the
MEPS health insurance eligibility unit (HIEU), which includes all members of the
family who would typically be covered under a private insurance family plan. HIEUs include adults, their spouses, and
their unmarried natural/adoptive children under age 18 and
children under age 24 who are full-time students.
include families in which at least one person is under age 65. Elderly families
in which all persons are age 65 years or above are not included in this
In these cases, family-level expenditures include the expenditures for
the elderly person as well.
Out-of-pocket expenditures on health care
Out-of-pocket expenses include all out-of-pocket payments for
deductibles, coinsurance, copayments, and payments for any noncovered services
and supplies. Using the HIEU definition of family unit, we add out-of-pocket expenditures
on health care services across all members of the family to calculate
family-level out-of-pocket expenditures on health care
Out-of-pocket expenditures on health
insurance premiums. MEPS collects out-of-pocket expenditures on
premiums for private health insurance from household respondents. We add private out-of-pocket premium costs and
(imputed) Medicare Part B premiums across all health insurance policies
covering family members. For example, if
there are two single policies covering the two adults of a childless couple
unit, we add these together. Premiums are prorated to account for the number of
months of coverage during the year. For
employer-sponsored group coverage, employer contributions toward premiums are
not included in this analysis.
Person-level insurance status. Individual health
insurance status is defined hierarchically for the categories
- Private, employer sponsored: people who had at
least 1 month of employer-sponsored insurance and no uninsured months in
- Private, nongroup: people who had least 1 month of nongroup private insurance and no uninsured months in 2007.
- Public only: people who had public insurance
only for all available months in MEPS during 2007.
- Part-year uninsured: people whose number of
uninsured months is less than the number of available months in MEPS during 2007.
- Full-year uninsured: people whose number of uninsured
months is equal to the number of available months in MEPS during 2007.
Total family income. Total family income is the sum of person-level pretax total
income, refund income, and sales income.
Round-specific variables—For analytic variables asked at specific
rounds, age and other population characteristics variables were also defined
using the round-specific variables. In
some cases, missing values were replaced with the value from the closest prior
Standard errors of the estimates
were provided to permit an assessment of sampling variability. All
estimates and standard errors were derived using SUDAAN statistical software, which accounts for the complex survey design of MEPS.
All estimated proportions and
ratios are weighted to reflect the experiences of the U.S. civilian noninstitutionalized
population at the aggregate and subpopulation levels. Person-level weights, specific to the SAQ and DCS, were used to weight measures derived with data from these supplements. For other person-level measures, including those from the Child
Health and Preventive Care section, the overall person-level weight
Tables containing estimates from
MEPS are included in the Data Tables appendix. Consistent with the established
criteria for data reporting in the NHDR and NHQR, MEPS estimates are suppressed
when they are based on sample sizes of fewer than 100, or when their relative
standard errors are 30% or more. In the tables, the cell value of these
estimates is replaced with the notation DSU (data statistically unreliable). Records in which analytic variables have
missing values were excluded for analysis.
1. Zhan C,
Sangl J, Bierman AS, et al. Potentially inappropriate
medication use in the community-dwelling elderly: findings from the 1996
Medical Expenditure Panel survey. JAMA 2001 Dec 12;286(22):2823-29.
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