AHRQ Data Resources to Inform Health Policy Research: The Medical Expenditures Panel Survey (MEPS) Slide Presentation from the AHRQ 2010 Annual ConferenceSlide presentation from the AHRQ 2010 conference. On September 29, 2010, Jeffrey Rhoades made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (3.8 MB). Free PowerPoint® Viewer (Plugin Software Help).Slide 1AHRQ 2010 Annual ConferenceAHRQ Data Resources to Inform Health Policy Research: The Medical Expenditures Panel Survey (MEPS)Jeffrey Rhoades, Ph.D.Slide 2Medical Expenditure Panel SurveyMEPS OverviewSlide 3MEPS OverviewHistory & PurposeSurvey Components & DesignSampleCore ContentSupplemental CAPI sections & QuestionnairesPublic Use FilesDissemination of DataSlide 4MEPS History1977 National Medical Care Expenditure Survey1987 National Medical Expenditure Survey1996 Medical Expenditure Panel SurveySlide 5MEPS-HC Purpose & UsesEstimates and tracks annual health care use, expenditures and insurance coverage.Provides estimates of expenditures and sources of payment by selected demographic variables.Used for policy-related and behavioral research on the determinants of health care use, spending, and insurance coverage.Used in microsimulation models to analyze alternative health care delivery proposals.Slide 6MEPS Survey ComponentsMEPS-HC—Household ComponentMEPS-MPC—Medical Provider ComponentMEPS-IC—Insurance ComponentSlide 7MEPS-HC Survey DesignSub-sample of respondents from the previous year's National Health Interview Survey (NHIS).Representative of the civilian non-institutionalized population of the US.Five in-person interviews over 2 1/2 year period using Computer Assisted Personal Interview (CAPI).Interviews average 90 minutes with a range of one to four hours.Slide 8 Oversampling in MEPS Panels 7-14 (2002-2009)Carryover from NHIS: BlacksHispanicsAsians (panels 12-14 after 2006 NHIS redesign)Additional MEPS Oversampling: AsiansLow income (panels 7-13)Blacks (panels 9-11, 13-14)Hispanics (panels 13-14)Slide 9MEPS Panel Design: Data Reference PeriodsImage: A graph showing Panel 10, Panel 11, Panel 12, and Panel 13 is shown. The vertical axis shows the years 2006, 2007, and 2008. Each year is broken down by Q1, Q2, Q3, and Q4. The sample size for 2006 is 32,577, 2007 is 29,370, and 2008 is 31, 262.N is equal to the number of people with a positive person weight on the file.Slide 10MEPS-HC Sample SizesYearFamiliesPersons19968,65521,571199713,08732,63619989,02322,95319999,34523,56520009,51523,839200112,85232,122200214,82837,418200312,86032,681200413,01832,737200512,81032,320200612,81132,577200711,61529,370200812,95731,262Slide 11MEPS-HC Core Interview ContentDemographicsCharges and PaymentsHealth StatusConditionsUtilizationEmploymentHealth InsuranceSlide 12MEPS-HC Supplemental CAPI SectionsSections asked in rounds 2 and 4:Access to care.Child preventive health.Satisfaction with health plans & providers.Sections asked in rounds 3 and 5:Assets (round 5 only).Income.Preventive Care.Slide 13MEPS-HC Supplemental Paper QuestionnairesDiabetes Care Survey (DCS) Given once a year to each person identified as having diabetes.Includes questions about diabetes related tests and managing diabetes.Adult Self-Administered Questionnaire (SAQ) Given once a year to each adult 18 years old and older.Focuses on self-reported information such as opinions about health care issues and quality of care measures, assessment of own health, and height/weight.Slide 14MEPS-HC Caveats and LimitationsSample size limitations preclude some analyses.Typically, one respondent provides data for the entire household.Household respondents may not be able to report accurately certain types of information: Type of health plan.Detailed event information.Diagnoses.Slide 15MEPS Public Use FilesSlide 16Levels of MEPS-HC Public Use FilesPerson Level—detailed person informationEvent Level—detailed event informationCondition Level—detailed condition informationJob Level—detailed job informationSlide 17Types of MEPS-HC FilesFull-year Files—Contain expenditure and utilization data for the calendar year from several rounds of data collection. Full Year Consolidated Data FileEvent FileMedical Conditions FileJobs FilePerson Round Plan Public Use FilePoint-in-time Files—Data for the beginning of the year providing early glimpses of what full-year estimates will likely be.MEPS/NHIS Link Files—Cross-walk files that allow merging of Household Component files and NHIS files.Slide 18Details on MEPS PUFsDocumentation Files: Contain general information about MEPS.Contain survey information specific to each file.Contain variable-source crosswalk to link back to questionnaire items.File Codebooks: Contains names and location of all variables.List both weighted and unweighted estimates.Data files and related documentation are available for downloading on MEPS Web site: www.meps.ahrq.gov/mepsWebSlide 19 Medical Expenditure Panel SurveyDissemination of Information and Data ProductsSlide 20Image: A screen shot of AHRQ's Medical Expenditure Panel Survey home page.Slide 21MEPS Web SiteMaterials on the MEPS Web site: Questionnaires Core and SupplementalSummary data tables: Expenditures by Health Care ServiceExpenditures by Medical ConditionHealth InsuranceQuality of CarePrescription DrugsState-Level Medical ExpendituresAccess to CareInteractive MEPS query tool—MEPSnetPublications: Statistical BriefsMethodology ReportsResearch FindingsSlide 22Data User WorkshopsInformation will be posted on Workshops and Events section of Web site.For inquiries please e-mail: Workshopinfo@ahrq.hhs.gov.Slide 23 MEPS PublicationsStatistical Briefs: Easy-to-read, concise graphical summaries of MEPS data.Research Findings and Highlights: Tables and summaries of descriptive statistics.Methodology Reports: Detailed information on MEPS sample design and survey methods.Chartbooks: Policy-sensitive topics in an accessible question-and-answer format.Working Papers: Preliminary analyses of methodological and technical issues by AHRQ staff.Research in Action: Analyses using research results from AHRQ-sponsored studies, including MEPS data.Slide 24AHRQ Data Center (ADC)Provides researchers access to non-public use MEPS data (except directly identifiable information).Location of data analysis: On secure LAN at AHRQCensus Remote Data Center (RDC)Slide 25ADC Application And ProceduresApplication procedures are on the MEPS Web site.Submit proposal to Data Center coordinator.Review within 2 weeks for feasibility, and data availability.Institutional Review Board (IRB) review required.Slide 26ADC FeesUser fee of $300 for approved projects to cover technical assistance, simple file construction, and/or up to 4 hours of programming support from data contractor.Additional programming support available from an AHRQ contractor at a cost of $105.00/hr.User fee waived for full-time students.No fee if you use a RDC.Slide 27ADC GuidelinesResearcher may bring data in, but not out.Researcher has access only to data needed for approved project.All tabular data will be reviewed for confidentiality before release from Center.Only approved tables can leave the Center.Center will store data files, foreign merge files, and all outputs needed for replication.Slide 28Medical Expenditure Panel SurveyMedical Conditions DataSlide 29MEPS Condition RosterOne roster per person.Cumulates medical conditions reported across MEPS interviews.Interviewer records verbatim responses to questions in the following 3 sections: Condition EnumerationMedical EventsDisabilitySlide 30Condition Enumeration QuestionWe're interested in learning about health problems that may have bothered (Person) {since (Start Date)/between (Start Date) and (End Date)}. Health problems include physical conditions, accidents, or injuries that affect any part of the body as well as mental or emotional health conditions, such as feeling sad, blue, or anxious about something.Slide 31Medical Events Condition QuestionsWhat conditions were discovered or led (Person) to make this visit? Probe: Any other condition? If Condition is Already Listed, Ask: Is this the same (Name of Condition) that we have already talked about before? Types of visits InpatientOutpatientEmergency RoomOffice BasedHome HealthConditions associated with Prescribed Medicine purchases: What health problem is (Medicine) prescribed for?Probe: Any other health problems?Slide 32Disability Days Condition QuestionsMissed school or work: What are the health problems that caused (Person) to miss work/school on those days? Probe: Any other health problems?Bed days: What are the health problems that caused (Person) to spend half day or more in bed on those days? Probe: Any other health problems?Slide 33Reporting and Recording ConditionsRespondents may report having the same condition more than once: Interviewer probes whether occurrence of condition already reported.Each unique episode of a condition recorded only once Person may have multiple colds in year.Each cold has separate record.Slide 34Accidents and Injury QuestionsFollowing items asked if relevant to reported condition: Date of accidentPlace (work, home, school, etc.)Cause (gun, vehicle, fall, fire, etc.)Whether or not the person has recovered from the injurySlide 35Medical Conditions File StructureEach record represents unique condition or procedure for a person.Persons may be represented on file once, several times or not at all.Can be linked to person and event files for analysis.Slide 36Condition Coding and EditingFully specified ICD-9 CM codes (up to 5 digits).ICD-9 condition codes collapsed to 3 digits to maintain confidentiality.Approximately 10% of condition codes are collapsed further by combining 2 or more 3-digit codes.Slide 37Procedure Coding and EditingOnly obtained from Medical Events Questions.Fully specified ICD-9 CM codes (up to 4 digits): Collapsed to 2-digit codes .Approximately 3% collapsed further by combining 2 or more 2-digit codes.Slide 38 Clinical Classification Codes (CCC)ICD-9 codes aggregated into broad clinically meaningful categories.Edited to preserve confidentiality.Crosswalk included in documentation.Formerly Clinical Classification for Health Policy Research (CCHPR).Slide 39Condition-Event Link FilesUsed to link conditions to: Persons on person files All reported conditions or just those associated with eventsEvents on event files: Most conditions associated with events already included on event filesSeparate link file for prescribed medicines.Slide 40National Estimates of ConditionsMost appropriate to estimate "treated prevalence" MEPS Web site summary data tables on Expenditures by Medical Condition .Condition more likely to be underreported if: Respondent/person not aware.Not salient or bothersome.No medical care received.Slide 41Condition Data Limitations/CaveatsHousehold-reported: One respondent usually providing information for all household members.Many recorded text strings not easily classifiable into ICD-9 codes.Limited information on procedures.Not suitable for prevalence estimates.More salient conditions tend to be better reported.Slide 42Priority Conditions SectionSeparate section of questionnaire.Series of questions asking if "ever" had condition: "yes/no" responses, no ICD9 coding .Responses not directly linked to conditions roster.Factors used in determining priority conditions: Prevalence.Expenditures.Policy relevance.Slide 43Priority Conditions List (Panel 12 and beyond)Heart diseaseHeart attackAnginaHigh cholesterolCancerStrokeHigh blood pressureDiabetesAsthmaArthritis/Joint painEmphysemaChronic bronchitisAttention deficit disorderSlide 44Priority Condition Section RevisionsRevised section in Panel 12: Priority Conditions Enumeration (PE) section replaced PC section in prior panels.Primary differences between PE and PC: Questions asked all rounds rather than 3/5 only.PE section substantially earlier in CAPI.Follow-up question on cancer remission added.Age of diagnosis collected for more conditions.Revisions may increase reporting of conditions and associated medical events.Slide 45Medical Expenditure Panel SurveyHealth Care Utilization And Expenditures DataSlide 46Health Care UtilizationMEPS household respondents asked to report all health care use for family members during reference period.Utilization is called an "event" in MEPS.Event type categories: Office-Based Medical Provider Visits (OB)Hospital Inpatient Stays (IP)Outpatient Department Visits (OP)Emergency Room Visits (ER)Dental Visits (DN)Prescription Medicine Purchases (RX)Home Health Care (HH)Other Medical Expenses (OM)Slide 47Health Care ExpendituresCollected at the event level.Represent payments to providers of the health care.Payments are reported by source (e.g., out-of-pocket, private insurance, public program).Total expenditure is sum of payments across all sources of payment.Slide 48Source of Payment Categories in CAPISelf or familyMedicareMedicaid/SCHIPPrivate insuranceVATRICAREOther federal gov't.State or local gov't.Worker's compOther insuranceSlide 49Sources of Expenditure DataExpenditures derived from two survey components: Medical Provider Component (MPC)Household Component (HC)MPC data used when available.HC data used when no MPC data available.Events with no MPC or HC data on expenditures are imputed: Results in no missing values.Slide 50Sources of Expenditure Data by Event TypeEvent typeHCMPCOB: PhysicianyesyesOB: Non-PhysicianyesnoIP/OP/ER (hospital events)yesyesDNyesnoRXno*yesHH: AgencynoyesHH: Paid independentyesnoOMyesno* Except for self-filers.Slide 51Annual Utilization and Expenditure DataAnnual data cumulated across approx 2 1/2 rounds of data collection.Event level files: Separate by type of service.Unique record for each reported event Some persons have no events.Some persons have multiple events.Person-level file (full year consolidated): Variables derived from event levelSlide 52Event Level File Record UnitsEvent TypeRecord UnitOBvisitOPvisitERvisitIPstayDNvisitHHmonthRXoriginal script or refillSlide 53Event File Expenditure Variables: OB, DN and OM12 expenditure by source of payment variables.A total expenditure variable: Sum of 12 source of payment variables.A total charge variable: Provider's charge before adjustment or discount.Slide 54Hospital Event Files Expenditure Variables: IP, OP, and ERFacility Expenditure Variables: 12 expenditure by source of payment variables.A total facility expenditure variable.A total facility charge variable.Separately Billing Doctor Expenditure (SBD) Variables: 12 SBD expenditure by source of payment variables.A total SBD expenditure variable.A total SBD charge variable.Total Expenditures for the event: Sum of facility and SBD expendituresTotal charges for the event: Sum of facility and SBD chargesSlide 55Common Variables in Event FilesPerson/event IDDate(s) of care (not RX)Services/proceduresType of provider (not RX,ER,IP)Expenditure variablesFull year person weightVariance estimation variablesImputation flagSlide 56Event Files: Medical ConditionsIP: Up to 4 per eventOB, OP, ER & RX: Up to 3 per eventHH: Need to obtain from condition fileDN & OME: No medical conditions.Slide 57IP variablesHave operation?Stay begin with ER visit?Number of nights in hospital.Reason for stay (5 broad reasons).Stay related to specific condition (yes or no); if yes, provide condition(s).VA facility?Slide 58Diagnostic Tests/Services Received During OB, OP, or ER VisitLaboratory testsSonogram/ UltrasoundX-rayMammogramMRI/CAT SCANEKG/ECGEEGVaccinationSurgeryAnesthesiaOther tests or examsSlide 59Main Medical Provider OB and OP VisitsSpecialty if a physician: 33 specialties plus "other".Type of provider if not a physician: 17 types plus "other".Slide 60Category of Care Received During an OB or OP VisitGeneral checkupDiagnosis or treatmentEmergencyWell child examFollow-up or post-op visitPsychotherapy or mental health counselingMaternity careImmunizations or shotsLaser eye surgerySlide 61Treatments During an OB or OP VisitPhysical therapyOccupational therapySpeech therapyChemotherapyRadiation therapyKidney dialysisIV therapyTreatment for drug or alcoholReceived allergy shotPsychotherapy or counselingSlide 62Prescribed Medicines (PMED) Event FileEach record represents an original RX script or refill: Includes diabetic supply/equipment and insulin purchasesContains drug characteristic and expenditure variablesSlide 63PMED File Expenditure VariablesSource: Nearly all MPC (pharmacy) data.Some source of payment information collected from households filing their own insurance claims.Variables: 12 expenditure by source of payment.Total expenditure variable.No total charge variable.Slide 64Variables in the PMED FileHousehold Component (HC) variables collected in each round: Medicine nameNumber of times purchasedUsed to treat a conditionDate first usedPharmacy informationNames of free samplesWho files prescribed drug insurance claimsSlide 65Drug characteristicsDrug characteristics included for each prescribed medicine event: Medication nameNational drug code (NDC)Quantity dispensed (e.g., 50)Form (e.g., suspension)Strength (e.g., 10)Unit of measurement of form (e.g., cc) and strength (e.g., mg)Brand/generic designation (from Multum Lexicon)Therapeutic class, sub-class, and sub sub-class (from Multum Lexicon)Pregnancy category (from Multum Lexicon)Slide 66Home Health (HH) Event FileThree broad categories: Agency care (including hospitals and nursing homes).Paid independent providers.Informal providers (e.g., family and friends).Each record in file represents monthly aggregate for specific type of careSlide 67HH File Expenditure VariablesAgency care: 12 expenditure by source of payment variables.A total expenditure variable.A total charge variable.Paid independent providers: Same expenditure variables as Agency care.Informal care: No expenditure variables.Slide 68Home Health VariablesType of worker(s) provided: Agency care onlyType of careAmount of care: (frequency and length of visits).Slide 69Dental Event File Type of Provider SeenGeneral dentistDental HygienistDental TechnicianDental SurgeonOrthodontistEndodontistPeriodontistOtherSlide 70Dental Services and ProceduresDiagnostic or preventativeRestorative or endodonticPeriodontic (gum treatment)Oral surgeryProstheticsOrthodonticsOther proceduresSlide 71Other Medical Expenditures FileType (Omtypex)Record UnitGlasses or contactsroundAmbulance servicesannualOrthopedic itemsannualHearing devicesannualProsthesisannualBathroom aidsannualMedical equipmentannualDisposable suppliesannualAlterations/modificationsannualOtherannualSlide 72Flat FeesWhat is a Flat Fee? Fixed dollar amount paid for a group of health care services.Common examples: orthodontic, prenatal care.Flat Fee ID: FFEEIDX.Flat fee structure (FFevTYPE) Stem—Initial medical visit—expendituresLeaf—subsequent medical visits—zero expendituresSlide 73Zero Dollar EventsReasons for $0 total expenditures: Flat fee leaf event from prior year .Follow-up visit without extra charge.Free care.Bad debt.Slide 74Annual Person-Level File with Expenditure DataFull Year Consolidated File: One record for each person in MEPS.Summary of all events and expenditures Appendix 1 of documentation contains naming conventions for use and expenditure variables.No detail on expenditures or characteristics of individual events.Slide 75Medical Expenditure Panel SurveyHealth Insurance DataSlide 76Health Insurance Public Use Files, 2007-2008MEPS HC-117:2009 P13R3/P14R1, Point-in-Time Population CharacteristicsMEPS HC-115:2008 Full Year Population Characteristics Data FileMEPS HC-111:2007 Person Round Plan Public Use FileSlide 772009 Point-in-Time Public Health Insurance VariablesTRINW31X COV BY TRICARE AT INTERVIEW—EDITEDMCARE31X COV BY MEDICARE—EDITEDMCAID31X COV BY MEDICAID—EDITEDOTPUBA31 COV BY/PAYS OTH GOV MCAID HMOOTPUBB31 COV BY OTH PUBLIC NOT MCAID HMOSTPRG31 COV BY STATE SPECIFIC PROGRAMPUB31X COV BY PUBLIC INS—EDITEDSlide 782009 Point-in-Time Private Health Insurance VariablesPRIEU31 COV BY PRIV EMPL/UNION PLANPRIDK31 COV BY PRIV DK PLANPRING31 COV BY NONGROUP PLANPRIOG31 COV BY OTH GROUP PLANPRIS31 COV BY SELF-EMP-1 INSPRIOUT31COV BY HOLDER OUTSIDE RUPRIV31 COV BY PRIVATE INSINSRD31X INSURED—EDITEDSlide 79 2009 Point-in-Time Policy Holder Insurance VariablesHPRIEU31 HOLDER OF PRIV EMPL/UNION PLANHPRIDK31 HOLDER OF PRIV DK PLANHPRING31 HOLDER OF NONGROUP PLANHPRIOG31 HOLDER OF OTH GROUP PLANHPRIS31 HOLDER OF SELF-EMP-1 INSHPRIV31 HOLDER OF PRIV INS PLANSlide 80 2008 Full Year Population Characteristics Data File Public InsuranceMonth by month indicatorsTRIJA08X-TRIDE08X—TRICAREMCRJA08X-MCRDE08X—MedicareMCDJA08X-MCDDE08X—Medicaid/SCHIPOPAJA08-OPADE08—managed care, other public insuranceOPBJA08-OPBDE08—not managed care, other public insuranceSTAJA08-STADE08—state-specific program participationPUBJA08X-PUBDE08X—indicates public insurance in monthSlide 812008 Full Year Population Characteristics Data File Private InsuranceMonth by month indicatorsPEGJA08-PEGDE08—employer/union group insurancePNGJA08-PNGDE08—non-group private insurancePOGJA08-POGDE08—other group private insurancePDKJA08-PDKDE08—don't know source of insurancePOUJA08-POUDE08—policy holder is outside the householdPRSJA08-PRSDE08—self-employed with firm size of 1PRIJA08-PRIDE08—indicates private insurance in monthPolicy Holders (repeat of Private) "H"Slide 822008 Full Year Population Characteristics Data File Summary VariablesMonth by month indicatorsPUBJA08X-PUBDE08X—indicates public insurance in monthPRIJA08-PRIDE08—indicates private insurance in monthINSJA08X-INSDE08X—indicates any insurance in monthSlide 832008 Full Year Population Characteristics Data File Summary Variables (continued)UNINS08—uninsured all of 08INSCOV08—health insurance indicator 08: 1 = Any Private during 20082 = Public Only during 20083 = Uninsured all of 2008Slide 842008 Full Year Population Characteristics Data File Managed CarePublic insuranceMedicare Managed Care PlanMedicaid or SCHIP HMOMedicaid/SCHIP Gatekeeper PlansSlide 85 2008 Full Year Population Characteristics Data File Managed CarePrivate insurancePrivate HMOsPrivate HMO Plans that Pay for Visits to Non-Plan DoctorsPrivate Gatekeeper PlansPrivate Gatekeeper Plans that Pay for Visits to Non-Plan DoctorsPrivate Plan that has a Book or List of DoctorsPrivate Plan that has a Book or List of Doctors that Pays for Non-Plan VisitsSlide 862008 Full Year Population Characteristics Data File Ever Covered During the YearTRIEV08—by TRICAREMCREV08—by MedicareMCDEV08—by MedicaidOPAEV08—managed care, other public insuranceOPBEV08—not managed care, other public insurancePRVEV08—by private health insuranceSlide 872008 Full Year Population Characteristics Data File Medicare Part DMCRPD31X Medicare prescription drug benefit (Part D), Rounds 3 and 1MCRPD42X Medicare prescription drug benefit (Part D), Rounds 4 and 2MCRPD08X Medicare prescription drug benefit (Part D), end of yearSlide 882008 Full Year Population Characteristics Data FileDENTIN31/42/53—round specific variables: Covered by a private health insurance plan that included at least some dental coverage.PMEDIN31/42/53—round specific variables: Covered by a private health insurance plan that included at least some prescribed medicine coverage.Slide 89 Person Round Plan Public Use File (PRPL)Reflects complex and dynamic relationships between people and their private insurance.Contains records for persons with: Hospital/physician coverageMedigapDental, vision, or prescription medication coverageContains variables pertaining to managed care and satisfaction with plan.Out-of-pocket premiums (starting in 2001).Slide 90MEPS-IC SurveyNationwide, annual survey of both private and public sector establishments.Funded by the Agency for Healthcare Research and Quality (AHRQ).Conducted by the U.S. Census Bureau.Survey data available for 1996 through 2008 (not 2007).Slide 91Types of Information CollectedEstablishment-level (location) characteristics.Health insurance plan characteristics.Firm-level (company) characteristics.Slide 92 Slide 92. Establishment-level (Location) CharacteristicsEstablishment-level (Location) CharacteristicsNumber of active employees.Whether or not establishment offers health insurance.Number of plans offered.Number of employees eligible for health insurance and number enrolled (full-time and part-time employees separately).Workforce characteristics.Slide 93Health Insurance Plan CharacteristicsPremiums (single, employee-plus-one, family)ContributionsPlan types (by type of provider arrangement)Self-Insured / Fully-InsuredEnrollments (single, employee-plus-one, family coverage)Deductibles / CopaymentsSlide 94Firm (Company) CharacteristicsSizeIndustryAge of firmRetiree offeringsEmployee characteristicsSlide 95MEPS-IC Sample DesignPrivate establishments from the Census Bureau's Business Register: Approximately 42,000 establishments sampledState and local governments from the Census of Governments: Approximately 2,500 governmental units sampledSlide 96MEPS-IC Sample DesignAnnual estimates: NationalStateSome Metro areasData Census Bureau Confidential—Public Use Files not available.Methodology Reports available on MEPS Web site. Current as of December 2010 Internet Citation: AHRQ Data Resources to Inform Health Policy Research: The Medical Expenditures Panel Survey (MEPS): Slide Presentation from the AHRQ 2010 Annual Conference. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/rhoades/index.html