Medical Expenditure Panel Survey (MEPS)

2009 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Background

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 the U.S. 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 care expenditures.

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).

For more detailed information about MEPS and the information discussed here, refer to the documentation for the MEPS 2006 Full Year Consolidated Data File available at the MEPS Web site (http://meps.ahrq.gov).

Time Period

National health care estimates from MEPS for the 2009 NHQR and NHDR were derived from the 2006 MEPS HC survey, including the Self-Administered Questionnaire (SAQ), the Child Health and Preventive Care section, and the Diabetes Care Survey (DCS).

The SAQ was a supplement to the MEPS HC and was completed in late 2006 (Panel 10, Round 4, and Panel 11, 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® Health Survey and the EQ-5D™, a standardized instrument used as a measure of health outcomes.

The Child Health and Preventive Care section was part of the regular MEPS HC interview that, like the SAQ, took place in late 2006 (Panel 10, Round 4, and Panel 11, Round 2). 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 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.

Population Characteristics

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 age.

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/inforeg_statpolicy). 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—For the 2009 NHDR and NHQR, the 2006 NCHS Urban-Rural Classification Scheme for Counties was used. 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. Based on this scheme, the urban-rural categories used in the 2009 NHQR and NHDR are as follows:

  1. Large central metro ("central" counties of metropolitan areas of 1 million or more population).
  2. Large fringe metro ("fringe" counties of a metropolitan areas of 1 million or more population).
  3. Medium metro (counties in metropolitan areas of 250,000 to 999,999 population).
  4. Small metro (counties in metropolitan areas of 50,000 to 249,999 population).
  5. Micropolitan (counties with at least one urban cluster of at least 10,000 residents).
  6. 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.

For more information, visit http://www.cdc.gov/nchs/data_access/urban_rural.htm and http://www.ers.usda.gov/Briefing/Rurality/MicropolitanAreas/.

Employment status—MEPS 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.

Perceived health status—MEPS includes five-level round-specific categorical variables for perceived health status: excellent, very good, good, fair, and poor. �For the 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" (CSHCN42=3). For the tables, the "unknown" category is not shown.

Preferred language at home—For each 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.�

CAHPS® composite measure—This measure applies to adults and children who had a doctor's office or clinic visit in the last 12 months. It measures how often health providers listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them. The measure shows the 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 year—Prescription 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—The measure used in the 2009 NHQR and NHDR for MEPS is based on the work of an interagency work group that was instituted to provide a measure of disability as consistent and compatible as possible across all the datasets used for the reports. In the 2009 NHDR, the Adults With Disabilities section uses MEPS data. For the purpose of the 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. The committee recommended using paired measures in displaying disability data for adults to preserve the qualitative aspects of the data. 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, or ADLs); domestic life (instrumental ADLs, or IADLs); 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 activity limitations.

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 family income.

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.

Nonelderly families 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 analysis. Only 2.6 percent of nonelderly families include an elderly person.2 � In these cases, family-level expenditures include the expenditures for the elderly person as well.�

Out-of-pocket expenditures on health care services.� 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 services.

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. Results are reported by individual health insurance status, which is defined hierarchically for the categories below:

  • Private, employer sponsored: people who had at least 1 month of employer-sponsored insurance and no uninsured months in 2006.
  • Private, nongroup: people who had least 1 month of nongroup private insurance and no uninsured months in 2006.
  • Public only: people who had public insurance only for all available months in MEPS during 2006.
  • Part-year uninsured: people whose number of uninsured months is less than the number of available months in MEPS during 2006.
  • Full-year uninsured: people whose number of uninsured months is equal to the number of available months in MEPS during 2006.

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 round.

MEPS Estimates

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. For example, the SAQ person-level weight (SAQWT06F) was used for measures from the SAQ, and the diabetes person-level weight (DIABW06F) was used for measures from the DCS. For other person-level measures, including those from the Child Health and Preventive Care section, the overall person-level weight (PERWT06F) was used. �For the Child Health and Preventive Care measures, child population included children under age 18 years (0<=AGE42X<17) with a positive person-level weight who had been asked these questions during the latter half of 2006 (where PERWT06F>0 and PSTATS42 was not equal to 31 (deceased)).

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.

Additional Information

For further information, go to the MEPS Web site: http://meps.ahrq.gov.


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.

2. Bernard D, Banthin J. Family-level expenditures on health care and insurance premiums among the U.S. nonelderly populations, 2004. Research Findings No. 26. Rockville, MD: Agency for Healthcare Research and Quality; April 2007. Available at: http://meps.ahrq.gov/mepsweb/data_files/publications/rf26/rf26.pdf. Plugin Software Help

Current as of March 2010
Internet Citation: Medical Expenditure Panel Survey (MEPS): 2009 National Healthcare Quality and Disparities Reports. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr09/methods/MEPS.html