Medical Expenditure Panel Survey (MEPS)
2012 National Healthcare Quality and Disparities Reports: Detailed Methods Appendix
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 2 1/2-year period. Through the use of computer-assisted personal interviewing 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. 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 Hispanics.
For more detailed information about MEPS and the information discussed here, refer to documentation for the MEPS 2002-2009 Full Year Consolidated Data Files, available at http://www.meps.ahrq.gov.
National health care estimates from MEPS for the 2012 NHQR and NHDR were derived from the 2002-2009 MEPS HC survey, including the Self-Administered Questionnaire (SAQ), the Child Health and Preventive Care section, and the Diabetes Care Survey (DCS). Data were collected as indicated below:
- 2002: rounds 3, 4, and 5 of panel 6 and rounds 1, 2, and 3 of panel 7.
- 2003: rounds 3, 4, and 5 of panel 7 and rounds 1, 2, and 3 of panel 8.
- 2004: rounds 3, 4, and 5 of panel 8 and rounds 1, 2, and 3 of panel 9.
- 2005: rounds 3, 4, and 5 of panel 9 and rounds 1, 2, and 3 of panel 10.
- 2006: rounds 3, 4, and 5 of panel 10 and rounds 1, 2, and 3 of panel 11.
- 2007: rounds 3, 4, and 5 of panel 11 and rounds 1, 2, and 3 of panel 12.
- 2008: rounds 3, 4, and 5 of panel 12 and rounds 1, 2, and 3 of panel 13.
- 2009: rounds 3, 4, and 5 of panel 13 and rounds 1, 2, and 3 of panel 14.
The SAQ is a supplement to the MEPS HC that includes 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 is part of the regular MEPS HC interview. It includes 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, is a self-administered questionnaire given to people identified with diabetes. It questions respondents 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 include 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 or 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 ethnic data. The new standards allow respondents to identify more than one racial group (http://www.whitehouse.gov/omb/fedreg_1997standards/). For all tables, race is classified into five single race categories and a multiple-race category, as follows: (1) White, (2) Black, (3) Asian, (4) Native Hawaiian or Other Pacific Islander, (5) American Indian or Alaska Native, and (6) multiple races. Because of differences in the classification of race, racial estimates reported using MEPS data from 2002 and subsequent years is not directly comparable with estimates that use data prior to 2002.
Ethnicity—Ethnicity was designated as either Hispanic or non-Hispanic. People of Hispanic origin may be of any race. Estimates were derived for both Hispanic and non-Hispanic subpopulations. In addition, race was combined with ethnicity to enable estimation of data for categories that include 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. 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.
Education—Reporting of educational attainment is based on 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) any 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—Insurance coverage was constructed in a hierarchical manner and in relation to a person's age. For the population under age 65, 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 "private insurance"; and those who had only public coverage (i.e., no private) at any time during the year were classified as "public only." The population age 65 and over was classified as "Medicare only," "Medicare and private," or "Medicare and other public assistance." A small number of people age 65 and over were found to only have private insurance or to be uninsured. This residual group is not shown in the tables.
Residence location—The 2012 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 Census 2000 and 2004 postcensal population estimates. Urban-rural categories used in the NHQR and NHDR follow:
- Large central metro ("central" counties of metropolitan area of 1 million or more population).
- Large fringe metro ("fringe" counties of a metropolitan area of 1 million or more population).
- Medium metro (counties in metropolitan areas of 250,000 to 999,999 population).
- Small metro (counties 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. 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. Employment was defined as adults who were (1) currently employed, (2) had a job to return to, or (3) had a job but did not work during the reference period.
Perceived health status—MEPS includes five-level round-specific categorical variables for perceived health status; these categories include "excellent," "very good," "good," "fair," and "poor." For purposes of analyzing data in the NHQR and NHDR, these five levels were collapsed into two: (1) excellent, very good, or good; and (2) fair or 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 under the coordination of the Foundation for Accountability. Children whose "special health care needs" status could not be determined were coded as "unknown." Data for individuals classified as "unknown" are not reported.
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. These categories were collapsed into "English" and "Other."
Adult disability status as measured by activity limitations—The NHQR and NHDR define adults with disabilities as 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 activity limitations.
Round-specific variables—For analytic data collected during specific rounds, age and other population 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 were generated separately for 2002-2009. 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 2002-2009. The SAQ person-level weight for the year (SAQWTyyF) was used for measures from the SAQ for that year.
For tables created from the DCS, a "diabetes pseudo-weight" (DIABPSWF) was created and used for each year. Using 2008 DCS as example, DIABPSWF equals the diabetes weight (DIABW08F) when the diabetes weight is positive. When the diabetes weight is zero and the SAQ weight is positive, the DIABPSWF equals 1. The diabetes pseudo-weight is not defined for cases where the SAQ weight is zero. To obtain standard errors using the pseudo-weight, the complete data file was used and subset to those cases in which the original diabetes weight was positive.
For the Child Health and Preventive Care measures, the population included children under 18 (0<=AGE42X<17) with a positive person-level weight who had been asked these questions during the latter half of the year (e.g., in 2008 where PERWT08F>0 and PSTATS42 was not equal to 31 (deceased)).
Some measures were age adjusted to the 2000 U.S. standard population. Among the measures that are age adjusted are those pertaining to:
- Adults with obesity.
- Adult current smokers.
- People with office-based or outpatient department visits.
- People who received prescription medications.
- People with hospital emergency department visits.
- People who had hospital inpatient discharges.
Measures pertaining to children were not age adjusted. Table 1 lists measures that are age adjusted in the 2012 NHQR and NHDR and provides information about the age groups used for adjustment.
Table 1. Age-adjusted measures in the 2012 National Health Care Quality Report and National Health Care Disparities Report
|Measure||Measure Title||Age groups used in Adjustment (Years)|
|2_4_1_1||Composite measure: Adults age 40 and over with diagnosed diabetes who received all four recommended services for diabetes in the calendar year (two or more hemoglobin A1c measurements, dilated eye examination, foot examination, and flu shot)||40-59, 60+|
|2_4_1_2||Adults age 40 and over with diagnosed diabetes who received two or more hemoglobin A1c measurements in the calendar year||40-59, 60+|
|2_4_1_3||Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year||40-59, 60+|
|2_4_1_4||Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year||40-59, 60+|
|2_4_1_5||Adults age 40 and over with diagnosed diabetes who received an influenza vaccination in the last 12 months||40-59, 60+|
|2_9_3_1||People with current asthma who are now taking preventive medicine daily or almost daily (either oral or inhaler)||0-17, 18-44, 45-64, 65+|
|2_10_1_1||Adult current smokers with a checkup in the last 12 months who received advice to quit smoking||18-44, 45-64, 65+|
|2_10_1_4||Adults with obesity who ever received advice from a health provider to exercise more||18-44, 45-64, 65+|
|2_10_1_7||Adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods||18-44, 45-64, 65+|
|2_10_1_5||Adults with obesity who spend half an hour or more in moderate or vigorous physical activity at least three times a week||18-44, 45-64, 65+|
|9_2_1_1||People who had an office-based or outpatient department visit in the calendar year||0-17, 18-44, 45-64, 65-74, 75+|
|9_2_1_2||People who received a prescription medication in the calendar year||0-17, 18-44, 45-64, 65-74, 75+|
|9_2_1_4||People who had a hospital emergency room visit in the calendar year||0-17, 18-44, 45-64, 65-74, 75+|
|9_2_1_5||People who received a hospital inpatient discharge in the calendar year||0-17, 18-44, 45-64, 65-74, 75+|
Tables containing estimates from MEPS are included in the Data Tables Appendix. Consistent with the established criteria for data reporting in the NHQR and NHDR, 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. Records in which analytic variables have missing values were excluded for analysis.