1. Medical Expenditure Panel Survey Karen Beauregard Steve Machlin Jeffrey Rhoades

2. Medical Expenditure Panel Survey SURVEY OVERVIEW

3. MEPS History 1977 National Medical Care Expenditure Survey 1977 National Medical Care Expenditure Survey 1987 National Medical Expenditure Survey 1987 National Medical Expenditure Survey 1996 Medical Expenditure Panel Survey 1996 Medical Expenditure Panel Survey

4. Medical Expenditure Panel Survey (MEPS) Annual Survey of 15,000 households: provides national estimates of health care use, expenditures, insurance coverage, sources of payment, access to care and health care quality Permits studies of: Distribution of expenditures and sources of payment Distribution of expenditures and sources of payment Role of demographics, family structure, insurance Role of demographics, family structure, insurance Expenditures for specific conditions Expenditures for specific conditions Trends over time Trends over time

5. MEPS Survey Components Household Component (HC) Household Component (HC) – Medical Provider Component (MPC) – Insurance Component (IC)– Link Sample Insurance Component (IC) – List Sample Insurance Component (IC) – List Sample

6. MEPS-Household Component (HC) Survey Design Sub-sample of household respondents from the previous year’s National Health Interview Survey (NHIS), sponsored by NCHS Sub-sample of household respondents from the previous year’s National Health Interview Survey (NHIS), sponsored by NCHS Representative of the civilian non- institutionalized population of the US Representative of the civilian non- institutionalized population of the US 5 in-person interviews (CAPI) over 2 ½ year period 5 in-person interviews (CAPI) over 2 ½ year period Person and family level data collected Person and family level data collected

7. Oversampling in MEPS Every year: Blacks and Hispanics – – Carryover from NHIS 1997: Selected subpopulations – – Functionally impaired adults – – Children with activity limitations – – Adults 18-64 predicted to have high medical expenditures – – Low income – – Adults with other impairments 2002 and beyond: – – Asians – – Low income – – Additional over sampling of blacks in 2004

8. MEPS-HC Sample Sizes Year HouseholdsPersons Year HouseholdsPersons 1996 9,400 23,500 199713,500 33,000 1998-200010,000 24,000 200113,500 32,000 2002+15,000 37,000

9. MEPS-HC Core Interview Content Demographics Demographics Charges and Payments Charges and Payments Health Status Health Status Conditions Conditions Utilization Utilization Employment Employment Health Insurance Health Insurance

11. MEPS Overlapping Panels (Panels 8 and 9) MEPS Household Component MEPS Panel 8 2003- 2004 Round 2Round 3Round 4Round 5 Round 1Round 2Round 3 MEPS Panel 9 2004-2005 1/1/20031/1/2004 Round 1 NHIS2002 NHIS2003 Round 4Round 5

12. MEPS-HC Purpose Estimates annual health care use and expenditures Estimates annual health care use and expenditures Supports distributional estimates Supports distributional estimates Tracks changes in insurance coverage and employment Tracks changes in insurance coverage and employment Longitudinal design; linkage to NHIS Longitudinal design; linkage to NHIS

13. MEPS-HC Utilization Data Hospital stays Hospital stays Other hospital care Other hospital care Office based physician care Office based physician care Other medical providers Other medical providers Dental services Dental services Home health Home health Prescribed medications Prescribed medications Medical equipment and supplies Medical equipment and supplies

14. MEPS- HC Periodic Supplements Access to care Access to care Satisfaction with health plans & providers Satisfaction with health plans & providers Health status Health status Income Income

15. New Supplements Adult SAQ Adult SAQ Preventive Care Preventive Care Enhanced Access to Care Section Enhanced Access to Care Section Children’s Health Supplement Children’s Health Supplement

16. Condition Supplements Priority Conditions Priority Conditions – Diabetes – Asthma – Hypertension – Ischemic Heart Disease – Arthritis – Stroke – COPD Diabetes Care SAQ (DCS) Diabetes Care SAQ (DCS)

17. MEPS-HC Caveats and Limitations Sample size limitations preclude some analyses Sample size limitations preclude some analyses Household respondents may not be able to report accurately certain types of information Household respondents may not be able to report accurately certain types of information – type of health plan – detailed event information – diagnoses – limited capacity to produce state level estimates

18. Types of MEPS-HC Files Full-year Files - calendar year data Full-year Files - calendar year data Point-in-time Files - snap shot first part of year Point-in-time Files - snap shot first part of year

19. Levels of MEPS-HC Public Use Files Person Level - detailed person information Person Level - detailed person information Event Level - detailed event level information Event Level - detailed event level information Condition Level - detailed condition information Condition Level - detailed condition information Job Level - detailed job information Job Level - detailed job information

20. Sub-national Analysis Supports state estimates: Direct state level estimates of cost, coverage and use for the largest states. Supports metro area estimates: Direct MSA level estimates of cost, coverage and use for the largest metropolitan areas.

21. Medical Expenditure Panel Survey DISSEMINATION OF INFORMATION AND DATA PRODUCTS

22. MEPS Web-site Redesign More User Friendly More User Friendly Additional Content Added Additional Content Added More Powerful Databases and Search Engines More Powerful Databases and Search Engines Upgraded to Meet Federal, HHS, and AHRQ Web Standards Upgraded to Meet Federal, HHS, and AHRQ Web Standards

23. Medical Expenditure Panel Survey Methods of Dissemination MEPS Website at www.meps.ahrq.gov MEPS Website at www.meps.ahrq.gov MEPS e-mail address - MEPSPD@ahrq.gov MEPS e-mail address - MEPSPD@ahrq.gov MEPSPD@ahrq.gov AHRQ clearinghouse 800-358-9295 AHRQ clearinghouse 800-358-9295 – for CD-ROMs and print publications

25. MEPS Website www.meps.ahrq.gov Overview of MEPS and Frequently Asked Questions (FAQs) Overview of MEPS and Frequently Asked Questions (FAQs) Staff Reports using MEPS Staff Reports using MEPS Findings/Statistical Briefs/Chart books Findings/Statistical Briefs/Chart books Data Tables of Estimates Data Tables of Estimates Public Use Files (microdata) Public Use Files (microdata) MEPSnet Interactive Query Tool MEPSnet Interactive Query Tool Survey Methodology Reports Survey Methodology Reports Survey Questionnaires and Other Collection Materials Survey Questionnaires and Other Collection Materials Data product availability and ordering information Data product availability and ordering information MEPS data workshop information and schedule MEPS data workshop information and schedule Mailing list and List server Mailing list and List server Data Center Information Data Center Information

26. Data User Workshops Hands-on Workshops planned for May and September in Rockville, MD Hands-on Workshops planned for May and September in Rockville, MD Information will be posted on Workshops and Events section of web site Information will be posted on Workshops and Events section of web site For inquiries please e-mail: Workshop06@ahrq.hhs.gov For inquiries please e-mail: Workshop06@ahrq.hhs.gov Workshop06@ahrq.hhs.gov

27. MEPS Mailing List/List Server Mailing List/List Server Mailing List/List Server Click on “Mail List/List Server” from Web site Click on “Mail List/List Server” from Web site Both receive e-mail notices of data and publications released on the Web Both receive e-mail notices of data and publications released on the Web List Server allows for interactive exchange of ideas and information List Server allows for interactive exchange of ideas and information

28. Micro Data Files Public Use Files (Microdata) – Available for downloading from web site (Household survey only) Public Use Files (Microdata) – Available for downloading from web site (Household survey only) Restricted Access Files (Microdata) Restricted Access Files (Microdata) – MEPS-HC – Available for Use at AHRQ Data Center – MEPS-IC – Available for Use at Census Research Data Centers For more information go to www.ces.census.gov

29. Recent Data Releases Recent Data Releases 2004 Utilization and Quality of Care 2004 Utilization and Quality of Care – (new variables include K6 and PH2 mental health assessment tools) 2004 Jobs File 2004 Jobs File 1996-2001 Risk Adjustment File 1996-2001 Risk Adjustment File Link to 2003 NHIS File Link to 2003 NHIS File

30. Recent Data Releases Recent Data Releases 2005 First Part of Year File 2005 First Part of Year File 2004 Event Files 2004 Event Files 1996-2004 Pooling File 1996-2004 Pooling File

31. Upcoming Data Releases 2004 Consolidated File (Use and Expenditures)-November 2004 Consolidated File (Use and Expenditures)-November 2004 Condition file -November 2004 Condition file -November 2002-2004 Risk adjustment File - December 2002-2004 Risk adjustment File - December

32. AHRQ Data Center (ADC) Provides researchers access to non- public use MEPS data (except directly identifiable information); Provides researchers access to non- public use MEPS data (except directly identifiable information); Mode of data analysis Mode of data analysis – on secure LAN at AHRQ - Rockville, Maryland – task order agreement with data contractor – combinations of both

33. ADC Procedures Researcher may bring data in, but not out Researcher may bring data in, but not out Researcher has access only to data needed for approved project Researcher has access only to data needed for approved project All tabular data will be reviewed for confidentiality before release from Center All tabular data will be reviewed for confidentiality before release from Center Only approved tables can leave the Center Only approved tables can leave the Center Center will store data files, foreign merge files, and all outputs needed for replication Center will store data files, foreign merge files, and all outputs needed for replication

34. ADC Facilities Secure room Secure room Terminal connected to secure LAN Terminal connected to secure LAN SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS software available, and others upon request SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS software available, and others upon request Limited staff support by people who know: Limited staff support by people who know: – the data – the confidentiality issues – the software

35. ADC Application And Review Process Application procedures are on the MEPS web site Application procedures are on the MEPS web site Submit proposal to data center coordinator Submit proposal to data center coordinator Review within 1 week for feasibility, and data availability Review within 1 week for feasibility, and data availability Institutional Review Board (IRB) review required Institutional Review Board (IRB) review required

36. ADC Fees User fee of $150.00 for approved projects to cover technical assistance, simple file construction, and/or up 2 hours of programming support from data contractor User fee of $150.00 for approved projects to cover technical assistance, simple file construction, and/or up 2 hours of programming support from data contractor Additional programming support available from an AHRQ contractor at a cost of $80.00/hr Additional programming support available from an AHRQ contractor at a cost of $80.00/hr User fee waived for full-time students User fee waived for full-time students

37. ADC Limited Remote Access Once you have an established data center project, and have worked on site to develop and debug programs, jobs may be submitted to our Data Center Supervisor to run. Out-put will be reviewed for confidentiality and mailed to you. Once you have an established data center project, and have worked on site to develop and debug programs, jobs may be submitted to our Data Center Supervisor to run. Out-put will be reviewed for confidentiality and mailed to you.

38. Confidential Data Available for ADC Projects Linked MEPS-HC and Secondary Data (full geo-coding for 1996, 1997 and 2000-2004, FIPS codes for other years) Linked MEPS-HC and Secondary Data (full geo-coding for 1996, 1997 and 2000-2004, FIPS codes for other years) Selected Medical Provider Component Data Selected Medical Provider Component Data Selected State and MSA identifiers and estimation variables Selected State and MSA identifiers and estimation variables – 29 largest states and 10 largest MSA’s

39. Confidential Data Available for Data Projects in ADC Fully specified industry/occupation codes Fully specified industry/occupation codes Fully specified condition codes Fully specified condition codes Continuous poverty measure Continuous poverty measure Linked MEPS Household Component (HC) and Insurance Component (IC) data ( 96-98, 2001-excluding federal workers ) Linked MEPS Household Component (HC) and Insurance Component (IC) data ( 96-98, 2001-excluding federal workers )