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Performance Budget Submission for Congressional Justification

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Fiscal Year 2004: Medical Expenditure Panel Survey (MEPS)

Contents

Purpose and Method of Operation
Overview
Achievements
Funding Summary
Funding History
Rationale for the FY 2004 Request

Purpose and Method of Operation

The objectives of AHRQ's MEPS are to provide public and private sector decisionmakers with the ability to:

  • Obtain timely national estimates of health care use and expenditures, private and public health insurance coverage, and the availability, costs and scope of private health insurance benefits among the U.S. population.
  • Analyze changes in behavior as a result of market forces or policy changes (and the interaction of both) on health care use, expenditures, and insurance coverage.
  • Obtain information on access to medical care, quality and satisfaction for the US population and for those with specific conditions, and for important sub-populations and related to health care disparities.
  • Develop cost and savings estimates of proposed changes in policy.
  • Identify the impact of changes in policy for key subgroups of the population (i.e., who benefits and who pays more).

These objectives are accomplished through the fielding of MEPS. MEPS is an interrelated series of surveys that replaces the National Medical Expenditure Survey (NMES). MEPS not only updates information that was last collected more than a decade ago in FY 1987, but also provides more timely health care expenditure data and new information on the quality of care received, at a lower cost per year of data, through the move to an ongoing data collection effort.

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Overview

MEPS collects detailed information regarding the use and payment for health care services from a nationally representative sample of Americans. Since 1977, AHRQ's expenditure surveys have been an important and unique resource for public and private sector decisionmakers. No other surveys supported by the Federal Government or the private sector provide this level of detail regarding:

  • The health care services used by Americans at the household level and their associated expenditures (for families and individuals).
  • The cost, scope, and breadth of private health insurance coverage held by and available to the U.S. population.
  • The specific services purchased through out-of-pocket and/or third-party payments.

AHRQ fields a new MEPS panel each year. Two calendar years of information are collected from each household in a series of five rounds of data collection over a 2½ year period. These data are then linked with additional information collected from the respondents' medical providers and employers. This series of data collection activities is repeated each year on a new sample of households, resulting in overlapping panels of survey data.

The data from earlier surveys (1977 and 1987) have quickly become a linchpin for the Nation's economic models and their projections of health care expenditures and utilization. This level of detail enables public and private sector economic models to develop national and regional estimates of the impact of changes in financing, coverage, and reimbursement policy, as well as estimates of who benefits and who bears the cost of a change in policy. No other surveys provide the foundation for estimating the impact of changes on different economic groups or special populations of interest, such as the poor, elderly, veterans, the uninsured, or racial/ethnic groups.

The public sector (e.g., Office of Management and Budget, Congressional Budget Office [CBO], Medicare Payment Advisory Commission [MedPAC], and Treasury Department), relies upon these data to evaluate health reform policies, the effect of tax code changes on health expenditures and tax revenue, and proposed changes in government health programs such as Medicare.

In the private sector (e.g., RAND, Heritage Foundation, Lewin-VHI, and the Urban Institute), these data are used by many private businesses, foundations and academic institutions to develop economic projections. These data represent a major resource for the health services research community at large.

Since 2000, data on premium costs from the MEPS Insurance Component have been used by the Bureau of Economic Analysis to produce estimates of the Gross Domestic Product (GDP) for the nation. In addition, the MEPS establishment surveys have been coordinated with the National Compensation Survey conducted by the Bureau of Labor Statistics through participation in the Inter-Departmental Work Group on Establishment Health Insurance Surveys.

Based on the Department's Survey Integration Plan, MEPS linked its household survey and NCHS' National Health Interview Survey (NHIS), achieving savings in sample frame development and enhancements in analytic capacity. MEPS has also moved from a survey every 10 years to following a cohort of families on an ongoing basis. Doing so has four primary benefits:

  1. It decreases the cost per year of data collected.
  2. It provides more timely data on a continuous basis.
  3. It creates for the first time the ability to assess changes over time.
  4. It permits the correlation of these data with the National Health Accounts.

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Achievements

The first MEPS data (from 1996) became available in April 1997 (select for key findings). This rich data source has become not only more comprehensive and timely, but MEPS' new design has enhanced analytic capacities, allowed for longitudinal analyses, and developed greater statistical power and efficiency.

New MEPS Supplements Detail Americans' Experiences with Health Care Services

A new questionnaire incorporated into MEPS, beginning in 2000, indicates that among those aged 18 to 64, people without insurance were more likely than those with coverage to report sometimes or never receiving urgent care as soon as they wanted (28.6 percent, uninsured; 19.1 percent, publicly insured; and 16.1 percent, privately insured). MEPS collects information yearly on health care use, access, health status and quality from a nationally representative sample of the U.S. civilian non-institutionalized population (2000: 24,000 individuals and 10,000 households; 2002: 39,000 Individuals and 15,000 households).

The questions were taken from the AHRQ's CAHPS®, a research-based, validated survey tool that assesses people's experiences with their own health plans. Respondents were asked about the timeliness in which they received urgent and routine medical care and they also were asked about their experiences during care. These measures will be included in the National Healthcare Quality Report (NHQR), first due out in 2003, which will provide information to policymakers, providers and consumers to monitor the nation's progress toward improved health care quality.

In addition, slightly more than half of Americans age 18 and older (53.8 percent) who do not live in institutions or serve in the military always received urgent medical care as soon as they wanted it in calendar year 2000. While there was very little difference between blacks and whites aged 18 to 64 in their reports of timeliness of receiving urgent care, 51.5 percent and 52.9 percent respectively, only 41.2 percent of Hispanics reported always receiving urgent care when they wanted it.

The detailed findings include:

  • In 2000, 72.3 percent (145.4 million) of the U.S. population aged 18 and older visited a doctor or medical clinic in the 12 months prior to the survey. Of that total, 82.6 percent reported no problems receiving the care they or their doctor believed was necessary; 89.8 percent said their health care providers always or usually listened carefully to them; and 84 percent said their health providers always or usually spent enough time with them.
  • Among those receiving care, blacks (64.4 percent) were more likely than whites (58.6 percent) or Hispanics (53.1 percent) to say their providers always explained things so they understood.
  • Fewer than half of all those surveyed (43 percent) said they always received an appointment at a clinic or doctor's office as soon as they wanted. But people age 65 and older (54.7 percent) were more likely to say they always obtained an appointment as soon as they wanted.
  • A majority of patients who visited a doctor's office at least one time in the previous 12 months reported that health providers always treated them with respect (58.4 percent, always; 31.8 percent, usually; and 9.8 percent sometimes or never). People aged 65 and older were more likely than adults under 65 to report being treated with respect.
  • Among those age 18-64, those with private insurance (84.5 percent) were more likely to say it was no problem getting needed care than were those with only public coverage (71.5 percent) and the uninsured (72.9 percent).

Select for Figure (11 KB).

A new questionnaire incorporated into MEPS beginning in 2000, covering children's experiences with health care access, indicates that parents of publicly insured and uninsured children under age 18 (20.4 percent and 15.8 percent, respectively) were more likely to report having a problem receiving necessary care during a doctor's office or clinic visit than were parents of privately insured (7.9 percent) children. The questions also were taken from the AHRQ's CAHPS® and will be included in the National Healthcare Quality Report.

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Funding Summary

  2002
Actual
FY 2003
President's
Budget
2004
Request
Increase or
Decrease
Total
Budget Authority $0 $0 $0 $0
PHS Evaluation Funds ($48,500,000) ($53,300,000) ($53,300,000) (2,000,000)
Full-Time Equivalents NA NA NA NA

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Funding History

Funding for the MEPS program during the last 5 years has been as follows:

  Budget
Authority
PHS
Evaluation Funds
Total
1999 Actual $29,300,000 $29,300,000
2000 Actual $36,000,000 $36,000,000
2001 Actual $40,850,000 $40,850,000
2002 Actual $48,500,000 $48,500,000
2003 President's budget $53,300,000 $53,300,000
2004 Request $53,300,000 $53,300,000

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Rationale for the FY 2003 Request

The FY 2004 request for the MEPS totals $55,300,000 in PHS evaluation funds, an increase of $2,000,000 over the FY 2003 President's budget. The $2.0 million in additional funds for MEPS in FY 2004 will be used to improve the usability and timeliness of MEPS data through several activities. Work would begin on re-CAPIing the MEPS Household instrument to support improvements in the timeliness and quality of data, especially those data elements that are required for the NQR and NDR. Improvements in the timeliness of data development activities associated with the production of MEPS public use tapes will be implemented. Funds will also be allocated to the MEPS Insurance Component to improve the availability of data to the States. Each year, estimates on employer sponsored health insurance are available for 40 States (all States over a 3-year period) and these funds would be used to enhance the tabulations we provide to the States to support their analysis of private, employer sponsored health insurance.

The FY 2004 request for MEPS will maintain enhancements to the sample size and content of the MEPS Household and Medical Provider Surveys necessary to satisfy the congressional mandate to submit an annual report on national trends in health care quality and to prepare an annual report on health care disparities. The MEPS Household Component sample size increase was maintained at 15,000 households in 2004 with full calendar year information. The funding in FY 2004 reflects the second full calendar year of data collection at the 15,000 household level. The funding in FY 2004 also maintains the increase in the sample size of the MEPS Medical Provider Survey that is associated with MEPS Household Sample.

This sample size specification for the MEPS implemented in 2002 permits more focused analyses of the quality of care received by special populations due to significant improvements in the precision of survey estimates. This modification in concert with the sample enhancements initiated in 2001 significantly enhances AHRQ's capacity to report on the quality of care Americans receive at the national and regional level, in terms of clinical quality, patient satisfaction, access, and health status both in managed care and fee-for-service settings. These funds will permit the continuation of an oversample in MEPS of Asian and Pacific Islanders and individuals with incomes <200 percent of the poverty level in MEPS. These enhancements, in concert with the existing MEPS capacity to examine differences in the cost, quality and access to care for minorities, ethnic groups and low income individuals, will provide critical data for the National Healthcare Quality Report and the National Healthcare Disparities Report.

In FY 2004, data collection will be ongoing for the MEPS Household Survey, the MEPS Medical Provider Survey, and the MEPS Insurance Component, which consists of a sample of establishments linked to the MEPS Household sample and a separate national employer health insurance survey. More specifically, in-person interviews will be conducted with 15,000 families to obtain calendar year 2004 health care data. The Medical Provider Survey will consist of interviews with more than 4,000 facilities, 22,000 office-based providers, 11,000 hospital-identified physicians, 800 home health providers and 9,000 pharmacies. In addition, the MEPS Insurance Component will consist of interviews with more than 40,000 employers.

The request also maintains enhancements made to the MEPS Insurance Component both in terms of sample size and improvements in the collection of information from employers about health insurance offerings and costs for their employees. It will also maintain adopted enhancements for the subset of the MEPS IC associated with the MEPS household sample to permit more detailed analyses for population subgroups that include Asian and Pacific Islanders and individuals with incomes <200 percent of the poverty level.

A PART assessment was conducted for this program (along with HCUP and CAHPS®) and helped inform the FY 2004 budget policy. Select for a summary of the PART assessment.

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