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Performance Budget Submission for Congressional Justification

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FY 2005: Medical Expenditure Panel Survey (MEPS)

Contents

Data Development Portfolio
Funding Summary, MEPS
Funding History
Rationale for the FY 2005 Request

Data Development Portfolio

MEPS is the only national source for annual data on how Americans use and pay for medical care. It supports all of AHRQ's research related strategic goal areas. The survey collects detailed information from families on access, use, expense, insurance coverage and quality. Data are disseminated to the public through printed and Web-based tabulations, micro data files and research reports/journal articles.

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.

Government and non-governmental entities rely 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 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.

Survey Components

Household Component (HC) of MEPS

The HC collects data on approximately 15,000 families and 39,000 individuals across the Nation, drawn from a nationally representative sub-sample of households that participated in the prior year's National Center for Health Statistic's National Health Interview Survey.

The objective is to produce annual estimates for a variety of measures of health status, health insurance coverage, health care use and expenditures, and sources of payment for health services. These data are particularly important because statisticians and researchers use them to generalize to people in the civilian non-institutionalized population of the United States as well as to conduct research in which the family is the unit of analysis.

The panel design of the survey, which features several rounds of interviewing covering two full calendar years, makes it possible to determine how changes in respondents' health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related. Because the data are comparable to those from earlier medical expenditure surveys, it is possible to analyze long-term trends.

Medical Provider Component (MPC) of MEPS

The MPC covers approximately 4,000 hospitals, nearly 22,000 physicians, and 700 home health care providers, and 9,000 pharmacies. Its purpose is to supplement information received from respondents to the MEPS HC. The MPC also collects additional information that can be used to estimate the expenses of people enrolled in health maintenance organizations and other types of managed care plans.

Insurance Component (IC) of MEPS

The IC consists of two sub-components, the household sample and the list sample. The household sample collects detailed information on the health insurance held by and offered to respondents to the MEPS HC. The number of employers and union officials interviewed varies from year to year as the number of respondents in the previous year's HC varies. These data, when linked back to the original household respondent, allow for the analysis of individual behavior and choices made with respect to health care use and spending.

The list sample consists of a sample of approximately 40,000 business establishments and governments throughout the United States. From this survey, national, regional, and state-level estimates, for approximately 40 states each year, can be made of the amount, types, and costs of health insurance available to Americans through their workplace.

Accomplishments

The first MEPS data (from 1996) became available in April 1997, and key findings are summarized in Table 16. 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. During the last few years, AHRQ has developed a series of Statistical Briefs using MEPS data. These briefs, released on the MEPS Web site, provide timely statistical estimates on topics of current interest to policymakers, medical practitioners and the public at large. During 2003, topics included smoking, asthma treatment, trends in antibiotic use among children, expenditures, and insurance. For illustrative purposes, some findings are also presented in this section. Future plans include the preparation of statistical briefs on prescribed medication use, obesity and continuing our briefs on the costs and characteristics of employer sponsored health insurance from the IC component.

National Survey Detail Americans' Experiences with Asthma Treatment and Medications

More than 25 million Americans have been told by a physician or other health care provider that they have asthma, according to data collected in 2000 by MEPS. In the 12 months prior to their interview, 6.5 million adults and 3.2 million children had an asthma attack. Asthma is a chronic lung disease caused by inflammation of the lower airways and obstruction of airflow, and asthma attacks can vary from mild to life-threatening. For details, select Figures 4 and 5 (20 KB).

Trends in Antibiotic Use Among U.S. Children Aged 0 to 4 Years, 1996-2000

The majority of outpatient antibiotics in the United States are prescribed for respiratory tract infections, such as otitis media, bronchitis, and sinusitis, which are common ailments of young children. It is not surprising, therefore, that rates of antibiotic drug use are higher for young children than for any other age group and that trends in antibiotic use among young children are a major public health concern. For details, select Figure 6 (8 KB).

  • The proportion of children aged 0 to 4 years that used at least one antibiotic during the year decreased from 47.9 percent in 1996 to 38.1 percent in 2000.
  • The average number of antibiotic prescriptions decreased from 1.42 prescriptions per child in 1996 to 0.78 prescriptions per child in 2000.
  • The average expenditure for antibiotics decreased from $31.45 per child in 1996 (in CPI-adjusted 2000 U.S. dollars) to $21.04 per child in 2000.
  • Aggregate expenditures for antibiotics accounted for 53.8 percent of total drug spending by children in 1996 but accounted for 42.9 percent in 2000.
Performance Goals

Select to access Table 17 for performance goals of the Data Development Portfolio.

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Funding Summary, MEPS

  FY 2003 Actual FY 2004 Enacted FY 2005 Request Increase or Decrease

Total

   Budget Authority

   PHS Evaluation Funds

 

$0

($53,300,000)

 

$0

($55,300,000)

 

$0

($55,300,000)

 

$0

+(0)

Full-Time Equivalents NA NA NA NA

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Funding History

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

Year Budget 
Authority
PHS
Evaluation Funds
Total
2001 Actual $40,850,000 $40,850,000
2002 Actual $48,500,000 $48,500,000
2003 Actual $53,300,000 $53,300,000
2004 Enacted $53,300,000 $53,300,000
2005 Request $53,300,000 $53,300,000

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Rationale for the FY 2005 Request

The FY 2005 request for MEPS totals $55,300,000 in PHS evaluation funds, maintaining the level provided in the FY 2004 enacted level. These funds will be used to 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 is maintained at 15,000 households in 2005 with full calendar year information. These sample size specifications for the MEPS permit more focused analyses of the quality of care received by special populations due to significant improvements in the precision of survey estimates. This design, in concert with the survey enhancements initiated in prior years, 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 also 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. The request also covers cost of living increases to maintain enhancements made to the MEPS Insurance Component list sample, both in terms of sample size and improvements in the collection of information from employers about health insurance offerings and costs for their employees.

The funds for MEPS in FY 2005 will also help maintain the usability and timeliness of MEPS data through several activities. Work would continue on the implementation of improvements to the MEPS computer assisted interview programs (CAPI) for the Household instrument. These CAPI modifications are essential to support improvements in the timeliness, content, and quality of data, especially those data elements that are required for the National Healthcare Quality Report and the National Healthcare Disparities Report. 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 list sample of the MEPS Insurance Component to improve the availability of data to the States. The IC consists of two sub-components, the household sample and the list sample. In FY 2005, the MEPS Insurance Component employer survey linked to the household sample will not be conducted. In prior years, the data obtained, when linked back to the original household respondent, allow for the analysis of individual behavior and choices made with respect to health care use and spending.

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