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National Healthcare Disparities Report, 2004

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Medical Expenditure Panel Survey (MEPS)

Background

The Medical Expenditure Panel Survey (MEPS) is designed to provide nationally representative estimates of healthcare use, expenditures, sources of payment, and insurance coverage for the U.S. civilian non-institutionalized population. MEPS is cosponsored by the Agency for Healthcare Research and Quality (AHRQ) (formerly the Agency for Health Care Policy and Research (AHCPR)) 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 non-institutionalized population, collects medical expenditure data at both the person and household levels. The HC collects detailed data on demographic characteristics, health conditions, health status, 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 - year period. Using computer-assisted personal interviewing (CAPI) technology, data on medical expenditures and use for two 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 NHIS, conducted by NCHS. The NHIS provides a nationally representative sample of the U.S. civilian non-institutionalized population, with oversampling of Hispanics and blacks.

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Time period

National healthcare estimates from MEPS for the 2004 NHDR were derived primarily from the 2001 MEPS HC survey, including the Self-Administered Questionnaire (SAQ), the Child Health and Preventive Care section, and another self-administered survey about diabetes care.

The 2001 SAQ was a supplement to the MEPS HC and was completed in late 2001 and early 2002. It included: Health care quality measures taken from the health plan version of CAHPS®, 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 was part of the regular MEPS HC interview that took place during the later half of 2001. It included: health care quality measures taken from the health plan version of CAHPS®; the Children with Special Health Care Needs 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. The CAHPS® questions and the Children with Special Health Care Needs Screener questions had been in a Parent-Administered Questionnaire in 2000. The CAHPS® questions and the Children with Special Health Care Needs Screener may produce slightly different estimates in 2001 than in 2000 due to the change in mode from a self-administered parent questionnaire in 2000 to an interviewer administered questionnaire in 2001.

A third supplement to the MEPS HC was a self-administered questionnaire given out to persons identified with diabetes concerning the care they received in the treatment of their diabetes.

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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, and proximity to metropolitan areas. A brief description of how each of these population characteristics was defined is provided below.

Age -- For general measures, age was defined as a person's age on December 31, 2001. Age subpopulations were identified as 1) 0-17 years, 2) 18-44 years, 3) 45-64 years, and 4) 65+ years.

For SAQ and Child supplemental measures , age at panel 5 round 4 or panel 6 round 2 was used without the "back-filling". It was also used for constructing health insurance coverage and education status variables.

Gender -- Male and Female.

Race/Ethnicity -- MEPS classifies persons into one of five race categories: 1) White, 2) Black, 3) Asian/Pacific Islander, 4) Aleut, Eskimo or 5) American Indian. Ethnicity is determined to be either Hispanic or non-Hispanic. The race groups include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. For analytic and reporting purposes race was reduced to a four-level variable by collapsing Aleut, Eskimo and American Indian into one group. This was done primarily to pool their small sample sizes and increase the likelihood that reliable estimates could be obtained, thereby allowing these minority populations to be included in the report. 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" or "Non-Hispanic, Black". Estimates for persons of other racial/ethnic origins (e.g., Hispanic White, Hispanic Black, Non-Hispanic other, Hispanic other, etc.) are not presented in the report.

In 2001, MEPS had not yet transitioned to the most recent OMB standards issued in 1997 for collecting racial and ethnic data which allows respondents to identify more than one race/ethnic group. Federal data systems are required to comply with the 1997 standards by 2003. These standards have been implemented in MEPS as of 2002. Future reporting of MEPS racial and ethnic data will reflect these changes when the data become available.

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 are combined. This results in a four-level categorical variable of poverty status: 1) negative or poor (household incomes below the Federal poverty line), 2) near poor/low income (over the poverty line to just below 200 percent of the poverty line), 3) middle income (200 percent to just below 400 percent of the poverty line, and 4) high income (over 400 percent of the poverty line).

Education -- In MEPS, a person's educational attainment is indicated as the number of completed years of education. For the NHDR, this continuous measure was grouped into three categories. 1) less than high school (persons with less than 12 completed years of education), 2) high school graduate (persons with exactly 12 completed years of education), and 3) at least some college (persons with greater than 12 completed years of education). This variable was constructed only for persons 18 years of age or older and any measure presented for the education subpopulations includes only persons in this age cohort.

Insurance Coverage -- The insurance coverage variable was constructed in a hierarchical manner and in relation to a person's age. For persons less than 65 years of age, those who were uninsured the entire year were classified as uninsured; those who had private coverage any time during the year (including CHAMPUS/VA) were classified as having had private insurance; and persons who had only public coverage (i.e., no private) any time during the year were classified as public only. Persons over 65 years of age were categorized as having Medicare only, Medicare and private, or Medicare and other public assistance. A negligible number of persons (n<50) were identified as having no Medicare and no other private or public assistance. These people were not included in insurance related analyses.

Residence Location -- A variable was constructed by combining the 12 levels of the 2003 Urban Influence Codes to 5 levels, 1) Metropolitan-large: in a metro area with at least 1 million residents; 2) Metropolitan-small: in a metro area with fewer than 1 million residents; 3) Micropolitan: adjacent to a large metro area, small metro area, or not adjacent to a metro area; 4) Noncore-Adjacent: noncore, adjacent to a large or a small metro area, or adjacent to a micro area and contains a town of 2,500- 9,999 residents; 5), Noncore-Rural: noncore, adjacent to a micro area and does not contain a town of at least 2,500 residents, or not adjacent to a metro/micro area. For measures with subpopulations, such as diabetes measures, level 4 and 5 were combined as "Noncore" to increase the possibility that reliable estimates could be obtained.

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Healthcare Measures

In analyzing data from the MEPS HC one needs to use the appropriate person-level weight to reflect the experiences of the U.S. civilian non-institutional population. For example for the 2001 MEPS, the SAQ person-level weight is used for measures from the SAQ, and the diabetes person-level weight is used for measures from the diabetes care survey. For other person-level measures including those from the Child Health and Preventive Care section, the overall person-level weight is used. For measures from the Child Health and Preventive Care section, one needs to subset to the 9,235 sample children with a positive person-level weight and who had been asked these questions during the later half of 2001 (where PERWT01F>0 and LSHLTH42 is not equal to -1). To obtain estimates at the family-level, it is necessary to prepare a family-level file containing one record per family and containing family-level summary characteristics, and to use the MEPS family-level weight. Standard errors of the estimates are provided to permit an assessment of the 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 non-institutionalized population at the aggregate and subpopulation levels. Specific weight was used for specific survey. For example, the SAQ weight was used for measures with a SAQ analytical variable, diabetes weight was used for diabetes measures, and family weight was used for family measures. The final person weight was used for other measures, including the children measures, for which the PAQ weight was used in 2003 NHDR. Standard errors of the point estimates are also provided to permit an assessment of the sampling variability. All point estimates and standard errors were derived using SUDAAN statistical software which account for the complex survey design of the MEPS data.

Tables containing estimates from MEPS are compiled in Appendix D: Data Tables. Consistent with the established criteria for data reporting in the NHDR, MEPS estimates are suppressed when they are based on sample sizes of less than 100, or when their relative standard errors are 30% or more. In the tables, these data are replaced with symbols to indicate that data are statistically unreliables.

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Additional Information

For further information, see The Medical Expenditure Panel Survey. A new national health information resource. AHRQ Publication No. 00-P050, May 2000. Agency for Healthcare Research and Quality, Rockville, Maryland. Information also available at the MEPS website: http://www.meps.ahrq.gov

 

 

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