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National Healthcare Disparities Report, 2007

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Medicare Current Beneficiary Survey (MCBS)

Overview

The Medicare Current Beneficiary Survey (MCBS) is conducted by the Office of Strategic Planning of the Centers for Medicare & Medicaid Services (CMS). It is a continuous, multipurpose survey of a nationally representative sample of the Medicare population, providing information on aged and disabled Medicare beneficiaries living in communities and long-term care facilities. The sample is selected from Medicare enrollment files, and sample persons are interviewed three times per year over a 4-year period. Sample data are collected through computer-assisted personal interviews of the beneficiary or a proxy respondent if the sample person is not available for the interview. Survey questionnaires are tailored to the residence of the sample person—community or long-term care facility. If the sample person moves from one setting to the other during the period covered by an interview, a separate interview is administered for the time spent in each setting. Thus, beneficiaries are followed continuously over time regardless of where they live.

The primary goal of the survey is to collect comprehensive information on all medical services used by Medicare beneficiaries, sources of payment, health insurance coverage, and socioeconomic and demographic characteristics of the population. These data are used by the Office of Strategic Planning and the Office of the Actuary to support a host of activities related to the administration of the Medicare program (health insurance for older and disabled people) and the Medicaid program (Federal grants to States for medical assistance programs). CMS also uses the data to evaluate the Medicare and Medicaid programs and to assess the financial impact of programmatic change on beneficiaries and the Medicare trust fund.

Two public use files (PUFs) are created for each calendar year of data collected in the MCBS: Access to Care and Cost and Use. The Access to Care PUFs provide "snapshot" estimates of the characteristics of the Medicare population who were enrolled on January 1 and were still alive and eligible for the survey in the fall of each year. They contain information on access to and satisfaction with care, health status and functioning, and demographic and economic characteristics of the sample population. Access to Care PUFs also contain summarized utilization and program payment data from Medicare claims, but they do not include survey-reported information on health care use and expenditures. By omitting the survey-reported information, these PUFs can be produced quicker than cost and use files, which contain complete information on the cost and use of health care services.

The 2003 Cost and Use file is the 12th in an annual series of files containing comprehensive data on the cost and use of medical services by the Medicare population. It links Medicare claims to survey-reported events and provides complete data on expenditure and source of payment for all health care services, including those not covered by Medicare. Expenditure data were developed through a reconciliation process that combines information from survey respondents and Medicare administrative files. The process produces a comprehensive picture of health services received, amounts paid, and sources of payment. The file can support a broader range of research and policy analyses on the Medicare population than would be possible using either survey data or administrative claims data alone.

The strength of the Cost and Use file stems from the integration of information that can be obtained only from a beneficiary and Medicare claims data on provider services and covered charges. Survey-reported data include information on the use and cost of all types of medical services, as well as information on supplementary health insurance, living arrangements, income, health status, and physical functioning. Medicare claims data include use and cost information on inpatient hospitalizations, outpatient hospital care, physician services, home health care, durable medical equipment, skilled nursing home services, hospice care, and other medical services.

For more information about the 2003 MCBS data, go to "2003 Appendix A: Technical Documentation for The Medicare Current Beneficiary Survey, Health & Health Care of the Medicare Population: 2003," available at http://www.cms.hhs.gov/MCBS.

Files Used for the NHDR

MCBS data for the 2007 National Healthcare Disparities Report (NHDR) are primarily drawn from the Cost and Use file for the data year 2003. The Cost and Use file was chosen over the Access to Care file as the primary source of data on Medicare beneficiaries for three reasons. First, it contains a nationally representative sample of all Medicare beneficiaries rather than just the always enrolled population. Second, it has information on health care expenditures not included in the Access to Care files (e.g., noncovered services such as dental and vision care and prescribed medicines). Third, information on beneficiary income is complete and continuous for each sample person in the Cost and Use file, as opposed to incomplete and categorical in the Access to Care file.

MCBS Table Notes

Tables Used in the 2007 NHDR

The 2007 NHDR tables include five MCBS tables for full-year community residents age 65 and over (H_AGE ≥65 and TYPE = "C").

Measure number Measure title Source variable
264

Medicare beneficiaries age 65 and over who had an eye examination in the past year

EDOCEXAM
265

Female Medicare beneficiaries age 65 and over who had a mammogram in the past year

MAMMOGRM
266

Medicare beneficiaries age 65 and over who had an influenza vaccination in the past year

FLUSHOT
267

Medicare beneficiaries age 65 and over with delayed care due to cost

HCDELAY
268

Medicare beneficiaries age 65 and over who received dental care

DUAEVNTS

Measure 267 shows the percentage of persons who reported that in the year preceding the interview they delayed seeking care because they were worried about the cost. The source variable "HCDELAY" is from the Access to Care file. Source variables for other measures are from the Cost and Use file. For all five measures, the denominator excludes persons with missing values.

MCBS Sample for NHDR

The sample size and weighted sample size used to generate statistics for the 2007 NHDR are given in the following table. Because the denominator excludes records with missing values, the sample size varies slightly among tables.

Sample Population Residents age 65 and older
Sample size Weighted size
Total   9,462 33,946,647
Gender Male 4,145 14,741,052
Female 5,317 19,205,595
Age 65 to 74 4,243 17,813,579
75 to 84 3,718 12,323,494
85 and older 1,501 3,809,574

Newly enrolled sample persons from Rounds 37 and 40 are colloquially referred to as "ghosts" because they did not become eligible for Medicare in time to be selected as part of the sample that received all three 2003 interviews. Utilization data for ghosts are included in the 2003 Cost and Use file at the type-of-service and person summary levels, even though they were not interviewed until late 2003 (Round 37) if they were new Medicare enrollees in late 2002, or late 2004 (Round 40) if they were new Medicare enrollees in 2003. While survey data on service use and costs were not available for ghosts, complete profiles of Medicare-covered service use by fee-for-service ghosts were available from administrative bill files. To estimate total service use and costs for the entire sample, ghosts were matched to donor beneficiaries in the 2003 file based on common Medicare use profiles. The donor records were used to impute noncovered services for fee-for-service ghosts and all services for Medicare-risk HMO ghosts. This imputation process provided estimates of missing cost and use data for the ever-enrolled population in the 2003 Cost and Use summary files.

Contrast (Column) Variables

MCBS tables were created with standardized column headings for race, ethnicity, and poverty status. The MCBS race and ethnicity variables are coded from beneficiary responses to the survey questions, and the categories are recorded as interpreted by the respondent. Race categories include American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, White, more than one race, or other race. Ethnicity categories include total non-Hispanic, all races; non-Hispanic White; non-Hispanic Black; and Hispanic. Hispanics include persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

Poverty status categories were created for sample persons in the survey based on their reported or imputed income from all sources. Each person was assigned to a poverty status category by using U.S. Bureau of the Census data on poverty thresholds for 2002, by size of family and number of related children under age 18. The constructed variables are based on the assumption that unmarried beneficiaries were one-person families and married beneficiaries were two-person families.

Other (Row) Variables

Age—Three age categories were developed for the NHDR tables on older community residents: 65 to 74, 75 to 84, and 85 and over.

Gender—Gender is recorded as reported on the Medicare/Social Security administrative record for the sample person.

Insurance coverage—Insurance coverage in the MCBS is based on a combination of Medicare and Medicaid administrative data and survey-reported information on public and private insurance.

The types of insurance identified in the MCBS include Medicare fee-for-service, Medicare managed care, Medicaid, private employer-sponsored, private individually purchased (Medigap), private health maintenance organization (HMO), and other insurance. Summary versions of these variables were used to create four mutually exclusive groups of Medicare beneficiaries by prioritizing insurance coverage as follows:

  • Group 1 contains everyone who had Medicaid regardless of other coverage.
  • Group 2 contains persons in Medicare managed care plans regardless of other coverage.
  • Group 3 contains persons with private insurance (i.e., Medigap, employer-sponsored, or HMO).
  • Group 4 contains all remaining beneficiaries (i.e., Medicare fee-for-service beneficiaries who did not have Medicaid or private insurance).

Residence location—Sample persons are classified as living in a metropolitan or nonmetropolitan area based on their addresses in the Medicare administrative files.

Perceived health status—Each sample person in the MCBS is asked to compare his or her general health to other persons of the same age. Persons receiving a community interview answer the question themselves. If a sample person is not able to do so, the proxy for that person answers the question. The possible responses to the question include excellent, very good, good, fair, and poor. Persons reporting fair or poor health are shown in the NHDR tables.

Functional limitations—Sample persons are identified as having functional limitations through their responses to six sets of questions about activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Sample persons are asked whether they have a health or physical problem that makes it difficult to perform any of the specified activities. If the response is yes, they are recorded as having a limitation in that particular activity. If the response is "doesn't do," they are asked whether it is because of a health or physical problem. Then, if the response to the followup question is "yes," they are recorded as having a limitation in that particular activity.

The ADLs are activities related to personal care; they include bathing or showering, dressing, eating, getting in or out of bed or a chair, walking, and toileting. The IADLs are activities related to independent living; they include using the telephone, doing light housework, doing heavy housework, preparing meals, shopping for personal items, and managing money. Any limitation reported by a sample person may have been temporary or chronic at the time of the interview.

Computation of Statistics and Standard Errors

The percentages in the tables are weighted, and standard errors are included in the tables in order to assess the impact of sampling variability on the accuracy of the estimates. They were estimated by using a software package (SUDAAN) that accounts for the impact of non-random sampling procedures on the precision of the weighted estimates.

If a cell had fewer than 30 observations or the relative standard error of the estimate was greater than 0.30, the value for that cell was suppressed. This rule was implemented to avoid reporting statistically unreliable estimates of the characteristics of older community residents.

Return to Appendix B: Detailed Methods

 

 

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