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The following journal article and two in-house reports present findings from the Medical Expenditure Panel Survey (MEPS). MEPS is the third in a series of nationally representative surveys of medical care use and expenditures sponsored by the Agency for Health Care Policy and Research. MEPS is co-sponsored by the National Center for Health Statistics (NCHS). The first of these surveys, the National Medical Care Expenditure Survey (NMCES), was conducted in 1977, and the second, the National Medical Expenditure Survey (NMES), in 1987.

MEPS collects detailed information on health care use and expenses, sources of payment, and insurance coverage of individuals and families in the United States. The journal article and reports described below are available from AHCPR Publications Clearinghouse.

Changes in access to care, 1977-1996: The role of health insurance." (1999, April). Zuvekas, S.H., and Weinick, R.M. Health Services Research 34(1), supplement, pp. 271-279.

Declines in health insurance coverage were responsible for only one-fifth of the declines in access to health care services experienced by Hispanic Americans and young adults aged 18 to 24 between 1977 and 1996, according to this study. The authors conclude that simply increasing health insurance coverage will not be enough to eliminate these disparities.

Using data from NMCES, NMES, and MEPS, the authors looked at three groups (Hispanic Americans, young adults aged 18-24, and the uninsured) and their access to care, measured by whether they had a usual source of health care. In conducting this study, the authors specifically isolated the role of health insurance, which is widely believed to be the primary determinant of access to care, from other factors.

Hispanic Americans were affected both by declining rates of insurance and, for those who were uninsured, declining rates of access to care, as measured by usual source of care. The proportion of Hispanic Americans with a usual source of health care declined from 80.3 percent in 1977 to 70.4 percent in 1996. During this same period, in addition to declining rates of insurance and declining rates of access among the uninsured, young adults with insurance experienced declines in access. The percentage of young adults with a usual source of care declined from 78.6 percent to 66 percent. Overall, during this period, the percentage of all uninsured Americans with a usual source of care declined from 74.4 percent to 62 percent.

These declines resulted in growing gaps in access to care between these groups and other Americans over the last 20 years. The authors found that even if rates of health insurance had remained constant, these groups still would have experienced declines in access to care.

Reprints (AHCPR Publication No. 99-R054) are available from the AHCPR Publications Clearinghouse.

Special Care Units in Nursing Homes—Selected Characteristics, 1996. Research Findings No. 6. Freiman, M., and Brown, E.

This report summarizes information on special care units in nursing homes, with emphasis on Alzheimer's units. This information is drawn from the 1996 Nursing Home Component of MEPS. In 1996, almost a fifth (19.2 percent) of all nursing homes had at least one formal and distinct special care unit. These special care units contained 120,400 beds, or 6.9 percent of all nursing home beds. By far the largest category of special care units was for Alzheimer's and related dementias, which constituted 65.7 percent of all the special care units in nursing homes.

More than a tenth of nursing homes had an Alzheimer's unit. Hospital-based nursing homes were less likely to have special care units than other facility types. Special care units were more likely to be found in nursing homes that were part of a group or chain than in independent facilities. Nursing homes with special care units were more likely to be certified by both Medicare and Medicaid than facilities without a special care unit. Further, over half of nursing homes with special care units had 125 or more total nursing beds, whereas less than a fifth of homes without any special care units fell into this size range. Copies of this report (AHCPR Publication No. 99-0017) are available from the AHCPR Publications Clearinghouse.

Use of Health Care Services, 1996. MEPS Research Findings No. 7. Krauss, N.A., Machlin, S.S., and Kass, B.L.

This report presents estimates of health care use for the civilian noninstitutionalized population of the United States during calendar year 1996. Data are derived from the Household Component of MEPS. Aspects of health care use described in this report include the proportion of people receiving ambulatory medical care in office-based and hospital-based settings, dental care, inpatient hospital care, home health services, and prescription medicines. Specific comparisons are made by selected demographic characteristics—such as age, sex, and race/ethnicity—as well as by health insurance coverage, perceived health status, and whether or not a respondent had a usual source of care. Separate estimates also are reported for children's use of ambulatory medical and dental services.

About three-quarters (74.9 percent) of the population received ambulatory care from a medical provider, and 7.3 percent of the population (19.6 million people) had at least one hospital stay during 1996. In general, health care use estimates were highest for elderly people, people in poor health, and those who died during calendar year 1996. The uninsured, both elderly and nonelderly, were less likely to use both ambulatory and inpatient services.

Copies of this report (AHCPR Publication No. 99-0018) are available from the AHCPR Publications Clearinghouse.

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