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Performance Budget Submission for Congressional Justification

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Medical Expenditure Panel Survey (MEPS)


Purpose and Method of Operation
Major Components of MEPS
Key MEPS Data Findings
MEPS Funding Summary
MEPS Funding History
Rationale for the Fiscal Year 2000 Request

Purpose and Method of Operation

The objectives of AHCPR's Medical Expenditure Panel Survey (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.
  • Develop cost/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, an interrelated series of surveys that replaces the National Medical Expenditure Survey (NMES). MEPS not only updates information that was last collected a decade ago in fiscal year 1987, but will also provide more timely data, at a lower cost per year of data, through the move to an ongoing data collection effort.

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AHCPR's Medical Expenditure Panel Survey collect detailed information regarding the use and payment for health care services from a nationally representative sample of Americans. Since 1977, AHCPR'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; and the specific services purchased through out-of-pocket and/or third-party payments.

AHCPR 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, employers, and insurance providers. 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, and 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 [OMB], Congressional Budget Office [CBO], Physician Payment Review Commission [PPRC], Prospective Payment Assessment Commission [ProPAC], and Treasury Department) relies on 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.

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

  • It will decrease the cost per year of data collected.
  • It will provide more timely data on a continuous basis.
  • It will create for the first time the ability to assess changes over time.
  • It will permit the correlation of these data with the National Health Accounts.

Integrating many complex surveys while decreasing costs and enhancing analytic capacity is a continuing effort. During 1997 and 1998, AHCPR explored the possibility of using the Census Bureau for collection of Household Component data. This proved to be unfeasible, and AHCPR awarded a new, competitively procured contract for the performance of the MEPS Household Survey and Medical Provider Survey Components through 2002. The Insurance Survey Component will remain at the Census Bureau.

The first MEPS data (from 1996) became available in April 1997; key findings are summarized in Table 1. 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.

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Major Components of MEPS

MEPS consists of a series of interrelated surveys. The individual components of MEPS and the information each will provide are outline below:

  • Household Survey: Five interviews will be conducted with each new sample of households for MEPS over a 2.5-year period to obtain health care use, and expenditure and insurance coverage data for 2 consecutive calendar years. The 1996 MEPS sample included 10,800 families, the combined 1997 MEPS sample consisted of 14,100 families, and the combined 1998 MEPS sample consisted of 10,800 families. The combined 1999 MEPS sample will consist of 11,000 new families and the combined 2000 MEPS sample will also consist of 11,000 new families. This is the only survey that collects health care expenditures of American families.
  • Medical Provider Survey: Interviews will be conducted with 3,000 hospitals, 12,000 office-based physicians, 500 home health providers, and 7,000 hospital-identified physicians in 1999 to obtain health care information on MEPS Household Survey participants. A separate interview will be conducted to obtain information for each of the calendar years associated with the MEPS Household Survey Panel. This survey allows AHCPR to verify information collected at the household level and to get information from providers when it is not known by the household (e.g., households receiving Medicaid or that are in capitated plans will not know their expenditures).
  • MEPS Insurance Component, Health Insurance Plans Survey: Interviews will be conducted with 7,000 employers, 500 unions, and 500 insurers in 1999 and 10,000 employers, 500 unions, and 500 insurers in 2000 to obtain detailed information on the health insurance benefits and premiums associated with health insurance coverage held by the MEPS Household Survey participants. A separate interview will be conducted to obtain information for each of the calendar years associated with the MEPS Household Survey Panel. This survey allows for the evaluation of insurance purchasing choices and the impact of those choices on use and access to care.
  • MEPS Insurance Component Establishment Level (formerly NEHIS): Interviews will be conducted with 30,000 establishments to obtain national and State-specific (40 States) estimates of the availability of health insurance at the workplace, the type of coverage provided by employers, and the associated costs of coverage. For each establishment surveyed, the MEPS Insurance Component Establishment Level Survey will obtain information on the number and characteristics of plans offered, the scope and breadth of benefits included in each plan and the corresponding copayment provisions, the number of current workers and retirees enrolled in each plan, and whether each plan is fully or self-insured. The MEPS Insurance Component Establishment Level Survey data will also include characteristics of each establishment including its size, the type of workforce employed, aggregate data on payroll and available fringe benefits, industrial classification, and corporate status.
  • National Nursing Home Expenditure Study: This survey will provide calendar year expenditure estimates for nursing home care for persons residing in a nursing home anytime during 1996. In addition to making expenditure estimates by sources of payment, the survey estimates change in sources of payment (e.g., Medicaid) over the year. The design of the survey permits expenditure estimates by important subpopulations, including persons admitted or discharged during the year; by functional health status, insurance coverage, and income distributions; and by characteristics of the nursing home residents' caregivers who reside in the community. Also, the Survey can provide estimated physician use, prescribed medicine use, and hospital use by nursing home residents. No other national nursing home survey has the capability of uniformly measuring health status using data collection materials based on the Health Care Financing Administration's (HCFA's) Resident Assessment Instrument or collecting data from the nursing home residents' next-of-kin who reside in the community.

The information derived from these surveys will enable the Congress, the Administration, and other public and private sector policy makers to evaluate the impact of:

  • Growing enrollment in managed care.
  • Enrollment in different types of managed care.
  • Changes in how chronic care and disability are managed and financed.
  • Alternative approaches to provision of long-term care.
  • Changes in employer-supported health insurance.
  • Changes in Federal and State policy.

In addition to assessing broad trends such as these, MEPS will address a host of specific, policy-relevant questions.

MEPS will make a significant contribution to improving the accuracy of the Nation's economic models in at least two ways. First, with each passing year, attempts to extrapolate the 1987 data to the current year are increasingly subject to error; current data are essential and MEPS will provide them. Second, the fact that this survey will provide a third data series for these sophisticated models will significantly improve their ability to identify and assess trends that may not be obvious with data from only two points in time (1977 and 1987). Thus, the critical importance of collecting this third series of data cannot be overemphasized.

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Table 1. Key MEPS Data Findings

Date Public Use Data ReleaseKey Findings
Spring 1997 Round 1 1996

Medical Expenditure Panel Survey Component person-level demographics, employment, health status, and health insurance.
¹) 17% of the U.S. population was uninsured during the first half of 1996.

¹) 19.6% of privately insured children in single parent families get health insurance coverage from a policyholder not residing in their household.

¹) Almost 53% of children covered by Medicaid have at least one parent that works.

¹) A greater percentage of workers are being offered health insurance by their employers in 1996 than in 1987; however, a smaller proportion is accepting insurance.

¹) Less than half of all Hispanic Americans (44.0%) and Black Americans (48.6%) were covered by private health insurance as compared to over three-quarters of White Americans (75.3%).

¹) 33.5% of Hispanic Americans and 22.9% of Black Americans were uninsured.

¹) 37.2% of Hispanic Americans males were uninsured, the highest percentage among all racial and ethnic groups.

¹) Young adults ages 19-24 were most likely to lack health insurance. More than one-third were uninsured, more than twice the rate at which all Americans lacked coverage.
Spring 1997 Round 1 1996

MEPS—Nursing Home Survey Component²)—person-level demographic and health status data and Round 1 facility characteristics data.
¹) Almost 66% of U.S. nursing homes in 1996 were operated for-profit.

¹) More than 80% status of nursing home residents needed help with 3 or more activities of daily living.

¹) Almost half of all nursing home residents have some form of dementia.
Fall 1997 Release 2 1996

Household Survey Component—Round 1 parent identifiers and managed care data, and Round 2 health status and access to care data.
¹) Nearly 18% of the population had no usual source of health care in 1996.

¹) Approximately 12% of all American families experienced barriers to receiving needed health care services.

¹) During fiscal year (FY) 1996, Hispanic-Americans (30%), young adults ages 18-24 (34%), and the uninsured under age 65 (38%), were the most likely groups to lack a usual source of care.
Fall 1998 Release 3 1996

Household Survey Component. Full year person level demographics, employment, health status, health insurance, and health care utilization.
¹) 77.5% of children with a usual source of health care had at least one ambulatory visit compared to 43.3% of children who lacked a usual source of health care in 1996.

¹) Persons under the age of 65 years with either public or private insurance coverage were more likely to receive ambulatory care than their uninsured counterparts.

¹) Indicative of higher health care utilization rates during the last months of life, the mean number of ambulatory visits for persons who died is about two and a half times higher than the rest of the population.

¹) Only 43.2% of the population received dental care in 1996.
Winter 1999 MEPS—Household Survey Component 1996. Selected employment and family weights related variables. ²) Employment status as of Dec. 31, 1996.

²) Family level weights.
Winter 1999 MEPS Nursing Home Survey Component 1996. Population characteristics data file. ²) Nursing Home Survey Component (January 1st residents and first admissions): person level demographics, nursing home use, and income and assets data. January 1st sample only: preliminary insurance, baseline health status data as reported by the nursing home, and basic facility characteristics.
Winter 1999 1997 Point in Time Estimates ²) Household Survey Component: person level demographics, employment, health status, and health insurance.
Winter 1999 MEPS Nursing Home Survey Component 1996. Person-level file, residence history stay-level file, and facility-level file. ²) Nursing home residents and admissions data: demographics, nursing home use and expendi- tures, health status, prior long-term care use, final insurance, data about the person prior to admission, and information on the person's living kin. Facility-level file: nursing home information collected in Rounds 1-3. Residence history file: information for all sampled persons on their 1996 stays of one night or more.
Spring 1999 MEPS Nursing Home Survey Component. Person-level, prescribed medicine, and caregiver files. ²) Nursing home person-level file with medical provider use data and person-level caregiver information, as well as a file of prescribed medicine use while a NH resident.
Spring 1999 MEPS Household Survey Component, 1996. Use and expenditure data file. ²) Person level use, source of payment, expenditures, health status, health insurance, and income.
Spring/Summer 1999 1996 Panel Household Survey Component. Conditions, events, and job data files. ²) Detailed condition, event and job information
Fall 1999 Linked Household-Insurance Surveys Component data file. ²) 1996 full-year use and expenditure file linked with 1996 Insurance Survey Component file.
Fall 1999 1998 Point in Time Estimates ²) Household Survey Component person level demographics, employment, health status, and health insurance.

¹ ) Denotes actual key findings.
² ) Denotes prospective key findings.

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MEPS Funding Summary

Authorizing Legislation—Title IX and Section 301 of the Public Health Service Act (PHSA).

Fiscal Year 1998, Actual Fiscal Year 1999, Appropriation Fiscal Year 2000, EstimateIncrease or Decrease
Full-Time Equivalent Budget Authority Full-Time Equivalent Budget Authority Full-Time Equivalent Budget Authority Full-Time Equivalent Budget Authority
N/A ($36,300,00) N/A ($27,800,00) N/A ($36,000,000) N/A +($8,200,000)

N/A=Not Applicable.

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MEPS Funding History

Funding for the MEPS program prior to fiscal year 2000 has been as follows:

Year AmountFTEs
1994 $10,000,000 ---
1995 $15,000,000 ---
1996 $15,100,000 ---
1997 $38,886,000 ---
1998 $36,300,000 ---
1999 $27,800,000 ---
2000 $36,000,000 ---

Sources of MEPS funding follow:

Year Budget Authority 1% EvaluationTotal
1994 Actual $10,000,000 --- $10,000,000
1995 Actual $9,918,000 $5,082,000 $15,000,000
1996 Actual $10,000,000 $5,000,000 $15,000,000
1997 Actual $224,000 $38,662,000 $38,886,000
1998 Actual --- $36,300,000 $36,300,000
1999 Appropriation --- $27,800,000 $27,800,000
2000 Request --- $36,000,000 $36,000,000

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Rationale for the Fiscal Year 2000 Request

The fiscal year 2000 request for MEPS totals $36,000,000 in one percent evaluation funds. The total reflects an increase of $8,200,000 from the fiscal year 1999 level of $27,800,000. This increase consists of:

  • Ongoing data collection efforts and related survey activities for MEPS ($29,000,000).
  • New Tools and Talent for a New Century ($7,000,000).

In fiscal year 2000, data collection will be ongoing for the MEPS Household Survey, the MEPS Medical Provider Survey, and the MEPS Insurance Component, which consists of the MEPS Health Insurance Plans Survey and a national employer health insurance survey. More specifically, in-person interviews will be conducted with more than 11,000 families to obtain calendar year 1998 and 1999 health care data. The Medical Provider Survey will consist of interviews with approximately 3,000 facilities, 8,500 office-based providers, 7,000 hospital-identified physicians, and more than 500 home health providers. In addition, the MEPS Insurance Component will consist of interviews with more than 40,000 employers and 1,000 insurance carriers.

All of the MEPS components will be heavily engaged in survey-related activities directed to the following tasks: data editing, imputation, data preparation and data processing, development of estimation weights and variance estimation capabilities for the component surveys, preparation of public use tapes, and development of analytical and methodological reports.

This request also includes $7,000,000 to increase the capacity of MEPS. In fiscal year 2000, the following enhancements will be made to MEPS to close the knowledge gap:

  • Include in the MEPS Household Survey sample sufficient sample of individuals with certain illnesses of national interest in terms of quality of care and burden of disease. This enhancement will permit more focused analyses of the quality of care received for these special populations.
  • Expand the clinical detail in the Household and Medical Provider Surveys. AHCPR will enhance the Medical Provider Component of the MEPS by increasing the collection of clinical detail on the content of care to determine the quality of care provided to individuals. The MEPS will also collect, as part of the Household Component, more information on use of clinical preventive services.
  • Add new questions, including a more extensive module on children, to enable users to understand the impact of changes in health and human service programs.

With these enhancements, we will for the first time be able 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.
  • Examine quality, cost, access, and use of clinical preventive services. Enhanced data collection, in conjunction with the existing MEPS capacity to examine differences in minorities and ethnic groups, will provide critical data for closing the gaps in medical care as outlined in the President's Race Initiative.
  • Track the national impact of new Federal and State programs, including Title XXI (the new State Child Health Insurance Program), on access and cost of care for children, and compare and evaluate the effectiveness of different strategies to reduce the number of uninsured children and increase access to needed services by those who are covered.

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Current as of February 1999


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