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National Healthcare Disparities Report, 2003

Medical Expenditure Panel Survey (MEPS)

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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 2½-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 among 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 this initial submission of the NHDR were derived primarily from the 1999 MEPS HC survey. Estimates were also derived from responses to the Self-Administered Questionnaire (SAQ) and the Parent Administered Questionnaire (PAQ).

The SAQ is a supplemental mail-back survey and includes questions from the Consumer Assessment of Health Plans (CAHPS®), the SF-12, the EuroQol 5D, and attitude items. The PAQ is a supplemental self-administered questionnaire administered to parents of children under 18 years of age and includes questions from the Consumer Assessment of Health Plans (CAHPS®) and the Living with Illness Measure (LWIM). A third supplemental mail-back survey was administered to diabetes patients and solicited information on the care received for the treatment of diabetes.

Data from the SAQ, PAQ, and the diabetes supplement are reflective of healthcare experiences in 2000.

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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/operationalized is provided below.

Age – Age was defined as a person's age on December 31, 1999. When this information was not available (i.e., variable information was missing) a person's age was determined by sequentially "back-filling" in valid values from the previous two rounds of data collection. This process resulted in all persons having a valid value for age. Age subpopulations were then identified to as 1) 0-17 years, 2) 18-44 years, 3) 45-64 years, and 4) 65+ years.

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 are reported persons classified as non-Hispanic, White or non-Hispanic, Black. Estimates for persons of other racial/ethnic origins (e.g., Hispanic White, Hispanic Black, etc.) are not presented in the report.

In 1999, 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 MESPS as of 2003. 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 measures presented for the education subpopulations include only person in this age cohort.

Insurance Coverage – The insurance coverage variable is 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 any private coverage 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 any of the analyses.

Metropolitan Proximity – Metropolitan Statistical Areas (MSA) and non-Metropolitan Statistical Areas (non-MSA). Metropolitan Statistical Area

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Healthcare Measures

Estimates were generated for a large number of measures across four dimensions of healthcare: access to care, utilization, expenditures, and quality. With the exception of the expenditure data all measures are conveyed as proportion/ratio estimates. Full distributional estimates are not shown. For example, for measures with more than two response categories (e.g., very satisfied, somewhat satisfied, not too satisfied, not at all satisfied) only the estimated proportion responding not very satisfied may be reported. Expenditure estimates are reported as mean dollars amounts.

All estimated proportions, ratios, and means are weighted to reflect the experiences of the U.S. civilian non-institutionalized population at the aggregate and subpopulation levels. 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 B. Tables. Consistent with the established criteria for data reporting in the NHDR, MEPS estimates generated when the unweighted sample size was less than 100 observations or when the observed relative standard error was greater than 30% are suppressed as indicated by DSU (Data Statistically Unreliable).

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Additional Information

For further information, go to 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:

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2003 National Healthcare Disparities Report


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