Methodology Report
#1: Design and Methods of the Medical Expenditure Panel Survey Household
Component
by Joel Cohen, Ph.D., Agency
for Health Care Policy and Research
Select for more information on
Health Care Information and Electronic Ordering Through the AHRQ Web Site.
Select for information on The Medical Expenditure Panel Survey (MEPS).
Introduction
The Medical Expenditure Panel Survey
(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 (formerly the National Center for
Health Services Research). The first of these surveys, called the
National Medical Care Expenditure Survey (NMCES), was conducted
in 1977, and the second, called the National Medical Expenditure
Survey (NMES), in 1987. The 1996 MEPS, which is cosponsored by
the National Center for Health Statistics (NCHS), will update the
1987 data to reflect the dramatic changes that have occurred in
the U.S. health care system over the last decade.
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Background
Major changes have taken place in
the Nation's health care delivery system since NMES was conducted
almost 10 years ago. The most notable is the rapid expansion of
managed care arrangements such as HMOs (health maintenance organizations),
PPOs (preferred provider organizations), and other provider networks
that seek to minimize increases in health care costs. New hybrid
forms of health insurance coverage also have appeared. Changes
such as these have affected both the private and public sectors.
The new MEPS provides information about the current state of the
health care system in the United States and the changes that have
taken place since the last national survey of medical expenditures
was conducted in 1987. The information collected by MEPS also provides
valuable baseline data for use in evaluating future changes in
the system.
The MEPS study design was developed
to enhance the capabilities to study changes in health care delivery
and the effects of new health policies. These are important objectives
in view of the various health reform initiatives being implemented
by States and the Federal Government. The MEPS design allows for
the production of annual estimates for 2 calendar years. It also
permits the tracking of changes in employment, income, health status,
and medical care use and expenditures over the 2 consecutive years
during which households will be interviewed. In addition, National
Health Interview Survey (NHIS) baseline data are available for
persons in the MEPS panels, thereby adding another data point for
comparisons of change over time.
MEPS extends the NMES series of
studies on medical expenditures and health insurance and provides,
for the first time, data suitable for detailed analysis of trends
and changes in these areas. The survey is a unique resource for
a number of reasons, including:
-
Scope. MEPS
provides information on a broad spectrum of the population.
The survey sample base represents the civilian noninstitutionalized
population and, in a separate component, the population institutionalized
in nursing homes. MEPS also provides information on many types
of health care services, expenditures, and sources of payment
for both individuals and families.
-
Population basis.
Because MEPS is a survey of persons, population groups that
are or may become of special policy concern can be identified
and analyzed. This is especially important for analyzing the
effect of particular eligibility requirements on the enrollment
and budgets of public programs and on those who are not eligible
for such programs.
-
Cost-effectiveness.
MEPS will collect data needed by groups that might otherwise
either sponsor separate or overlapping surveys, or do without
crucial information needed for important decisions. Experience
has demonstrated that broad-based data on use, expenses, and
financing of health care collected from a nationally representative
sample can meet the data needs of a wide variety of users in
a cost-effective manner.
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Household Component
The sample design of the NMES household
surveys has been revised for MEPS. The MEPS sample is not defined
through an initial screening round. Instead, it is selected as
a nationally representative subsample of households that participated
in NHIS. The 1996 MEPS sample (based on the 1995 NHIS) is being
carried forward into 1997 and combined with a new subsample of
households responding to the 1996 NHIS. These two panel samples
(the 1996 MEPS sample and the new MEPS selections from the 1996
NHIS) will jointly define the sample base for the 1997 MEPS Household
Component. Table 1 shows the study
design of the 1996 and 1997 MEPS Household Components. Table
2 summarizes various features of the study design of the Household
Component.
In 1996, the MEPS sample linked
to the 1995 NHIS was selected. It was drawn from a nationally representative
NHIS subsample that included 195 primary sampling units and approximately
1,700 segments, yielding approximately 10,500 responding NHIS households.
These households were recontacted in MEPS. This NHIS subsample
reflects an oversample of Hispanics and blacks. Other groups with
high public policy relevance in the areas of health care use and
financing are oversampled as part of the MEPS 1997 panel to improve
the precision of the estimates for those groups.
Households selected for participation
in the 1996 or 1997 MEPS Household Components are interviewed in
person five times (Rounds 1-5) and a last time during a brief telephone
interview (Round 6). The rounds of data collection are spaced approximately
4 months apart. The interviews take place with a family respondent
who reports for himself or herself and for other family members.
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Preliminary Contact
Mail and telephone contacts take
place prior to the first MEPS interview with the NHIS participating
households selected for each MEPS panel (Round 1). The purpose
of the preliminary contact is to enlist the household respondent
into MEPS and plan for the delivery of record-keeping materials
before the study observation period begins on January 1st of the
survey year. In December, an advance letter announcing MEPS is
mailed to the family respondent at the address where the NHIS interview
was conducted. An interviewer follows up on the letter with a telephone
call to confirm its arrival, verify the identity of the household,
identify the MEPS family respondent (if different from the NHIS
respondent), and announce the future mailing of a study calendar
and record file. These materials are sent, along with $5 to compensate
respondents for the time and effort devoted to keeping records
in preparation for the Round 1 interview. An interviewer telephones
a second time to confirm the arrival of these materials and arrange
for a convenient time to conduct the Round 1 interview.
Households that do not have a telephone
or cannot be reached using the telephone number from NHIS are contacted
by mail and asked to return a postcard identifying a telephone
number where they can be contacted (e.g., the number at work or
a neighbor's house).
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Core Rounds
Data collection for the MEPS Household
Component takes place using a computer-assisted personal interview
(CAPI) system. A core instrument is administered in each of the
first five rounds of data collection, with periodic supplements
added in selected rounds to deal with specific topics in greater
depth. Dependent interviewing methods, in which respondents are
asked to confirm or revise data provided in earlier interviews,
is used to update information in several of the core questionnaires,
such as employment and health insurance, after the initial interview.
Core Instrument
The core instrument is used to collect
data about all persons in sampled households. It includes questionnaires
on demographics, health status and conditions, use, charges and
payments, prescribed and over-the-counter medicines purchased,
employment, and health insurance.
Periodic Supplements
Supplements scheduled for inclusion
in the survey include questionnaires on access to and satisfaction
with care, income and assets, long-term care, and alternative care
(which includes approaches to health care that are different from
those typically practiced by medical doctors in the United States,
such as acupuncture and homeopathic treatments).
Self-Administered Questionnaire
All adults in sample households
are asked to complete a self-administered questionnaire in Round
2. This questionnaire collects information about health behaviors
and opinions that would be difficult, if not impossible, to collect
on a proxy basis from the family respondent. Similar information
is collected for children as part of the regular interview with
the household survey respondent, usually the mother.
Medical Provider Permission Forms
Signed permission forms are requested
in Round 1, much earlier than in past NMES studies, in order to
expedite the timetable for the later Medical Provider Component
of the survey, which collects data about specific medical events
directly from providers. Results from a previous methodological
study suggested that early requests for signed permission forms
involving office-based physicians have a modest negative effect
on survey cooperation rates in later rounds. Therefore, the requests
for signed permission forms in Round 1 are limited to events taking
place in hospitals. In Round 2 and subsequent rounds, requests
for signed permission forms apply to all types of providers included
in the Medical Provider Component of MEPS (that is, hospitals,
physicians, and home health agencies), including those associated
with use reported in Round 1.
Health Insurance Permission Forms
Signed permission forms are needed
to contact sources of employment and private health insurance coverage
in the Insurance Component of the survey, which collects data directly
from individuals' sources of health insurance (typically their
employers). These requests are initiated in Round 2 and apply to
the insurance sources associated with plans held at the time of
the Round 1 interview.
Health Insurance Policy Booklet
Requests
Following procedures tested successfully
in a previous methodological study, MEPS interviewers ask respondents
to provide health insurance booklets or other summary materials
that describe the characteristics of private plans held by family
members at the time of the Round 1 interview. The requests for
policy information include all sources of private insurance coverage,
not just employment-related coverage. Respondents are reimbursed
$15 for the time and effort involved in procuring policy booklets.
Provider Directories
To assist in the identification
of medical providers and the preparation of an unduplicated list
of medical providers, interviewers use a computerized database
(directory) of health providers that has been loaded into the CAPI
laptop computer. With search software loaded into the laptops,
interviewers can query the database of providers in the course
of the MEPS interview. If a match is found in the database for
the provider specified by the household respondent, the matched
directory record is associated with the household member. Directory
records include the following information for each provider: a
unique provider identification number; the provider's name, address,
and telephone number; and the provider's specialty (for individual
office-based physicians).
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Uses of Data
At the most basic level, the objective
of the MEPS Household Component is to collect data that can be
used to produce annual estimates for a variety of measures related
to the characteristics of individuals; their health insurance coverage;
and their health care use, expenditures, and sources of payment.
The data can also be used to support behavioral analyses that inform
researchers and policymakers about how the characteristics of individuals
and families, including their health insurance, affect medical
care use and spending.
Data obtained in this study will
be used to produce the following national estimates for calendar
years 1996 and 1997:
-
Annual estimates of health care
use and expenditures for persons and families.
-
Annual estimates of sources
of payment for health care expenses, including amounts paid
by public programs, such as Medicare and Medicaid, and by private
insurance, as well as out-of-pocket payments.
-
Annual estimates of health care
use, expenditures, and sources of payment for persons and families
by type of service, including inpatient hospital stays, ambulatory
care, home health care, dental care, and purchases of prescribed
and over-the-counter medicines.
-
The number and characteristics
of the population eligible for each of the public programs,
including the use of services and expenditures of the population
eligible for benefits under Medicare, Medicaid, CHAMPUS and
CHAMPVA (Civilian Health and Medical Program for the Uniformed
Services and Civilian Health and Medical Program, Veterans'
Affairs), and the Department of Veterans' Affairs.
-
The number, characteristics,
use of services, expenditures, and benefits of persons and
families with individual or group coverage; commercial or nonprofit
coverage; and coverage through HMOs or other managed care arrangements.
In addition to national estimates,
data collected in this longitudinal study will be used to study
determinants of the use of services and expenditures, and the effects
of individual characteristics and policy changes on medical care
use and expenses. These behavioral analyses will include studies
of:
-
Social and demographic factors
such as employment and income.
-
Methods of financing health
care and health insurance.
-
Health habits, lifestyles, and
behavioral patterns of individuals and families.
-
Health needs of specific subpopulation
groups of current or potential policy interest, such as the
elderly and members of racial or ethnic minorities.
Finally,
data collected in this surveyin conjunction with data from the 1977 NMCES and the 1987
NMESwill be used to study trends in the nature and distribution
of national health expenditures, sources of care, and amounts and
types of services used by the U.S. noninstitutionalized population.
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Table 1. Panel
design for the MEPS Household Component, 1996 and 1997
| Item |
Calendar
year
1996 |
Calendar
year
1997 |
Calendar
year
1998 |
| 1996 panel (from
1995 NHIS) |
Round 1 |
Round
2 |
Round 3 |
Round
4 |
Round 5 |
Round
6 |
| Field period |
3/96-7/96 |
8/96-11/96 |
2/97-5/97 |
8/97-11/97 |
2/98-5/98 |
6/98-7/98 |
| Responding households |
9,500 |
9,000 |
8,800 |
8,500 |
8,300 |
8,100 |
| 1997 panel (from
1996 NHIS) |
-- |
-- |
Round 1 |
Round 2 |
Round 3 |
Round 4 |
| Field period |
-- |
-- |
3/97-7/97 |
8/97-11/97 |
2/98-5/98 |
8/98-11/98 |
| Responding households |
-- |
-- |
5,800 |
5,500 |
5,400 |
5,200 |
| Total responding
households |
9,500 |
9,000 |
14,600 |
14,000 |
13,700 |
13,300 |
- Note: MEPS is Medical Expenditure
Panel Survey. NHIS is National Health Interview Survey.
Table 2. Design
features of the MEPS Household Component, 1996 panel
| Feature |
1995
|
1996
|
1997
|
1998
|
Data collection
|
Preliminary
contact
|
Round
1
|
Round
2
|
Round
3
|
Round
4
|
Round
5
|
Round
6
|
| Reference period |
-- |
1/1/96 to date
of Round 1 interview |
Date of Round
1 interview to date of Round 2 interview |
Date of Round
2 interview to date of Round 3 interview |
Date of Round
3 interview to date of Round 4 interview |
Date of Round
4 interview to 12/31/97 |
-- |
| Field period |
12/95-1/96 |
3/96-7/96 |
8/96-11/96 |
2/97-5/97 |
8/97-11/97 |
2/98-5/98 |
6/98-7/98 |
| Interview mode |
Mail and telephone |
In-person, CAPI |
In-person, CAPI |
In-person, CAPI |
In-person, CAPI |
In-person ,
CAPI |
Telephone |
- Note: CAPI is computer-assisted
personal interview. MEPS is Medical Expenditure Panel Survey.
Source: Agency for Health Care Policy
and Research, Center for Financing, Access, and Cost Trends
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Suggested Citation:
Methodology Report #1: Design and Methods of the Medical Expenditure Panel Survey Household Component. July 1997.
Agency for Health Care Policy and Research, Rockville, MD.
http://www.meps.ahrq.gov/data_files/publications/mr1/mr1.shtml
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