MEPS HC-110H: 2007 Home Health Visits
August 2009
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406
Table of Contents
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Survey Management and Data Collection
C. Technical and Programming Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Source and Naming Conventions
2.4.1 Variable-Source Crosswalk
2.4.2 Expenditure and Source of Payment Variables
2.5 File Contents
2.5.1 Survey Administration Variables
2.5.1.1 Person Identifiers (DUID, PID, DUPERSID)
2.5.1.2 Record Identifier (EVNTIDX)
2.5.1.3 Round Indicator (EVENTRN)
2.5.1.4 Panel Indicator (PANEL)
2.5.2 Home Health Event Variables
2.5.2.1 Date of Event (HHDATEYR, HHDATEMM)
2.5.2.2 Characteristics of Event (MPCELIG-OTHCWOS)
2.5.2.3 Treatments, Therapies, and Services (HOSPITAL-OTHSVCOS)
2.5.2.4 Frequency of Event (FREQCY-HHDAYS)
2.5.3 Flat Fee Variables
2.5.4 Condition, Procedure, and Clinical Classification Codes
2.5.5 Expenditure Data
2.5.5.1 Definition of Expenditures
2.5.5.2 Data Editing and Imputation Methodologies of Expenditure Variables
2.5.5.2.1 General Data Editing Methodology
2.5.5.2.2 General Hot-Deck Imputation
2.5.5.2.3 Home Health Data Editing and Imputation
2.5.5.3 Imputation Flag Variable (IMPFLAG)
2.5.5.4 Flat Fee Expenditures
2.5.5.5 Zero Expenditures
2.5.5.6 Sources of Payment
2.5.5.7 Home Health Expenditure Variables (HHSF07X - HHXP07X)
2.5.5.8 Rounding
3.0 Sample Weight (PERWT07F)
3.1 Overview
3.2 Details on Person Weight Construction
3.2.1 MEPS Panel 11 Weight
3.2.2 MEPS Panel 12 Weight
3.2.3 The Final Weight for 2007
3.2.4 Coverage
3.3 Using MEPS Data for Trend Analysis
4.0 Strategies for Estimation
4.1 Developing Event-Level Estimates
4.2 Person-Based Estimates for Home Health Care
4.3 Variables with Missing Values
4.4 Variance Estimation (VARPSU, VARSTR)
5.0 Merging/Linking MEPS Data Files
5.1 Linking to the Person-Level File
5.2 Linking to the Prescribed Medicines File
5.3 Linking to the Medical Conditions File
_._ References
D. Variable - Source Crosswalk
A. Data Use Agreement
Individual identifiers have been removed from the
micro-data contained in these files. Nevertheless, under sections 308 (d) and
903 (c) of the Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1),
data collected by the Agency for Healthcare Research and Quality (AHRQ) and/or
the National Center for Health Statistics (NCHS) may not be used for any purpose
other than for the purpose for which they were supplied; any effort to determine
the identity of any reported cases is prohibited by law.
Therefore in accordance with the above referenced
Federal Statute, it is understood that:
No one is to use the data in this data set in any way except for
statistical reporting and analysis; and If the identity of any person or establishment should be discovered
inadvertently, then (a) no use will be made of this knowledge, (b) the
Director Office of Management AHRQ will be advised of this incident, (c) the
information that would identify any individual or establishment will be
safeguarded or destroyed, as requested by AHRQ, and (d) no one else will be
informed of the discovered identity; and - No one will attempt to link this data set with individually identifiable
records from any data sets other than the Medical Expenditure Panel Survey
or the National Health Interview Survey.
By using these data you signify your agreement to
comply with the above stated statutorily based requirements with the knowledge
that deliberately making a false statement in any matter within the jurisdiction
of any department or agency of the Federal Government violates Title 18 part 1
Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5
years in prison.
The Agency for Healthcare Research and Quality
requests that users cite AHRQ and the Medical Expenditure Panel Survey as the
data source in any publications or research based upon these data.
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B. Background
1.0 Household Component
The Medical Expenditure Panel Survey (MEPS) provides
nationally representative estimates of health care use, expenditures, sources of
payment, and health insurance coverage for the U.S. civilian
non-institutionalized population. The MEPS Household Component (HC) also
provides estimates of respondents’ health status, demographic and socio-economic
characteristics, employment, access to care, and satisfaction with health care.
Estimates can be produced for individuals, families, and selected population
subgroups. The panel design of the survey, which includes 5 Rounds of interviews
covering 2 full calendar years, provides data for examining person level changes
in selected variables such as expenditures, health insurance coverage, and
health status. Using computer assisted personal interviewing (CAPI) technology,
information about each household member is collected, and the survey builds on
this information from interview to interview. All data for a sampled household
are reported by a single household respondent.
The MEPS-HC was initiated in 1996. Each year a new
panel of sample households is selected. Because the data collected are
comparable to those from earlier medical expenditure surveys conducted in 1977
and 1987, it is possible to analyze long-term trends. Each annual MEPS-HC sample
size is about 15,000 households. Data can be analyzed at either the person or
event level. Data must be weighted to produce national
estimates.
The set of households selected for each panel of the
MEPS HC is a subsample of households participating in the previous year’s
National Health Interview Survey (NHIS) conducted by the National Center for
Health Statistics. The NHIS sampling frame provides a nationally representative
sample of the U.S. civilian non-institutionalized population and reflects an
oversample of blacks and Hispanics. In 2006, the NHIS implemented a new sample
design, which included Asian persons in addition to households with black and
Hispanic persons in the oversampling of minority populations. MEPS further
oversamples additional policy relevant sub-groups such as low income households.
The linkage of the MEPS to the previous year’s NHIS provides additional data for
longitudinal analytic purposes.
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2.0 Medical Provider Component
Upon completion of the household CAPI interview and
obtaining permission from the household survey respondents, a sample of medical
providers are contacted by telephone to obtain information that household
respondents can not accurately provide. This part of the MEPS is called the
Medical Provider Component (MPC) and information is collected on dates of visit,
diagnosis and procedure codes, charges and payments. The Pharmacy Component
(PC), a subcomponent of the MPC, does not collect charges or diagnosis and
procedure codes but does collect drug detail information, including National
Drug Code (NDC) and medicine name, as well as date filled and sources and
amounts of payment. The MPC is not designed to yield national estimates. It is
primarily used as an imputation source to supplement/replace household reported
expenditure information.
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3.0 Survey Management and Data Collection
MEPS HC and MPC data are collected under the authority
of the Public Health Service Act. Data are collected under contract with Westat,
Inc. Data sets and summary statistics are edited and published in accordance
with the confidentiality provisions of the Public Health Service Act and the
Privacy Act. The National Center for Health statistics (NCHS) provides
consultation and technical assistance.
As soon as data collection and editing are completed,
the MEPS survey data are released to the public in staged releases of summary
reports, micro data files, and tables via the MEPS Web site:
www.meps.ahrq.gov.
Selected data can be analyzed through MEPSnet, an on-line interactive tool
designed to give data users the capability to statistically analyze MEPS data in
a menu-driven environment.
Additional information on MEPS is available from the
MEPS project manager or the MEPS public use data manager at the Center for
Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality,
540 Gaither Road, Rockville, MD 20850 (301-427-1406).
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C. Technical and Programming Information
1.0 General Information
This documentation describes one in a series of public
use event files from the 2007 Medical Expenditure Panel Survey (MEPS) Household
Component (HC) and Medical Provider Component (MPC). Released as an ASCII data
file (with related SAS and SPSS programming statements) and a SAS transport
file, the 2007 Home Health public use file provides detailed information on home
health events for a nationally representative sample of the civilian
noninstitutionalized population of the United States. Data from the Home Health
event file can be used to make estimates of home health event utilization and
expenditures for calendar year 2007. The file contains 68 variables and has a
logical record length of 306 with an additional 2-byte carriage return/line feed
at the end of each record. As illustrated below, this file consists of MEPS
survey data obtained in the 2007 portion of Round 3, and Rounds 4 and 5 for
Panel 11, as well as Rounds 1, 2, and the 2007 portion of Round 3 for Panel 12
(i.e., the rounds for the MEPS panels covering calendar year 2007).
301 Moved Permanently
301 Moved Permanently
Counts of home health utilization are based entirely
on household reports. Agency home health providers were sampled into the MEPS
MPC (see Section B. 2.0). Only those providers for whom the respondent signed a
permission form were included in MPC. Information from MPC was used to
supplement expenditure and payment data reported by the household, and does not
affect use estimates.
Data from this event file can be merged with other
2007 MEPS HC data files for the purposes of appending person-level data such as
demographic characteristics or health insurance coverage to each home health
record.
This file can also be used to construct summary
variables for expenditures, sources of payment, and related aspects of home
health events for calendar year 2007. Aggregate annual person-level information
on the use of home health providers and other health services use is provided on
the 2007 Population Characteristics File, where each record represents a MEPS
sampled person.
The following documentation offers a brief overview of
the types and levels of data provided, and the content and structure of the file
and the codebook. It contains the following sections:
Data File Information
Sample Weight
Strategies for Estimation
Merging/Linking MEPS Data Files
References
Variable - Source Crosswalk
For more information on MEPS HC survey design see S.
Cohen, 1997; J. Cohen, 1997; and S. Cohen, 1996. For information on the MEPS MPC
design, see S. Cohen, 1999. A copy of the survey instruments used to
collect the information on this file is available on the MEPS Web site at the
following address: www.meps.ahrq.gov.
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2.0 Data File Information
The 2007 Home Health public use data set consists of
one event-level data file. The file contains characteristics associated with the
home health event and imputed expenditure data.
The home health services represented on this file are
provided by three kinds of home health providers: formal (paid) home health
agency providers, paid independent providers (self-employed), and informal
providers who do not reside in the same household as the MEPS sampled person
(care from informal providers who live in the same household as the sampled
person are not represented on this file).
Each record on this file represents a
household-reported home health event. A home health event is a MONTH of similar
services provided to a sampled person by the same PROVIDER (i.e., an employer in
the case of formal agency care and an individual in the case of paid independent
and informal care providers). For example, if a person received, from Provider
Agency A, four visits from a nurse, ten visits from a homemaker, and four visits
from a physical therapist each from the same provider one for each month every
month during the months of January, February, and March, and also received, from
Provider B, a physician visit in the month of January and February, there would
be five event records on the file (NOT 56 records). There would be one event
record representing all the visits from Provider A for the month of January,
another record for Provider A’s February visits, a third Provider A record for
the March visits, a fourth record representing the Provider B physician visit in
January and a fifth representing the Provider B physician visit in February.
Data were collected (and represented on this file) in this manner because
agencies, hospitals, and nursing homes provide MEPS expenditure data in this
manner. In order to be consistent with the definition of what is considered a
home health event on this file, this same definition (i.e., a month of similar
services) was applied to all types of home health providers.
This public use data set contains 4,645 home health
records; of the records, 4,529 are associated with persons having a positive
person-level weight (PERWT07F). It includes all records related to home health
events for all household survey respondents who resided in eligible responding
households and reported at least one home health event. Each record represents
one household-reported home health event that occurred during calendar year
2007. Some household respondents may have multiple events and thus will be
represented in multiple records on the file. Other household respondents may
have reported no events and thus will have no records on this file. These data
were collected during the 2007 portion of Round 3, and Rounds 4 and 5 for Panel
11, as well as Rounds 1, 2, and the 2007 portion of Round 3 for Panel 12 of the
MEPS HC. The persons represented on this file had to meet either (a) or (b):
Be classified as a key in-scope person who responded for his or her
entire period of 2007 eligibility (i.e., persons with a positive 2007
full-year person-level weight (PERWT07F > 0)), or - Be an eligible member of a family all of whose key in-scope members have
a positive person-level weight (PERWT07F > 0). (Such a family consists of
all persons with the same value for FAMIDYR.) That is, the person must have
a positive full-year family-level weight (FAMWT07F > 0). Note that FAMIDYR
and FAMWT07F are variables on the 2007 Population Characteristics file.
Persons with no home health events for 2007 are not
included on this event-level HH file but are represented on the person-level
2007 Full Year Population Characteristics file.
Home health providers include formal or paid, and
informal or unpaid providers. Formal or paid providers include: home health
agency and other independent paid providers. Informal or unpaid providers
include family and friends that reside outside of the sampled person’s
household.
For home health agencies it is important to
distinguish between the provider and the home health worker. In these cases, the
provider is the agency or the facility that employs the workers. The home health
workers are the people who administer the care. Examples of home health care
workers are the following: nurses, physical therapists, home health aides,
homemakers, and hospice workers, among others. These examples are generally the
types of workers associated with agencies. Paid independent providers generally
include companions, nursing assistants, physicians, etc. For each record on this
file, one or more types of workers can be reported. The respondent is asked to
mention all of the types of home health workers who provided home health care
(since records represent a month of service, there can be more than one type of
worker on a single record). For example, an agency that provides two types of
aides that provide home health care to the same person during a specific month
is represented as one event on the file even though two workers employed at the
same agency provided care. When using this file, analysts must keep in mind that
a record on the file corresponds to a provider entity, not an individual or
particular worker.
Expenditure data for home health agency events are
collected exclusively in the MPC. Expenditure data for other paid independent
home health care events are collected from the household, since these types of
events are not included in the MPC. Friends, family and volunteers providing
home health care to a person are considered unpaid and are not included in the
MPC. No expenditure information is available for them.
Each home health record also includes the following:
the month the provider visited the household; type of provider; types of
services provided and if this was a repeat event; whether or not care was
received due to hospitalization; whether or not a person was taught how to use
medical equipment; imputed sources of payment, total payment and total charge
for the home health event expenditure; and a full-year person-level weight.
To append person-level information such as demographic or health insurance coverage
to each event record, data from this file can be merged with 2007 MEPS HC
person-level data (e.g. Full Year Consolidated or Full Year Population
Characteristics files) using the person identifier, DUPERSID, Home Health events
can also be linked to the MEPS 2007 Medical Conditions File. Please see Section
5.0 or the MEPS 2007 Appendix File, HC-110I, for details on how to link MEPS
data files.
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2.1 Codebook Structure
For each variable on the Home Health event file, both
weighted and unweighted frequencies are provided in the accompanying codebook.
The codebook and data file sequence list variables in the following order:
Unique person identifier
Unique home health event identifier
Home health characteristic variables
Imputed expenditure variables
Weight and variance estimation variables
Note that the person identifier is unique within this data year.
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2.2 Reserved Codes
The following reserved code values are used:
| Value |
Definition |
| -1 INAPPLICABLE |
Question was not asked due to skip pattern |
| -7 REFUSED |
Question was asked and respondent refused to answer question |
| -8 DK |
Question was asked and respondent did not know answer |
| -9 NOT ASCERTAINED |
Interviewer did not record the data |
Generally, values of -1, -7, -8, and -9 for
non-expenditure variables have not been edited on this file. The values of -1
and -9 can be edited by the data users/analysts by following the skip patterns
in the HC survey questionnaire (located on the MEPS Web site:
www.meps.ahrq.gov/survey_comp/survey_questionnaires.jsp).
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2.3 Codebook Format
The codebook describes an ASCII data set (although the
data are also being provided in a SAS transport file). The following codebook
items are provided for each variable:
| Identifier |
Description |
| Name |
Variable name (maximum of 8 characters) |
| Description |
Variable descriptor (maximum 40 characters) |
| Format |
Number of bytes |
| Type |
Type of data: numeric (indicated by NUM) or character (indicated by CHAR) |
| Start |
Beginning column position of variable in record |
| End |
Ending column position of variable in record |
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2.4 Variable Source and Naming Conventions
In general, variable names reflect the content of the
variable, with an eight-character limitation. Generally, imputed/edited
variables end with an "X".
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2.4.1 Variable-Source Crosswalk
Variables were derived either from the HC
questionnaire itself, the MPC data collection instrument, or from the CAPI. The
source of each variable is identified in Section D "Variable - Source Crosswalk"
in one of four ways:
Variables derived from CAPI or assigned in sampling are so indicated as
"CAPI derived" or "Assigned in sampling," respectively; - Variables which come from one or more specific questions have those
questionnaire sections and question numbers indicated in the "Source"
column; questionnaire sections are identified as:
- EV – Event Roster section
- HH – Home Health Event section
- CP – Charge Payment section
Variables constructed from multiple questions using complex algorithms
are labeled "Constructed" in the "Source" column; and - Variables that have been edited or imputed are so indicated.
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2.4.2 Expenditure and Source of Payment Variables
The names of the expenditure and source of payment
variables follow a standard convention, are seven characters in length, and end
in an "X" indicating edited/imputed. Please note that imputed means that a
series of logical edits, as well as an imputation process to account for missing
data, have been performed on the variable.
The total sum of payments and the 12 source of payment
variables are named in the following way:
The first two characters indicate the type of event:
| IP - inpatient stay |
OB - office-based visit |
| ER - emergency room visit |
OP - outpatient visit |
| HH - home health visit |
DV - dental visit |
| OM - other medical equipment |
RX - prescribed medicine |
In the case of source of payment variables, the third and fourth characters indicate:
| SF - self or family |
OF - other Federal Government |
| MR - Medicare |
SL - State/local government |
| MD - Medicaid |
WC - Workers’ Compensation |
| PV - private insurance |
OT - other insurance |
| VA - Veterans Administration |
OR - other private |
| TR - TRICARE/CHAMPVA |
OU - other public |
| |
XP - sum of payments |
In addition, the total charge variable is indicated by
TC in the variable name.
The fifth and sixth characters indicate the year (07).
The seventh character, "X", indicates the variable is edited/imputed.
For example, HHSF07X is the edited/imputed amount paid
by self or family for 2007 home health expenditures.
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2.5 File Contents
2.5.1 Survey Administration Variables
2.5.1.1 Person Identifiers (DUID, PID, DUPERSID)
The dwelling unit ID (DUID) is a five-digit random
number assigned after the case was sampled for MEPS. The three-digit person
number (PID) uniquely identifies each person within the dwelling unit. The
eight-character variable DUPERSID uniquely identifies each person represented on
the file and is the combination of the variables DUID and PID. For detailed
information on dwelling units and families, please refer to the documentation
for the 2007 Full Year Population Characteristics file.
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2.5.1.2 Record Identifier (EVNTIDX)
EVNTIDX uniquely identifies each event (i.e., each
record on the home health file) and is the variable required to link home health
events to data files containing details on conditions (MEPS 2007 Medical
Conditions File). For details on linking see Section 5.0 or the MEPS 2007
Appendix File, HC-110I.
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2.5.1.3 Round Indicator (EVENTRN)
EVENTRN indicates the round in which the home health
event was reported. Please note: Rounds 3, 4, and 5 are associated with MEPS
survey data collected from Panel 11. Likewise, Rounds 1, 2, and 3 are associated
with data collected from Panel 12.
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2.5.1.4 Panel Indicator (PANEL)
PANEL is a constructed variable
used to specify the panel number for the person. PANEL will indicate either
Panel 11 or Panel 12 for each person on the file. Panel 11 is the panel that
started in 2006, and Panel 12 is the panel that started in 2007.
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2.5.2 Home Health Event Variables
This file contains variables describing home health
events reported by household respondents in the Home Health Section of the MEPS
HC survey questionnaire.
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2.5.2.1 Date of Event (HHDATEYR, HHDATEMM)
The date variables (HHDATEYR and HHDATEMM) indicate
the year and month that the household respondent reported as the year and month
of occurrence for this type of home health event. An artifact of the data
collection for the variable HHDATEYR is that a person may have started receiving
that type of home health care from that provider prior to 2007. These variables
should not be interpreted as "true" start dates.
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2.5.2.2 Characteristics of Event (MPCELIG-OTHCWOS)
The HC questionnaire asked the respondent to
indicate whether the home health provider event(s) for each month’s services
were provided through an agency or an independent paid provider (SELFAGEN). The
response to the SELFAGEN question dictated the skip pattern CAPI followed
regarding the questions in the home health section of the HC questionnaire. The
questionnaire also asked respondents if the provider was paid or whether a
friend, relative, or volunteer (HHTYPE) provided the home health services. The
constructed variable MPCELIG indicates whether the home health provider event
was eligible for MPC data collection and the type of imputation process the
event went through. MPCELIG is a more accurate variable for determining whether
the event was an agency, a paid independent or an informal care event. However,
SELFAGEN is a more accurate variable for determining the home health questions
asked of the respondent. All respondents receiving care from an agency, hospital
or nursing home were asked to identify the type of home health worker
(CNA-SPEECTHP) they saw – for example, certified nursing assistant, home health
aide, registered nurse, etc.
Analysts should keep in mind that these
identifications by household respondents are subjective in nature, are not
mutually exclusive or collectively exhaustive, and should not be used to make
certain estimates. For example, a person on one type of insurance may identify
an individual providing home health care services to them as a personal care
attendant while an individual having a different type of insurance coverage may
identify that same worker as a home care aide. Making estimates of personal care
attendants or home care aides based on their identification by household
respondents and treating these types of workers as mutually exclusive groups
will result in inaccurate estimates. Respondents may also have indicated that
they were seen by more than one home health care worker during a single event.
For example, since an event is a month of services, a respondent may have
reported being seen by a nurse, a physical therapist, and/or a home health aide
during a single event. Respondents were also asked to identify other
non-skilled, skilled, and other workers seen during that month of care
(NONSKILL-OTHCWOS). However, "other specify" variables (SKILLWOS and OTHCWOS)
were not reconciled with the type of health care worker variable (CNA-SPEECTHP).
In addition, the type of health care worker variables (CNA-SPEECTHP) were not
reconciled with MPCELIG, SELFAGEN and HHTYPE, so inconsistencies between these
variables are possible.
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2.5.2.3 Treatments, Therapies, and Services (HOSPITAL-OTHSVCOS)
Regardless of the type of provider, all respondents
were asked if the home health services received were due to a hospitalization
(HOSPITAL), whether services were due to a medical condition (VSTRELCN), if the
person was helped with daily activities (DAILYACT), if the person received
companionship services (COMPANY), and whether or not the person received any
other type of services (OTHSVCE and OTHSVCOS). Only persons receiving care from
a formal provider were asked if they were taught how to use medical equipment
(MEDEQUIP) and whether or not they received a medical treatment (TREATMT).
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2.5.2.4 Frequency of Event (FREQCY-HHDAYS)
Several variables identify the frequency and length of
home health events (FREQCY-MINLONG) and whether or not the same services were
received during each month (SAMESVCE). Frequency of event variables (FREQCY-
TMSPDAY) were used as building blocks to construct HHDAYS. HHDAYS indicates the
number of days the person received care during that event (i.e., month of care).
Frequency variables can be combined to get a measure of the intensity of care.
For example, HHDAYS can be used in conjunction with HRSLONG and TMSPDAY to form
a measure of intensity of care, that is, how many hours of care were provided in
one month.
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2.5.3 Flat Fee Variables
A flat fee is the fixed dollar amount a person is
charged for a package of health care services provided during a defined period
of time. Because MEPS does not collect flat fee information about home health
events, no flat fee variables are included in this file.
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2.5.4 Condition, Procedure, and Clinical Classification Codes
Information on household reported medical conditions
and procedures (including condition codes, procedure codes, and clinical
classification codes) associated with each home health event are NOT provided on
this file. To obtain complete condition information associated with an event,
the analyst must link to the 2007 Medical Conditions File. Details on how to
link to the MEPS 2007 Medical Conditions File are provided in the MEPS 2007
Appendix File, HC-110I.
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2.5.5 Expenditure Data
2.5.5.1 Definition of Expenditures
Expenditures on this file refer to what is paid for
health care services. More specifically, expenditures in MEPS are defined as the
sum of payments for care received, including out-of-pocket payments and payments
made by private insurance, Medicaid, Medicare and other sources. The definition
of expenditures used in MEPS differs slightly from its predecessors, the 1987
NMES and 1977 NMCES surveys, where "charges" rather than sum of payments were
used to measure expenditures. This change was adopted because charges became a
less appropriate proxy for medical expenditures during the 1990s due to the
increasingly common practice of discounting. Although measuring expenditures as
the sum of payments incorporates discounts in the MEPS expenditure estimates,
these estimates do not incorporate any payment not directly tied to specific
medical care events, such as bonuses or retrospective payment adjustments paid
by third party payers. Another general change from the two prior surveys is that
charges associated with uncollected liability, bad debt, and charitable care
(unless provided by a public clinic or hospital) are not counted as expenditures
because there are no payments associated with those classifications. While
charge data are provided on this file, data users/analysts should use caution
when working with this data because a charge does not typically represent actual
dollars exchanged for services or the resource costs of those services, nor are
they directly comparable to the expenditures defined in the 1987 NMES (for
details on expenditure definitions, see Monheit et al, 1999). For details on
expenditure definitions, please refer to the following, "Informing American
Health Care Policy" (Monheit et al., 2000). AHRQ has developed factors to apply
to the 1987 NMES expenditure data to facilitate longitudinal analysis. These
factors can be accessed via the CFACT Data Center. For more information, see the
Data Center section of the MEPS Web site at
www.meps.ahrq.gov/data_stats/onsite_datacenter.jsp.
If examining trends in MEPS expenditures or performing longitudinal analysis on
MEPS expenditures, please refer to section C, sub-section 3.3 for more
information.
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2.5.5.2 Data Editing and Imputation Methodologies of Expenditure Variables
The general methodology used for editing and imputing
expenditure data is described below. However, please note, the MPC included home
health events provided by an agency and did not include home health care
provided by paid independent providers. Although the general procedures remain
the same for all home health events, there were some differences in the editing
and imputation methodologies applied to those events followed in the MPC and
those events not followed in the MPC. Analysts should note that home health care
provided by friends, family, or volunteers was assumed to be free and was not
included in any imputation process. Please see below for details on the
differences between these editing/imputation methodologies.
Home health expenditure data for agency, hospital, and
nursing home providers were collected exclusively from the MPC (i.e., household
respondents were not asked to report home health expenditures from these types
of providers). The MPC contacted 100 percent of the agency, hospital, and
nursing home health providers identified by household respondents. Since paid
independent home health providers were not included in the MPC, all expenditure
data from these providers were collected from household respondents.
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2.5.5.2.1 General Data Editing Methodology
Logical edits were used to resolve internal
inconsistencies and other problems in the HC and MPC survey-reported data. The
edits were designed to preserve partial payment data from households and
providers, and to identify actual and potential sources of payment for each
household-reported event. In general, these edits accounted for outliers,
co-payments or charges reported as total payments, and reimbursed amounts that
were reported as out-of-pocket payments. In addition, edits were implemented to
correct for mis-classifications between Medicare and Medicaid and between
Medicare HMOs and private HMOs as payment sources. These edits produced a
complete vector of expenditures for some events, and provided the starting point
for imputing missing expenditures in the remaining events.
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2.5.5.2.2 General Hot-Deck Imputation
A weighted sequential hot-deck procedure was used to
impute for missing expenditures, as well as total charge. This procedure uses
survey data from respondents to replace missing data, while taking into account
the respondents’ weighted distribution in the imputation process. Classification
variables vary by event type in the hot-deck imputations, but total charge and
insurance coverage are key variables in all of the imputations. Separate
imputations were performed for nine categories of medical provider care:
inpatient hospital stays, outpatient hospital department visits, emergency room
visits, visits to physicians, visits to non-physician providers, dental
services, home health care by certified providers, home health care by paid
independents, and other medical expenses. Within this file, simple events were
imputed separately. After the imputations were finished, visits to physician and
non-physician providers were combined into a single medical provider file. The
two categories of home care also were combined into a single home health file.
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2.5.5.2.3 Home Health Data Editing and Imputation
Expenditures for home health events were developed in
a sequence of logical edits and imputations. (Analysts should note that home
health care provided by friends, family, or volunteers was assumed not to have
associated expenditures and was not included in any imputation process. All
expenditures for home health care provided by informal care providers were
assigned "–1" (INAPPLICABLE) because those types of events were skipped out
(never asked) of the questions regarding expenditures.) "Household" edits were
applied to sources and amounts of payment for all household-reported events for
paid independent providers and unmatched agency providers. "MPC" edits were
applied to provider-reported sources and amounts of payment for records matched
to household-reported events for all agency home health providers. Both sets of
edits were used to correct obvious errors in the reporting of expenditures.
Imputations for independent paid providers and for agencies were conducted
separately. Within this file, separate imputations were performed for simple
events.
Logical edits were used to sort each event into a
specific category for the imputations. Events with complete expenditures were
flagged as potential donors for the hot-deck imputations while events with
missing expenditure data were assigned to various recipient categories. Each
event with missing expenditure data was assigned to a recipient category based
on the extent of its missing charge and expenditure data. For example, an event
with a known total charge but no expenditure information was assigned to one
category, while an event with a known total charge and partial expenditure
information was assigned to a different category. Similarly, events without a
known total charge and no or partial expenditure information were assigned to
various recipient categories.
The logical edits produced eight recipient categories
for HHP (Home Healthcare Paid Independents) and eight recipient categories for HHA (Home Healthcare Agency) for events with missing data. Expenditures were
imputed through separate hot-deck imputations for each of the eight recipient
categories. The donor pool in these imputations includes events with complete
expenditures from the HC for HHP or the MPC for HHA.
The donor pool included "free events" because, in some
instances, providers are not paid for their services. These events represent
charity care, bad debt, provider failure to bill, and third party payer
restrictions on reimbursement in certain circumstances. (This does not include
MPCELIG=3 (informal) events. As stated previously, home health care provided by
friends, family, or volunteers (informal, MPCELIG=3) was assumed not to have
expenditures associated with it and was not included in any imputation process.)
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2.5.5.3 Imputation Flag Variable (IMPFLAG)
IMPFLAG is a six-category variable that indicates if
the event contains complete Household Component (HC) or Medical Provider
Component (MPC) data, was fully or partially imputed, or was imputed in the
capitated imputation process. The following list identifies how the imputation
flag is coded; the categories are mutually exclusive.
IMPFLAG=0 not eligible for imputation (includes zeroed out events)
IMPFLAG=1 complete HC data
IMPFLAG=2 complete MPC data
IMPFLAG=3 fully imputed
IMPFLAG=4 partially imputed
IMPFLAG=5 complete MPC data through capitation imputation (not applicable to HH)
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2.5.5.4 Flat Fee Expenditures
A flat fee is the fixed dollar amount a person is
charged for a package of health care services provided during a defined period
of time. Because MEPS does not collect flat fee information about home health
events, there are no flat fee expenditure data included in this file.
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2.5.5.5 Zero Expenditures
There are some medical events reported by respondents
where the payments were zero. This could occur for several reasons including (1)
free care was provided, (2) bad debt was incurred, (3) follow-up events were
provided without a separate charge (e.g., after a surgical procedure), or (4)
the event was paid for through government or privately-funded research or
clinical trials. If all of the medical events for a person fell into one of
these categories, then the total annual expenditures for that person would be
zero. All expenditures for home health care provided by informal care providers
(family, friends, or volunteers, MPCELIG=3) were assigned –1 "INAPPLICABLE"
because those types of events were skipped out (never asked) of the questions
regarding expenditures.
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2.5.5.6 Sources of Payment
In addition to total expenditures, variables are
provided which itemize expenditures according to major source of payment
categories. These categories are:
- Out-of-pocket by user or family,
- Medicare,
- Medicaid,
- Private Insurance,
- Veterans Administration, excluding TRICARE/CHAMPVA,
- TRICARE/CHAMPVA,
- Other Federal sources - includes Indian Health Service, Military
Treatment Facilities, and other care by the Federal government,
- Other State and Local sources - includes community and neighborhood
clinics, State and local health departments, and State programs other than
Medicaid,
- Workers’ Compensation, and
- Other Unclassified sources - includes sources such as automobile,
homeowner’s, and liability insurance, and other miscellaneous or unknown
sources.
Two additional source of payment variables were
created to classify payments for events with apparent inconsistencies
between insurance coverage and sources of payment based on data collected in
the survey. These variables include:
- Other Private - any type of private insurance payments reported for
persons not reported to have any private health insurance coverage during
the year as defined in MEPS, and
- Other Public - Medicare/Medicaid payments reported for persons who were
not reported to be enrolled in the Medicare/Medicaid program at any time
during the year.
Though relatively small in magnitude, data
users/analysts should exercise caution when interpreting the expenditures
associated with these two additional sources of payment. While these payments
stem from apparent inconsistent responses to health insurance and source of
payment questions in the survey, some of these inconsistencies may have logical
explanations. For example, private insurance coverage in MEPS is defined as
having a major medical plan covering hospital and physician services. If a MEPS
sampled person did not have such coverage but had a single service type
insurance plan (e.g., dental insurance) that paid for a particular episode of
care, those payments may be classified as "other private." Some of the "other
public" payments may stem from confusion between Medicaid and other state and
local programs or may be from persons who were not enrolled in Medicaid, but
were presumed eligible by a provider who ultimately received payments from the
public payer.
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2.5.5.7 Home Health Expenditure Variables (HHSF07X - HHXP07X)
Home health agency, hospital, and nursing home events
are sampled at a rate of 100% for the MPC. Households were not asked any
expenditure-related questions in regards to these types of events; therefore,
there are no household reported expenditure data for these events. Conversely,
paid independent providers are not included in the MPC. Household reported
responses are the only data available for these types of events. All expenditure
data for paid independent providers are fully imputed from household reported
expenditures. There are no expenditure data for informal care providers.
Informal care (MPCELIG=3, unpaid care provided by family, friends, or
volunteers) was assigned -1, "INAPPLICABLE", in all expenditure categories.
The constructed variable MPCELIG is provided on this
file. MPCELIG indicates whether the home health provider event was eligible for
MPC data collection, and MPCELIG determines the imputation process applied to
that event.
All of these expenditures have gone through an editing
and imputation process and have been rounded to the nearest penny. HHSF07X -
HHOT07X are the 12 sources of payment. HHTC07X is the total charge, and HHXP07X
is the sum of the 12 sources of payment for the home health expenditures. The 12
sources of payment are: self/family (HHSF07X), Medicare (HHMR07X), Medicaid
(HHMD07X), private insurance (HHPV07X), Veterans Administration (HHVA07X),
TRICARE/CHAMPVA (HHTR07X), other Federal sources (HHOF07X), State and Local
(non-federal) government sources (HHSL07X), Workers’ Compensation (HHWC07X),
other private insurance (HHOR07X), other public insurance (HHOU07X), and other
insurance (HHOT07X). Analysts can determine if a home health event was provided
by an agency or by some other paid independent provider by subsetting the
variable MPCELIG to the appropriate and desired value.
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2.5.5.8 Rounding
Expenditure variables on the 2007 home health event
file have been rounded to the nearest penny. Person-level expenditure
information released on the 2007 Person-Level Expenditure File was rounded to
the nearest dollar. It should be noted that using the 2007 MEPS event files to
create person-level totals will yield slightly different totals than those on
the person-level expenditure file. These differences are due to rounding only.
Moreover, in some instances, the number of persons having expenditures on the
event files for a particular source of payment may differ from the number of
persons with expenditures on the person-level expenditure file for that source
of payment. This difference is also an artifact of rounding only. Please see the
MEPS 2007 Appendix File, HC-110I, for details on such rounding differences.
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3.0 Sample Weight (PERWT07F)
3.1 Overview
There is a single full year person-level weight
(PERWT07F) assigned to each record for each key, in-scope person who responded
to MEPS for the full period of time that he or she was in-scope during 2007. A
key person either was a member of an NHIS household at the time of the NHIS
interview, or became a member of a family associated with such a household after
being out-of-scope at the time of the NHIS (the latter circumstance includes
newborns as well as persons returning from military service, an institution, or
living outside the United States). A person is in-scope whenever he or she is a
member of the civilian noninstitutionalized portion of the U.S. population.
There has been an important change in the MEPS sample
design that is worth noting. The MEPS sample of households for Round 1 of a
given MEPS panel is a subsample of the responding households to the previous
year’s National Health Interview Survey (NHIS). A new NHIS sample design was
implemented in 2006 with a new sample of PSUs and segments, independent of the
sample design used from 1995-2005. Thus, MEPS Panel 12 households fielded
initially in 2007, selected from the 2006 NHIS household respondents, are from a
sample design independent of those sampled for MEPS Panel 11 from among 2005
NHIS household respondents. As a result, with two national samples of PSUs and
segments fielded for MEPS and with a somewhat reduced sample size for Panel 12,
the amount of clustering is reduced with the expectation of some increase in
precision for 2007 MEPS estimates. There will also be more degrees of freedom
due to more variance strata available for variance estimation purposes. The
trade-off for these expected increases in precision and degrees of freedom is
that it is more expensive to field a sample that is less concentrated. In 2008
both MEPS panels will have been sampled from the new NHIS sample design, with
corresponding reductions in survey costs, precision, and degrees of freedom.
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3.2 Details on Person Weight Construction
The person-level weight PERWT07F was developed in
several stages. Person-level weights for Panels 11 and 12 were created
separately. The weighting process for each panel included an adjustment for
nonresponse over time and calibration to independent population figures. The
calibration was initially accomplished separately for each panel by raking the
corresponding sample weights to Current Population Survey (CPS) population
estimates based on five variables. The five variables used in the establishment
of the initial person-level control figures were: census region (Northeast,
Midwest, South, West); MSA status (MSA, non-MSA); race/ethnicity (Hispanic,
non-Hispanic with black as sole reported race, non-Hispanic with Asian as sole
reported race, and other); sex; and age. A 2007
composite weight was then formed by multiplying each weight from Panel 11 by the
factor .56 and each weight from Panel 12 by the factor .44. The choice of
factors reflected the relative sample sizes of the two panels, helping to limit
the variance of estimates obtained from pooling the two samples. The composite
weight was again raked to the same set of CPS-based control totals. When poverty
status information derived from income variables became available, a final
raking was undertaken on the previously established weight variable. Control
totals were established using poverty status (five categories: below poverty,
from 100 to 125 percent of poverty, from 125 to 200 percent of poverty, from 200
to 400 percent of poverty, at least 400 percent of poverty) as well as the
original five variables used in the previous calibrations.
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3.2.1 MEPS Panel 11 Weight
The person-level weight for MEPS Panel 11 was
developed using the 2006 full year weight for an individual as a "base" weight
for survey participants present in 2006. For key, in-scope respondents who
joined an RU some time in 2007 after being out-of-scope in 2006, the 2006 family
weight associated with the family the person joined served as a "base" weight.
The weighting process included an adjustment for nonresponse over Rounds 4 and 5
as well as raking to population control figures for December 2007. These control
figures were derived by scaling back the population totals obtained from the
March 2008 CPS to correspond to a national estimate for the civilian
noninstitutionalized population provided by the Census Bureau for December 2007.
Variables used in the establishment of person-level control figures included:
census region (Northeast, Midwest, South, West); MSA status (MSA, non-MSA);
race/ethnicity (Hispanic, black but non-Hispanic, Asian but non-Hispanic,
and other); sex; and age. Overall, the weighted population estimate for
the civilian noninstitutionalized population on December 31, 2007 is
297,823,930. Key, responding persons not in-scope on December 31, 2007 but
in-scope earlier in the year retained, as their final Panel 11 weight, the
weight after the nonresponse adjustment.
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3.2.2 MEPS Panel 12 Weight
The person-level weight for MEPS Panel 12 was
developed using the MEPS Round 1 person-level weight as a "base" weight. For
key, in-scope respondents who joined an RU after Round 1, the Round 1 family
weight served as a "base" weight. The weighting process included an adjustment
for nonresponse over Round 2 and the 2007 portion of Round 3 as well as raking
to the same population control figures for December 2007 used for the MEPS Panel
11 weights. The same five variables employed for Panel 11 raking (census region,
MSA status, race/ethnicity, sex, and age) were used for Panel 12 raking.
Similarly, for Panel 12, key, responding persons not in-scope on December 31,
2007 but in-scope earlier in the year retained, as their final Panel 12 weight,
the weight after the nonresponse adjustment.
Note that the MEPS Round 1 weights incorporated the
following components: the original household probability of selection for the
NHIS; ratio-adjustment to NHIS-based national population estimates at the
household (occupied dwelling unit) level; adjustment for nonresponse at the
dwelling unit level for Round 1; and poststratification to figures at the family
and person level obtained from the March CPS data base of the corresponding year
(i.e., 2006 for Panel 11 and 2007 for Panel 12).
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3.2.3 The Final Weight for 2007
Variables used in the establishment of person-level
control figures included: poverty status (below poverty, from 100 to 125 percent
of poverty, from 125 to 200 percent of poverty, from 200 to 400 percent of
poverty, at least 400 percent of poverty); census region (Northeast, Midwest,
South, West); MSA status (MSA, non-MSA); race/ethnicity (Hispanic, non-Hispanic
with black as sole reported race, non-Hispanic with Asian as sole reported race,
and other); sex; and age. Overall, the weighted population estimate for the
civilian noninstitutionalized population for December 31, 2007 is 297,823,930
(PERWT07F>0 and INSC1231=1). In addition, the weights of two groups of persons
who were out-of-scope on December 31, 2007 were poststratified.
Specifically, the weights of those who were in-scope some time during the year,
out-of-scope on December 31, and entered a nursing home during the year were
poststratified to a corresponding control total obtained from the 1996 MEPS
Nursing Home Component. Those who died while in-scope during 2007 were
poststratified to corresponding estimates derived using data obtained from the
Medicare Current Beneficiary Survey (MCBS) and Vital Statistics information
provided by the National Center for Health Statistics (NCHS). Separate control
totals were developed for the "65 and older" and "under 65" civilian
noninstitutionalized populations. The sum of the person-level weights across all
persons assigned a positive person level weight is 301,309,149.
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3.2.4 Coverage
The target population for MEPS in this file is the
2007 U.S. civilian noninstitutionalized population. However, the MEPS sampled
households are a subsample of the NHIS households interviewed in 2005 (Panel 11)
and 2006 (Panel 12). New households created after the NHIS interviews for the
respective Panels and consisting exclusively of persons who entered the target
population after 2005 (Panel 11) or after 2006 (Panel 12) are not covered by
MEPS. Neither are previously out-of-scope persons who join an existing household
but are unrelated to the current household residents. Persons not covered by a
given MEPS panel thus include some members of the following groups: immigrants;
persons leaving the military; U.S. citizens returning from residence in another
country; and persons leaving institutions. The set of uncovered persons
constitutes only a small segment of the MEPS target population.
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3.3 Using MEPS Data for Trend Analysis
MEPS began in 1996, and the utility of the survey for
analyzing health care trends expands with each additional year of data. However,
it is important to consider a variety of factors when examining trends over time
using MEPS. Statistical significance tests should be conducted to assess the
likelihood that observed trends may be attributable to sampling variation. The
length of time being analyzed should also be considered. In particular, large
shifts in survey estimates over short periods of time (e.g. from one year to the
next) that are statistically significant should be interpreted with caution,
unless they are attributable to known factors such as changes in public policy,
economic conditions, or MEPS survey methodology. Looking at changes over longer
periods of time can provide a more complete picture of underlying trends.
Analysts may wish to consider using techniques to smooth or stabilize analyses
of trends using MEPS data such as comparing pooled time periods (e.g. 1996-97
versus 2004-05), working with moving averages, or using modeling techniques with
several consecutive years of MEPS data to test the fit of specified patterns
over time. Finally, researchers should be aware of the impact of multiple
comparisons on Type I error. Without making appropriate allowance for multiple
comparisons, undertaking numerous statistical significance tests of trends
increases the likelihood of concluding that a change has taken place when one
has not.
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4.0 Strategies for Estimation
4.1 Developing Event-Level Estimates
The data in this file can be used to develop national
2007 event level (i.e., monthly) estimates for the U.S. civilian
noninstitutionalized population on expenditures and sources of payment for home
health care medical provider visits. The weight assigned to each home health
care medical provider event reported is the person-level weight of the person
who was visited. If a person had several events reported, each event is assigned
that individual’s person-level weight. Estimates must be weighted by PERWT07F to
be nationally representative. For example, the appropriate estimate for the
overall mean out-of-pocket payment per month of care is computed as follows (the
subscript ‘j’ identifies each event and represents a numbering of events from 1
through the total number of events in the file):
 , where
 = PERWT07Fj(full year person weight for the person
associated with event j) and
 = HHSF07Xj (amount paid by self/family for event j)
Estimates and corresponding standard errors (SE) can
be derived using an appropriate computer software package for complex survey
analysis such as SAS, Stata, SUDAAN or SPSS (www.meps.ahrq.gov/survey_comp/standard_errors.jsp).
The tables below contain the correct event-level
estimates for several key variables on this file. Informal care (MPCELIG = 3) is
not included in the tables because, by definition, there are no payments for
those events and, therefore, no expenditure data are collected.
Selected Event-Level Estimates
Expenditures: Home Health Agency & Paid Independents (MPCELIG = 1, 2):
| Estimate of Interest |
Variable |
Estimate (SE) |
Estimate
Excluding Zero
Payment Events
(SE) |
| Proportion of events with expenditures>0* |
HHXP07X |
0.964 (0.0131) |
----- |
| Mean total payments per month of care |
HHXP07X |
$1,159 (157.0) |
$1,202 (161.4) |
| Mean out-of-pocket payments per month of care |
HHSF07X |
$73 (14.5) |
$75 (14.9) |
| Mean proportion of total monthly expenditures paid out of pocket |
HHSF07X/
HHXP07X |
----- |
0.207 (0.0265) |
| Mean total payments per month where any services provided due to hospitalization (HOSPITAL=1) |
HHXP07X |
$1,255 (100.2) |
$1,288 (102.6) |
Expenditures: Home Health Agency Providers only (MPCELIG=1)
| Estimate of Interest |
Variable |
Estimate (SE) |
Estimate
Excluding Zero
Payment Events
(SE) |
| Proportion of events with expenditures>0* |
HHXP07X |
0.982 (0.0042) |
----- |
| Mean total payments per month |
HHXP07X |
$1,337 (189.0) |
$1,362 (192.0) |
| Mean out-of-pocket payments per month |
HHSF07X |
$32 (7.2) |
$32 (7.3) |
| Mean proportion of total monthly expenditures paid out of pocket |
HHSF07X/
HHXP07X |
----- |
0.087 (0.0168) |
| Mean total payments per month where any services provided due to hospitalization (HOSPITAL=1) |
HHXP07X |
$1,332 (108.5) |
$1,367 (110.6) |
Expenditures: Paid Independent Providers only (MPCELIG=2)
| Estimate of Interest |
Variable |
Estimate (SE) |
Estimate
Excluding Zero
Payment Events
(SE) |
| Proportion of events with expenditures>0* |
HHXP07X |
0.890 (0.0628) |
----- |
| Mean total payments per month |
HHXP07X |
$385 (64.3) |
$432 (63.9) |
| Mean out-of-pocket payments per month of care |
HHSF07X |
$250 (52.0) |
$281 (50.8) |
| Mean proportion of total monthly expenditures paid out of pocket |
HHSF07X/
HHXP07X |
----- |
0.782 (0.0496) |
| Mean total payments per month where any services provided due to hospitalization (HOSPITAL=1) |
HHXP07X |
$552 (119.9) |
$567 (123.0) |
*Zero payment events can occur in MEPS for the
following reasons: (1) there was no charge for a follow-up event, (2) the
provider was never paid by an individual, insurance plan, or other source for
services provided, (3) charges were included in another bill, or (4) the event
was paid for through government or privately-funded research or clinical trials.
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4.2 Person-Based Estimates for Home Health Care
To enhance analyses of home health care, analysts may
link information about the home health care received by sample persons in this
file to the annual full year consolidated file (which has data for all MEPS
sample persons), or conversely, link person-level information from the full year
consolidated file to this event level file. Both this file and the full year
consolidated file may be used to derive estimates relative to persons with home
health care and annual estimates of total expenditures. However, if the estimate
relates to the entire population, this file cannot be used to calculate the
denominator, as only those persons with at least one month in which home health
care was provided are represented on this data file. Therefore, the full year
consolidated file must be used for person-level analyses that include both those
with and without home health care.
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4.3 Variables with Missing Values
It is essential that the analyst examine all variables
for the presence of negative values used to represent missing values. For
continuous or discrete variables, where means or totals may be taken, it may be
necessary to set negative values to values appropriate to the analytic needs.
That is, the analyst should either impute a value or set the value to one that
will be interpreted as missing by the computing language used. For categorical
and dichotomous variables, the analyst may want to consider whether to recode or
impute a value for cases with negative values or whether to exclude or include
such cases in the numerator and/or denominator when calculating proportions.
Methodologies used for the editing/imputation of expenditure variables (e.g.,
sources of payment and zero expenditures) are described in Section 2.5.5.2.
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4.4 Variance Estimation (VARPSU, VARSTR)
MEPS has a complex sample
design. To obtain estimates of variability (such as the standard error of sample
estimates or corresponding confidence intervals) for MEPS estimates, analysts
need to take into account the complex sample design of MEPS for both
person-level and family-level analyses. Several methodologies have been
developed for estimating standard errors for surveys with a complex sample
design, including the Taylor-series linearization method, balanced repeated
replication, and jackknife replication. Various software packages provide
analysts with the capability of implementing these methodologies. Replicate
weights have not been developed for the MEPS data. Instead, the variables needed
to calculate appropriate standard errors based on the Taylor-series
linearization method are included on this file as well as all other MEPS public
use files. Software packages that permit the use of the Taylor-series
linearization method include SUDAAN, Stata, SAS (version 8.2 and higher), and
SPSS (version 12.0 and higher). For complete information on the capabilities of
each package, analysts should refer to the corresponding software user
documentation.
Using the Taylor-series linearization method, variance
estimation strata and the variance estimation PSUs within these strata must be
specified. The variance strata variable is named VARSTR, while the variance PSU
variable is named VARPSU. Specifying a "with replacement" design in a computer
software package, such as SUDAAN, provides standard errors appropriate for
assessing the variability of MEPS survey estimates. It should be noted that the
number of degrees of freedom associated with estimates of variability indicated
by such a package may not appropriately reflect the actual number available. For
MEPS sample estimates for characteristics generally distributed throughout the
country (and thus the sample PSUs), one can expect at least 100 degrees of
freedom for the 2007 full year data associated with the corresponding estimates
of variance and usually substantially more.
Prior to 2002, MEPS variance strata and PSUs were
developed independently from year to year, and the last two characters of the
strata and PSU variable names denoted the year. However, beginning with the 2002
Point-in-Time PUF, the variance strata and PSUs were developed to be compatible
with MEPS data associated with the NHIS sample design used through 2006. Such
data can be pooled and the variance strata and PSU variables provided can be
used without modification for variance estimation purposes for estimates
covering multiple years of data.
As a result of the change in the NHIS sample design in 2006, a new set of variance
strata and PSUs have been established for variance estimation purposes for use
with MEPS Panel 12 and subsequent MEPS panels. There were 203 variance
estimation strata associated with MEPS Panel 11 and 165 variance strata
associated with MEPS Panel 12, or 368 variance strata in all, providing a
substantial number of degrees of freedom for subgroups as well as the nation as
a whole. Each variance stratum contains either two or three variance estimation
PSUs.
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5.0 Merging/Linking MEPS Data Files
Data from this file can be used alone or in
conjunction with other files for different analytic purposes. This section
provides instructions, or the details on where to find the instructions, for
linking the 2007 home health provider events with other 2007 MEPS public use
files, including the 2007 person-level and conditions files. Each MEPS panel can
also be linked back to the previous years’ National Health Interview Survey
public use data files. For information on obtaining MEPS/NHIS link files please
see
www.meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.
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5.1 Linking to the Person-Level File
Merging characteristics of interest from other 2007
MEPS files (e.g., the 2007 Full Year Consolidated File or the 2007
Prescribed Medicines File) expands the scope of potential estimates. For
example, to estimate the total number of home health provider events of persons
with specific characteristics (e.g., age, race, and sex), population
characteristics from a person-level file need to be merged onto the home health
provider file. This procedure is illustrated below. The MEPS 2007 Appendix File,
HC-110I, provides additional details on how to merge 2007 MEPS data files.
Create data set PERSX by sorting the 2007 Full Year Consolidated File by the person identifier, DUPERSID. Keep only variables
to be merged on to the home health provider event file and DUPERSID. Create data set HVIS by sorting the home health provider event file by
person identifier, DUPERSID. - Create final data set NEWHVIS by merging these two files by DUPERSID,
keeping only records on the home health provider event file.
The following is an example of SAS code, which completes these steps:
PROC SORT DATA=HCXXX (KEEP=DUPERSID AGE31X AGE42X AGE53X SEX RACEX EDUCYR) OUT=PERSX;
BY DUPERSID;
RUN;
PROC SORT DATA=HVIS;
BY DUPERSID;
RUN;
DATA NEWHVIS;
MERGE HVIS (IN=A) PERSX (IN=B);
BY DUPERSID;
IF A;
RUN;
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5.2 Linking to the Prescribed Medicines File
The RXLK provides a link from 2007 MEPS event files to
the 2007 Prescribed Medicines File. Because prescribed medicines data are not
collected for home health events, this Home Health File cannot be linked to the
2007 Prescribed Medicines File.
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5.3 Linking to the Medical Conditions File
The CLNK provides a link from 2007 MEPS event files to
the 2007 Medical Conditions File. When using the CLNK, data users/analysts
should keep in mind that (1) conditions are self-reported and (2) there may be
multiple conditions associated with a home health provider event. Data
users/analysts should also note that not all home health provider events link to
the condition file. For detailed linking examples, including SAS code, data
users/analysts should refer to the MEPS 2007 Appendix File, HC-110I.
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References
Cohen, S.B. (1999). Sample Design of the 1996 Medical
Expenditure Panel Survey Medical Provider Component. Journal of
Economic and Social Measurement. Vol 24, 25-53.
Cohen, S.B. (1997). Sample Design of the 1996 Medical
Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health
Care Policy and Research; 1997. MEPS Methodology Report, No. 2.
AHCPR Pub. No. 97-0027.
Cohen, J.W. (1997). Design and Methods of the Medical
Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health
Care Policy and Research; 1997. MEPS Methodology Report, No. 1.
AHCPR Pub. No. 97-0026.
Cohen, S.B. (1996). The Redesign of the Medical
Expenditure Panel Survey: A Component of the DHHS Survey Integration Plan.
Proceedings of the COPAFS Seminar on Statistical Methodology in the Public
Service.
Cox, B.G. and Cohen, S.B. (1985). Chapter 8:
Imputation Procedures to Compensate for Missing Responses to Data Items. In
Methodological Issues for Health Care Surveys. Marcel Dekker, New York.
Monheit, A.C., Wilson, R., and Arnett, III, R.H.
(Editors) (1999). Informing American Health Care Policy. Jossey-Bass Inc, San
Francisco.
Shah, B.V., Barnwell, B.G., Bieler, G.S., Boyle, K.E.,
Folsom, R.E., Lavange, L., Wheeless, S.C., and Williams, R. (1996). Technical
Manual: Statistical Methods and Algorithms Used in SUDAAN Release 7.0,
Research Triangle Park, NC: Research Triangle Institute.
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D. Variable-Source Crosswalk
VARIABLE-SOURCE CROSSWALK
FOR MEPS HC-110H: 2007 HOME HEALTH VISITS
Survey Administration Variables
Variable |
Description |
Source |
DUID |
Dwelling unit ID |
Assigned in sampling |
PID |
Person number |
Assigned in sampling |
DUPERSID |
Person ID (DUID + PID) |
Assigned in sampling |
EVNTIDX |
Event ID |
Assigned in sampling |
EVENTRN |
Event round number |
CAPI derived |
PANEL |
Panel Number |
Constructed |
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Home Health Events Variables
Variable |
Description |
Source |
HHDATEYR |
Event date – year |
CAPI derived |
HHDATEMM |
Event date – month |
CAPI derived |
MPCELIG |
MPC eligibility flag |
Constructed |
SELFAGEN |
Does provider work for agency or self |
EV06A |
HHTYPE |
Home health event type |
EV06 |
CNA |
Type of hlth care wrkr – cert nurse asst |
HH01 |
COMPANN |
Type of hlth care wrkr – companion |
HH01 |
DIETICN |
Type of hlth care wrkr – dietitian/nutrt |
HH01 |
HHAIDE |
Type of hlth care wrkr – home care aide |
HH01 |
HOSPICE |
Type of hlth care wrkr – hospice worker |
HH01 |
HMEMAKER |
Type of hlth care wrkr - homemaker |
HH01 |
IVTHP |
Type of hlth care wrkr – IV therapist |
HH01 |
MEDLDOC |
Type of hlth care wrkr – medical doctor |
HH01 |
NURPRACT |
Type of hlth care wrkr – nurse/practr |
HH01 |
NURAIDE |
Type of hlth care wrkr – nurse’s aide |
HH01 |
OCCUPTHP |
Type of hlth care wrkr – occup therap |
HH01 |
PERSONAL |
Type of hlth care wrkr – pers care attdt |
HH01 |
PHYSLTHP |
Type of hlth care wrkr – physicl therapy |
HH01 |
RESPTHP |
Type of hlth care wrkr – respira therapy |
HH01 |
SOCIALW |
Type of hlth care wrkr – social worker |
HH01 |
SPEECTHP |
Type of hlth care wrkr – speech therapy |
HH01 |
OTHRHCW |
Type of hlth care wrkr – other |
HH01 |
NONSKILL |
Type of hlth care wrkr – non-skilled |
HH02 |
SKILLED |
Type of hlth care wrkr – skilled |
HH02 |
SKILLWOS |
Specify type of skilled worker |
HH02OV1 |
OTHCW |
Type of hlth care wrkr – some other |
HH02 |
OTHCWOS |
Specify other type health care worker |
HH02OV2 |
HOSPITAL |
Any hh care svce due to hospitalization |
HH04 |
VSTRELCN |
Any hh care svce Related to Hlth Cond |
HH04 |
TREATMT |
Person received medical treatment |
HH06 |
MEDEQUIP |
Person was taught use of med equipment |
HH07 |
DAILYACT |
Person was helped with daily activities |
HH08 |
COMPANY |
Person received companionship services |
HH09 |
OTHSVCE |
Person received oth home care services |
HH10 |
OTHSVCOS |
Specify other home care srvce received |
HH10OV |
FREQCY |
Provider helped every week/some weeks |
HH11 |
DAYSPWK |
# days / week provider came |
HH12 |
DAYSPMO |
# days / month provider came |
HH13 |
HOWOFTEN |
Prov came once per day/more than once |
HH14 |
TMSPDAY |
Times/day provider came to home to help |
HH15 |
HRSLONG |
Hours each visit lasted |
HH16_01 |
MINLONG |
Minutes each visit lasted |
HH16_02 |
SAMESVCE |
Any oth mons per received same services |
HH17 |
HHDAYS |
Days per month in home health, 2007 |
Constructed |
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Imputed Expenditure Variables
Variable |
Description |
Source |
HHSF07X |
Amount paid, family (Imputed) |
CP Section (Edited) |
HHMR07X |
Amount paid, Medicare (Imputed) |
CP Section (Edited) |
HHMD07X |
Amount paid, Medicaid (Imputed) |
CP Section (Edited) |
HHPV07X |
Amount paid, private insurance (Imputed) |
CP Section (Edited) |
HHVA07X |
Amount paid, Veterans (Imputed) |
CP Section (Edited) |
HHTR07X |
Amount paid, TRICARE/CHAMPVA (Imputed) |
CP Section (Edited) |
HHOF07X |
Amount paid, other federal (Imputed) |
CP Section (Edited) |
HHSL07X |
Amount paid, state & local gov (Imputed) |
CP Section (Edited) |
HHWC07X |
Amount paid, workers comp (Imputed) |
CP Section (Edited) |
HHOR07X |
Amount paid, other private (Imputed) |
Constructed |
HHOU07X |
Amount paid, other public (Imputed) |
Constructed |
HHOT07X |
Amount paid, other insurance (Imputed) |
CP Section (Edited) |
HHXP07X |
Sum of HHSF07X – HHOT07X (Imputed) |
Constructed |
HHTC07X |
Hhld reported total charge (Imputed) |
CP Section (Edited) |
IMPFLAG |
Imputation status |
Constructed |
Return To Table Of Contents
Weights
Variable |
Description |
Source |
PERWT07F |
Expenditure file person weight, 2007 |
Constructed |
VARSTR |
Variance estimation stratum, 2007 |
Constructed |
VARPSU |
Variance estimation PSU, 2007 |
Constructed |
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