MEDICAL EXPENDITURE PANEL SURVEY
HOUSEHOLD COMPONENT MAIN STUDY

BLAISE SHOW CARDS

Panels 24, 23, and 22

January 2019

TABLE OF CONTENTS
ROUNDS 1-5
Card Number	Topic	Round(s) Used
RE-1	Periods of Active Duty Service	1, 2, 3, 4, 5
RE-2	Ethnic Background	1, 2, 3, 4, 5
RE-3	Racial Background	1, 2, 3, 4, 5
PE-1	Types of Cancer	1, 2, 3, 4
PE-2	Frequency Scale	1, 2, 3, 4
HE-1	Level of Difficulty Categories	1, 3
PP-1	Types of Hospital Visits	1, 2, 3, 4, 5
PP-2	Types of Emergency Room Services	1, 2, 3, 4, 5
PP-3	Types of Outpatient Care	1, 2, 3, 4, 5
PP-4	Types of Primary Care	1, 2, 3, 4 ,5
PP-5	Types of Medical Specialists	1, 2, 3, 4, 5
PP-6	Types of Dental Care Providers	1, 2, 3, 4, 5
PP-7	Types of Mental Health Professionals	1, 2, 3, 4, 5
PP-8	Types of Other Medical Professionals	1, 2, 3, 4, 5
PP-9	Types of Clinics	1, 2, 3, 4, 5
PP-10	Types of Laboratories	1, 2, 3, 4, 5
PP-11	Types of Therapists	1, 2, 3, 4, 5
PP-12	Types of Vision Care Providers	1, 2, 3, 4, 5
PP-13	Types of Alternative Care	1, 2, 3, 4, 5
PP-14	Types of Home Care Services	1, 2, 3, 4, 5
PP-15	Types of Residential Care	1, 2, 3, 4, 5
EV-1A	Examples of Where Care Received (Event Typing)	1, 2, 3, 4, 5
EV-1B	Examples of Where Care Received (Event Typing)	1, 2, 3, 4, 5
HS-1	Reasons for Entering the Hospital	1, 2, 3, 4, 5
ER-1	Care Received During ER Visit	1, 2, 3, 4, 5
ER-2	Services Received During ER Visit	1, 2, 3, 4, 5
OP-1	Care Received During Outpatient Visit	1, 2, 3, 4, 5
OP-2	Services Received During Outpatient Visit	1, 2, 3, 4, 5
MV-1	Care Received During Medical Provider Visit	1, 2, 3, 4, 5
MV-2	Services Received During Medical Provider Visit	1, 2, 3, 4, 5
DN-1	Types of Dental Care Providers	1, 2, 3, 4, 5
DN-2	Care Received During Dental Visit	1, 2, 3, 4, 5
HH-1	Types of Home Health Care Workers	1, 2, 3, 4, 5
HH-2	Types of Home Health Care Workers	1, 2, 3, 4, 5
IC-1	Types of Residential Care Facilities	1, 2, 3, 4, 5
OM-1	Types of Disposable Medical Supplies	1, 2, 3, 4, 5
OM-2	Types of Other Medical Equipment	1, 2, 3, 4, 5
CP-1	Reasons for Not Receiving Anything in Writing	1, 2, 3, 4, 5
CP-2	Total Charges for Disposable Supplies	1, 2, 3, 4, 5
CS-1	Scale for Child Health Supplement	2, 4
CS-2	Scale for Child Health Supplement	2, 4
CS-3	Number of Times Went to Doctor’s Office or Clinic	2, 4
CS-4	Scale for Child Health Supplement	2, 4
AC-1	Provider’s Race	2, 4
AC-2	Difficulty Scale	2, 4
AC-3	Frequency Scale	2, 4
HX-1	Sample Medicare Card	1, 2, 3, 4, 5
HX-2	Sample Medicaid Card (for STATE)	1, 2, 3, 4, 5
HX-3	Source of Health Insurance (for STATE)	1, 2, 3, 4, 5
HX-4	Types of Public Insurance	1, 2, 3, 4, 5
HX-5	Medicare HMO Premium Ranges	1, 3
HX-6	Medicare Part D Premium Ranges	1, 3
HX-7	Types of Health Insurance Coverage	1, 2, 3, 4, 5
HX-8	State Sources of Health Insurance for Self-Employed Jobs	1, 2, 3, 4, 5
IN-1	Yearly Income Ranges	3, 5
IN-2	Yearly Income Ranges	3, 5
IN-3	Monthly Income Ranges	3, 5
IN-4	Other Sources of Income Categories	3, 5
AS-1	Asset Ranges	5
AS-2	Asset Ranges	5

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CARD RE-1

One or more categories may be selected.

-- September 2001 or later
-- August 1990 to August 2001, including the Persian Gulf War
-- May 1975 to July 1990
-- Vietnam era, August 1964 to April 1975
-- February 1955 to July 1964
-- Korean War, July 1950 to January 1955
-- January 1947 to June 1950
-- World War II, December 1941 to December 1946
-- November 1941 or earlier

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CARD RE-2

One or more categories may be selected.

-- Mexican
-- Mexican-American/Chicano
-- Puerto Rican
-- Cuban/Cuban American
-- Dominican
-- Central or South American

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CARD RE-3

One or more categories may be selected.

-- White
-- Black or African American
-- American Indian or Alaska Native
-- Asian Indian
-- Chinese
-- Filipino
-- Japanese
-- Korean
-- Vietnamese
-- Other Asian
-- Native Hawaiian
-- Guamanian or Chamorro
-- Samoan
-- Other Pacific Islander

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CARD PE-1

-- Bladder
-- Blood
-- Bone
-- Brain
-- Breast
-- Cervical
-- Colon
-- Esophagus
-- Gallbladder
-- Kidney/Renal
-- Larynx-Windpipe
-- Leukemia
-- Liver
-- Lung
-- Lymphoma (Non-Hodgkin’s)
-- Mouth/Tongue/Lip
-- Ovarian
-- Pancreas
-- Prostate
-- Rectum
-- Skin – Melanoma
-- Skin – Non-Melanoma
-- Skin (unknown type)
-- Soft tissue muscle or fat
-- Stomach
-- Testicular
-- Throat or Pharynx
-- Thyroid
-- Uterine
-- Other

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CARD PE-2

-- Within the last 7 days
-- More than 7 days ago, but within last 30 days
-- More than 30 days ago

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CARD HE-1

-- No Difficulty
-- Some Difficulty
-- A Lot of Difficulty
-- Completely Unable To Do It

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CARD PP-1

-- Admitted to the hospital for one or more nights

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CARD PP-2

-- Any type of care received in a hospital emergency room

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CARD PP-3

Same-day care received at a hospital outpatient department such as...

-- Surgery Centers
-- Cancer Treatment Centers
-- Physical Therapy and Rehabilitation Centers
-- Cardiology Centers
-- Obesity Treatment Centers
-- Radiology and Imaging Centers

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CARD PP-4

Primary care doctor such as...

-- General Practitioner
-- Internist
-- Pediatrician
-- Family Medicine Provider
-- Medical Doctor

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CARD PP-5

Such as...

-- Orthopedist
-- Cardiologist
-- Dermatologist
-- Oncologist
-- Neurologist
-- Gynecologist
-- Allergist
-- Gastroenterologist
-- Surgeon
-- Kidney specialist (Nephrologist)
-- Radiologist
-- Ear, nose and throat specialist (Otorhinolaryngologist)
-- Urologist
-- Podiatrist
-- Audiologist
-- Any other type of medical specialist

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CARD PP-6

Such as...

-- Dentists
-- Oral Surgeons
-- Orthodontists
-- Dental Assistants
-- Dental Hygienists
-- Pediatric Dentists
-- Endodontists
-- Periodontists
-- Dental Technicians
-- Other Type of Dental Care Providers

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CARD PP-7

Such as...

-- Psychiatrist
-- Psychologist
-- Licensed Clinical Social Worker
-- Mental Health Therapist
-- Counselor
-- Psychiatric Social Worker
-- Other Mental Health Professional

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CARD PP-8

Such as...

-- Nurse (RN, LPN, PHN, BSN)
-- Nurse practitioner
-- Nurse’s aide
-- Physician’s assistant (PA)
-- Midwife
-- Health aide

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CARD PP-9

Such as...

-- Walk-in Urgent Care
-- Retail Clinic – in a pharmacy
-- Retail Clinic – in a grocery store
-- Family Planning Center
-- College or University Clinic
-- Employer Clinic
-- Free Clinic
-- Infirmary
-- Other type of Health Clinic

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CARD PP-10

Such as...

-- Independent Medical Lab
-- Testing Facility Lab

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CARD PP-11

Such as...

-- Physical Therapists
-- Occupational Therapist
-- Speech Therapist
-- Chiropractor
-- Physiatrist
-- Behavioral Therapist
-- Other type of Therapist

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CARD PP-12

Such as...

-- Optometrist
-- Ophthalmologist
-- Vision Technician
-- Optician
-- Orthoptist
-- Other Eye Care Professional

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CARD PP-13

Such as...

-- Acupuncture
-- Homeopathic care
-- Massage therapy
-- Hypnosis
-- Naturopathic care
-- Herbalist
-- Other alternative care professional

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CARD PP-14

Care received at home, such as...

Skilled Medical Care from -
- -- a home care nurse,
- -- any type of therapist,
- -- a social worker,
- -- anyone else providing nursing or medical care
Personal Care Services such as help with -
- -- bathing,
- -- dressing,
- -- taking medication
Household Chore Services
- -- help with cooking
- -- help with cleaning
Companionship Services such as -
- -- reading,
- -- talking,
- -- going for a walk or drive
Any Other Type of Home Care

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CARD PP-15

Residential or long-term care received at places such as...

-- Nursing Home for Rehabilitation Services
-- Inpatient Rehabilitation Facility or Convalescent Home
-- Hospice Care
-- Respite Care
-- Mental Health Treatment Center
-- Drug and Alcohol Treatment Center
-- Addiction Treatment Center
-- Eating Disorder Treatment Center
-- Other Treatment Center

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CARD EV-1A

-- Hospital – Inpatient Stay
-- Hospital Emergency Room
-- Hospital Outpatient Department
-- Dental Office
-- Medical Provider Office or Clinic
-- Care Received at Home
-- Residential or Long Term Care Facility
- e.g., Nursing Home, Rehabilitation Facility, Drug Treatment, Psychiatric Facility

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CARD EV-1B

-- Hospital – Inpatient Stay
-- Hospital Emergency Room
-- Hospital Outpatient Department
-- Dental Office
-- Medical Provider Office or Clinic
-- Care Received at Home
-- Residential or Long Term Care Facility
- e.g., Nursing Home, Rehabilitation Facility, Drug Treatment, Psychiatric Facility
-- Glasses/Contact Lenses
-- Other Medical Expenses

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CARD HS-1

-- Operation or Surgical Procedure
-- Treatment or Therapy, Not Including Surgery
-- Diagnostic Tests Only
-- Give Birth to a Baby - Normal or Caesarean Section (Mother)
-- To Be Born (Baby)
-- Pregnancy-Related Complications

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CARD ER-1

-- Diagnosis or Treatment
-- Emergency (e.g., Accident or Injury)
-- Psychotherapy or Mental Health Counseling
-- Follow-up or Post-Operative Visit
-- Immunization or Shots
-- Pregnancy-Related (Including Prenatal Care and Delivery)

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CARD ER-2

-- Laboratory Tests
-- Sonogram or Ultrasound
-- X-Rays
-- Mammogram
-- MRI or CAT Scan
-- EKG, ECG, or EEG
-- Vaccination

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CARD OP-1

-- General Checkup
-- Diagnosis or Treatment
-- Emergency (e.g., Accident or Injury)
-- Psychotherapy or Mental Health Counseling
-- Follow-up or Post-Operative Visit
-- Immunizations or Shots
-- Vision Exam
-- Pregnancy-Related (Including Prenatal Care and Delivery)
-- Well Child Exam
-- Laser Eye Surgery

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CARD OP-2

-- Laboratory Tests
-- Sonogram or Ultrasound
-- X-Rays
-- Mammogram
-- MRI or CAT Scan
-- EKG, ECG, or EEG
-- Vaccination

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CARD MV-1

-- General Checkup
-- Diagnosis or Treatment
-- Emergency (e.g., Accident or Injury)
-- Psychotherapy or Mental Health Counseling
-- Follow-up or Post-Operative Visit
-- Immunizations or Shots
-- Vision Exam
-- Pregnancy-Related (Including Prenatal Care and Delivery)
-- Well Child Exam
-- Laser Eye Surgery

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CARD MV-2

-- Laboratory Tests
-- Sonogram or Ultrasound
-- X-Rays
-- Mammogram
-- MRI or CAT Scan
-- EKG, ECG, or EEG
-- Vaccination

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CARD DN-1

-- General Dentist
-- Pediatric Dentist
-- Dental Specialist (e.g., Orthodontist, Endodontist, Periodontist)
-- Dental Hygienist

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CARD DN-2

Diagnostic or Preventive
- -- General Exam, Check-up or Consultation
- -- Cleaning, Prophylaxis, Polishing, or Periodontal Recall Visit (Periodic or Regular)
- -- X-Rays, Radiographs, or Bitewings
- -- Fluoride Treatment
- -- Sealant (Plastic Coatings on Back Teeth)
Restorative or Endodontic
- -- Fillings, Inlays, Crowns or Caps
- -- Root Canal
Periodontic (Gum Treatment)
- -- Periodontal Scaling, Root Planing, or Gum Surgery
Oral Surgery
- -- Extraction, Tooth Pulled, or Other Oral Surgery
- -- Implants
Prosthetics
- -- Fixed Bridges, Dentures or Removable Partial Dentures, Relining or Repair of Bridges or Dentures
Orthodontics
- -- Orthodontia, Braces, or Retainers
Additional Procedures

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CARD HH-1

-- Certified Nursing Assistant (CNA)
-- Dietitian/Nutritionist
-- I.V. or Infusion Therapist
-- Medical Doctor
-- Nurse/Nurse Practitioner
-- Occupational Therapist
-- Physical Therapist
-- Respiratory Therapist
-- Social Worker
-- Speech Therapist

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CARD HH-2

-- Companion
-- Homemaker or House Cleaner
-- Home Health or Home Care Aide
-- Hospice Worker
-- Nurse’s Aide
-- Personal Care Attendant

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CARD IC-1

-- Inpatient Rehabilitation Facility or Convalescent Home
-- Nursing Home
-- Residential Mental Health Treatment Center
-- Residential Eating Disorder Treatment Center
-- Residential Drug and Alcohol or Addiction Treatment Center
-- Residential Hospice Care
-- Residential Respite Care

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CARD OM-1

Disposable Supplies such as...

-- Ostomy supplies
-- Bandages and dressings
-- Tape
-- Adult disposable diapers
-- Catheters
-- Syringes not prescribed by a physician
-- IV supplies

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CARD OM-2

Medical Equipment such as...

Mobility aids
- -- Walker
- -- Scooter
- -- Wheelchair
- -- Braces
Equipment used in the home
- -- Hospital bed
- -- Monitor
- -- Bed pan
- -- Lift
- -- Special chair
- -- Adaptive feeding equipment
Home and automobile modifications
- -- Ramp
- -- Elevator
- -- Handrails
- -- Automobile modification
Hearing and speech assistance
- -- Hearing aid
- -- Amplifier for a telephone
- -- Adaptive speech equipment
Other
- -- Blood pressure monitor
- -- Oxygen
- -- Vaporizer or nebulizer

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CARD CP-1

-- Paid at Time of Visit
-- Made a Co-payment
-- Bill Sent Directly to Other Source
-- Bill Has Not Arrived
-- No Bill Sent:
- -- HMO Plan
- -- VA (Veterans Administration)/CHAMPVA
- -- Military Facility
- -- Public Assistance/Medicaid/SCHIP
- -- Indian Health Service (IHS)
- -- Worker’s Compensation
- -- Private Health Center/Clinic
- -- Public Clinic/Health Center or Private Charity
-- Telephone Call – No Charge
-- Free From Provider
-- Government-Financed Research and Clinical Trials