Methodology Report
#2: Sample Design of the 1996 Medical Expenditure Panel Survey Household Component
by Steven B. 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 and The
Medical Expenditure Panel Survey (MEPS).
Introduction
The Household Component of the 1996 Medical Expenditure Panel Survey
(MEPS) is designed to produce national and regional estimates of
the health care use, expenditures, sources of payment, and insurance
coverage of the U.S. civilian noninstitutionalized population. MEPS
includes surveys of medical providers, employers, and other health
insurance providers to supplement the data provided by household
respondents. The MEPS design permits both person-based and family-level
estimates. Government agencies, legislative bodies, and health professionals
need comprehensive national estimates to use in formulating and analyzing
national health policies. The scope and depth of this data collection
effort reflect this need.
MEPS collects data on the specific health services that Americans
use, how frequently they use them, the cost of these services, and
how they are paid for, as well as data on the cost, scope, and breadth
of private health insurance held by and available to the U.S. population.
MEPS is unparalleled for the degree of detail in its data. In addition,
through MEPS, the medical expenditures and health insurance data
of survey respondents can be linked to other characteristics such
as demographic variables, employment status, economic status, health
status, and use of health services. Moreover, MEPS is the only national
survey that provides a foundation for estimating the impact of changes
in sources of payment for health services and insurance coverage
on different economic groups or special populations of interest,
such as the poor, the elderly, veterans, the uninsured, and racial
and ethnic minorities.
In this report, the sample design of MEPS, initially referred to
as the National Medical Expenditure Survey (NMES-3), is described.
The 1995 National Health Interview Survey (NHIS) is the sample frame
for the 1996 MEPS. The redesigned MEPS reflects the first stage of
implementation of the Department of Health and Human Services (DHHS)
Survey Integration Plan, which provides directives targeted to improve
the analytic capacity of programs, fill major data gaps, and establish
a framework in which DHHS data activities are streamlined and rationalized.
Through this effort, specifically through a linkage to NHIS, MEPS
has achieved a number of significant design improvements and analytic
enhancements.
This report discusses the design efficiencies and enhancements in
analytic capacity that have been and will be realized through the
MEPS sample design integration with NHIS. It includes a summary of
sample size specifications and precision targets for national population
estimates and health care expenditure estimates for policy-relevant
population subgroups. It also discusses the modification of MEPS
from a periodic annual survey to an ongoing continuous data collection
effort with each expenditure panel of households followed for 2 years.
Return to Top
DHHS Survey Integration Plan
As part of the Reinventing Government Part II (REGO II) activities,
DHHS targeted improvement of the analytic capacity of its programs,
filling of major data gaps, and establishment of a survey consolidation
framework in which DHHS data activities are streamlined and rationalized.
A Survey Consolidation Working Group was charged with developing
a consensus plan for meeting these objectives (Hunter, Arnett, Cohen,
et al., 1995; Arnett, Hunter, Cohen, et al., 1996).
A major concentration of the Survey Integration Plan was the redesign
of the health care expenditure and insurance studies conducted by
DHHS, which include the National Medical Expenditure Survey (NMES),
the Medicare Current Beneficiary Survey (MCBS), the National Employer
Health Insurance Survey (NEHIS), and NHIS. The proposed survey integration
plan was designed to achieve significant cost efficiencies by eliminating
duplicative efforts and reducing overall respondent burden. Furthermore,
the analytic capacities of the component surveys are enhanced because
their design features are integrated. To improve survey design capabilities,
enhancements such as an ongoing longitudinal survey effort and the
capacity to derive State-specific health care estimates were considered.
Consideration was also given to including a periodic institutional
component in the survey to provide national use and expenditure estimates
for the population residing in nursing homes (Hunter, Arnett, Cohen,
et al., 1995).
Return to Top
Enhancements
and Efficiencies through Survey Integration
One attraction of the DHHS Survey Integration Plan is the enhanced
analytic capacity to be achieved by linking the distinct surveys
through design integration. This could be realized by sample size
expansions through survey mergers, such as the planned integration
between MEPS and MCBS and the consolidation of employer surveys conducted
by DHHS. Also, use of NHIS as a sample frame for MEPS increases the
analytic content of the resultant linked surveys. Through design
integration of DHHS surveys, inefficiencies associated with duplicative
survey efforts can be significantly reduced. Another goal is to reduce
survey design costs by implementing a uniform framework for DHHS-sponsored
surveys that has overlapping analytic focus with respect to questionnaire
content, data editing, imputation, estimation, database structure,
and development of analytic files. Additional efficiencies in survey
operations in future years are anticipated as a consequence of conducting
an annual medical expenditure survey rather than one every decade.
By moving to this integrated, annual household
data collection effort, DHHS expands and enhances its analytic capabilities.
The new format:
Retains the design of the core NHIS household interview.
This core will provide cross-sectional population statistics
on health status and health care use, with sufficient sample
size to allow for analyses based on detailed breakdowns by age,
race, sex, income, and other sociodemographic characteristics.
The core will also allow the use of data on a broad range of
topics currently covered by NHIS.
-
Retains the analytic capacity to obtain annual
and quarterly population estimates of health care use and the
prevalence of health conditions, both for the Nation and for
policy-relevant population subgroups.
-
Provides the ability to model individual and family-level
health status, access to care and use, expenditures, and insurance
behavior over the year and examine the distribution of these
measures across individuals. The longitudinal feature of MEPS
(collecting data over multiple years) further enhances the capacity
to model behavior over time.
-
Provides the ability to relate data from a detailed
sample (e.g., MEPS) to a larger sample (e.g., NHIS) to enhance
the utility of MEPS for national health account estimation and
microsimulation modeling, including disaggregation by age group
or geographic area.
-
Provides the potential to yield both national and
State-level estimates for marginal costs using the enhanced sample
design of the NHIS, which includes 358 primary sampling units.
-
Provides the following as a result of the longitudinal
aspect of the MEPS integrated data collection effort--
-
An increase in statistical power to examine
change or make comparisons over time.
-
The capacity to examine changes over time as
well as changes in the relationships among measures of health
status, access to care, health care use, expenditures, health
insurance coverage, employment, functional limitations and
disabilities, and demographic characteristics.
Return to Top
MEPS Household Component
The original NMES-3 sample design called for an independent screening
interview to identify a nationally representative sample and facilitate
oversampling of policy-relevant population subgroups. Data collection
and training costs associated with this independent screening interview
were projected to exceed $8 million. As part of the DHHS Survey Integration
Plan, this separate screening interview was eliminated. Instead,
NHIS was specified as the sampling frame for MEPS. NHIS is an ongoing
annual household survey of approximately 42,000 households (109,000
individuals) conducted by the National Center for Health Statistics
(NCHS) to obtain national estimates on health care use, health conditions,
health status, insurance coverage, and access for the U.S. civilian
noninstitutionalized population. In addition to the cost savings
achieved by substituting NHIS as the MEPS sample frame, the design
modification will result in an enhanced analytic capacity of the
resultant survey data. Use of the 1995 NHIS data in concert with
the 1996 MEPS data provides an additional capacity for longitudinal
analyses not available in the original (NMES-3) design. Furthermore,
the greater number and dispersion of the sample primary sampling
units that comprise the MEPS national sample should result in improvements
in precision over the original design specifications.
To fill major data gaps identified by DHHS, MEPS is specified as
a continuous survey with sample peaks at 5-year intervals. The initial
sample for the 1996 MEPS (10,597 NHIS dwelling units) is smaller
than originally planned but will now also permit estimates for calendar
year 1997 through an overlapping panel design. The 1996 panel will
be followed for data collection through 1997. A new nationally representative
sample of 6,300 dwelling units will be selected from the 1996 NHIS
to supplement the 1996 MEPS panel in order to meet the original precision
specifications for certain specified policy-relevant population subgroups
for calendar year 1997. As detailed in Cohen (1996), these policy-relevant
population subgroups are:
- Adults (18 years and older) with functional impairments.
- Children with limitations of activity.
- Individuals 18-64 years who are predicted to incur high medical
expenditures.
- Individuals predicted to have family income less than 200 percent
of the poverty level.
Before MEPS began, preliminary contact was made with the NHIS responding
households selected for MEPS to announce the survey and introduce
record-keeping activities. The revised MEPS study design includes
several components. In addition to the Nursing Home Component, it
comprises:
- The Household Component (HC), consisting of an overlapping panel
design in which any given sample panel is interviewed a total of
six times over 3 consecutive years to yield annual data for 2 calendar
years.
- The Medical Provider Component (MPC), with a sample of medical
providers that treated HC persons.
- The Insurance Component (IC), with a sample
of employers and other sources of health insurance of HC persons.
The survey is cosponsored by the Agency for Health Care Research
and Quality (AHRQ) and NCHS. Westat and the National Opinion Research
Center (NORC) are the data collection organizations for the 1996
MEPS Household Component.
Sample Design
The 1996 MEPS Household Component sample was selected from households
that responded to the 1995 NHIS. NHIS is designed to permit the selection
of nationally representative subsamples from any one of four panels.
Furthermore, any combination of one to four panels will provide a
nationally representative sample of households. Each NHIS panel subsample
for a given quarter of a calendar year is nationally representative.
The 1996 MEPS household sample was selected from two of the four
1995 NHIS panels and encompassed half of the households in the NHIS
sample during the second and third quarters of 1995.
The complete 1995 NHIS sample (panels 1-4) consists of 358 primary
sampling units, or PSUs (which are counties or groups of contiguous
counties), and approximately 42,000 responding households. The sample
PSUs selected for NHIS were stratified by geographic area (Census
region and State), metropolitan status, and sociodemographic measures
(Judkins, Marker, and Waksberg, 1994). Within sample PSUs, a sample
of blocks (segments) was selected after the blocks were stratified
by measures of minority population density that allowed for an oversample
of areas with high population concentrations of blacks and Hispanics.
A nationally representative sample of approximately 71,000 addresses
within sampled blocks was selected and targeted for further screening
to facilitate an oversample of blacks and Hispanics as part of the
1995 NHIS interview.
The 1995 NHIS subsample selected for the 1996 MEPS consists of 195
PSUs. In the two targeted quarters of 1995, these PSUs included 1,675
sample segments (second-stage sampling units) and 10,597 responding
households. This NHIS sample reflects oversampling of households
with Hispanics and blacks at a ratio of approximately 2.0:1 for Hispanics
and 1.5:1 for blacks. This 1996 MEPS sample constitutes a panel that
will be surveyed to collect annual data for 2 consecutive years.
A new 1997 MEPS panel sample will be selected as a nationally representative
subsample of households responding to the 1996 NHIS. More specifically,
this 1997 MEPS sample will be selected from two of the four NHIS
panels. It will reflect additional disproportionate sampling in order
to satisfy the precision requirements specified for the 1997 MEPS
Household Component, which generally coincide with the original plan
for the 1996 survey (Cohen, 1996). As in 1995, the complete 1996
NHIS sample will consist of 358 PSUs with a targeted sample of approximately
42,000 responding households. A nationally representative subsample
will be reserved for the 1997 MEPS prior to additional subsampling.
This subsampling will come from the same 195 PSUs selected for the
1996 MEPS household sample and include approximately 21,000 responding
NHIS households. It reflects an oversample of Hispanics and blacks
at the same ratios as before (Hispanics, 2.0:1; blacks, 1.5:1). A
nationally representative subsample of approximately 6,300 NHIS responding
households (6,480 reporting units) will be selected for the new 1997
MEPS panel. This sample will consist of an oversample of the following
policy-relevant subgroups: functionally impaired adults, children
limited in activities, adults predicted to have high medical expenditures,
and persons predicted to have family income less than 200 percent
of the poverty level.
An oversample of the elderly who are not functionally
impaired was not planned for the 1997 survey. Such data will be available
from
the 1997 Medicare Current Beneficiary Survey, and consolidation of
MCBS and MEPS is planned. MCBS, an annual person-based survey, obtains
data for Medicare beneficiaries. The same types of estimates of health
care use, expenditures, sources of payment, and health insurance
coverage can be derived from the two surveys. The new 1997 MEPS panel
will be fielded to collect annual data for 2 consecutive years.
The 1997 MEPS Household Component sample
will consist of the new 1997 MEPS panel in combination with the
second year of the 1996 MEPS
sample. Overall, the 1997 MEPS household sample will consist of approximately
13,700 reporting units that will complete the full series of MEPS
interviews, yielding use and expenditure data for calendar year 1997.
(The number of reporting units is adjusted for Round 1 "split-offs"--family
member(s) who move apart from the originally sampled household--but
not for split-offs in Rounds 2 and 3.) Sample selection procedures
for the 1997 MEPS have been implemented in-house by AHRQ staff, based
on data keyed from the 1996 NHIS interviews. In 1998, a new MEPS
sample of approximately 5,200 households (5,350 reporting units)
will be selected as a nationally representative
subsample of households that responded to the 1997 NHIS. In addition,
the entire 1997 panel of 5,397 reporting units will be continued
to obtain calendar year 1998 data on health care use and expenditures.
The targeted response rate for Rounds 4 and 5 is 97 percent. Consequently,
the 1998 MEPS sample will consist of approximately 9,500 reporting
units (adjusted for split-offs in Round 1) completing three core
rounds of data collection to obtain calendar year data (4,457 households
from the new sample, 5,078 from the 1997 MEPS sample). In 1998, the
1996 MEPS panel will be retired.
For 1998-2001, the survey will scale back to an overall sample of
approximately 9,500 reporting units completing three core rounds
of data collection to obtain calendar year data on health care use
and expenditures. Each year, approximately 5,000 reporting units
will continue from the previous year. In 2002, the survey will begin
another 5-year cycle, with an increase to 13,700 reporting units
(adjusted for Round 1 split-offs) completing three core rounds of
data collection to obtain calendar year data. Coupled with data from
MCBS, this will provide DHHS with the same analytic capabilities
with respect to sample size that were first proposed for the 1996
NMES-3.
Sampling Unit Definitions and Eligibility Criteria
The definitions for dwelling units and group
quarters in the MEPS Household Component are generally consistent
with the definitions
employed for NHIS. More specifically, a dwelling unit is a house,
apartment, group of rooms, or single room occupied as separate civilian
non-institutional living quarters or vacant but intended for occupancy
as separate living quarters. Group quarters consist of a single civilian
noninstitutional dwelling or structure in which nine or more unrelated
persons reside and where inhabitants are not considered a part of
any other dwelling unit. A reporting unit is a person or group of
persons in the sampled dwelling unit that are related by blood, marriage,
adoption, or other family associations, and are to be interviewed
at the same time in MEPS. Examples of discrete reporting units follow.
- A married daughter and her husband living with her parents in
the same dwelling are considered one reporting unit.
- A husband and wife and their unmarried daughter, age 18, who
is living away from home at college constitute one family, but
two reporting units.
- Three unrelated persons living in the same dwelling unit would
be three reporting units.
College students under 24 years of age who usually live in the sampled
household but are currently living away from home and going to school
are treated as separate reporting units for the purpose of data collection.
The 1996 MEPS sample consisted of households
(dwelling units) that responded to the 1995 NHIS in the two panels
reserved for MEPS, with
the basic unit of analysis defined as the person. Analysis is planned
using both the individual and the family as units. Through the renumeration
section of the Round 1 questionnaire, the status of each individual
sampled at the time of the NHIS interview is classified as "key" or "non-key," "in-scope" or "out-of-scope," and "eligible" or "ineligible" for
MEPS data collection. For an individual to be in-scope and eligible
for person-level estimates derived from the MEPS household survey,
he or she must be a member of the civilian noninstitutionalized population
for some period of time in the calendar year of analytic interest.
Because a person's eligibility for the survey may change after the
NHIS interview, sampling renumeration takes place in each subsequent
reinterview for persons in all households selected into the core
survey. The keyness, in-scope, and eligibility indicators, together,
define the target sample to be used for person-level national estimates.
Only persons who are key, in-scope, and eligible for data collection
are considered in the derivation of person-level national estimates
from MEPS.
Key Persons
Key survey participants are defined as all civilian noninstitutionalized
individuals who resided in households that responded to the nationally
representative NHIS subsample reserved for MEPS (e.g., approximately
10,600 households from the 1995 NHIS), with the exception of college
students interviewed at dormitories. Members of the Armed Forces
who are on full-time active duty are also defined as key persons
if they reside in responding NHIS households that include other family
members who are civilian noninstitutionalized individuals. However,
they are out of scope for person-level estimates derived from the
survey.
All individuals who join the NHIS reporting units that define the
1996 MEPS household sample (in Round 1 or later MEPS rounds) and
were not available for selection during the time of the NHIS interview
are also considered key persons. These include newborn babies, individuals
who were in an institution or outside the country, and military personnel
previously residing on military bases.
College students under 24 years of age interviewed
at dormitories in the 1995 NHIS are considered ineligible for the
1996 MEPS sample.
Furthermore, any unmarried college student under 24 years of age
who responded to the 1995 NHIS interview while living away at school
(not in a dormitory) is excluded from the sample if it is determined
in the MEPS Round 1 interview that the person is unmarried, under
24 years of age, and a student who has parents living elsewhere and
who resides at his or her current housing only during the school
year. If, on the other hand, the person's status at the time of the
MEPS Round 1 interview is no longer that of an unmarried student
under 24 years of age living away from home, then the person is retained
as a key person.
Additionally, during the MEPS Round 1 interview with NHIS sample
respondents, a determination is made whether there are any related
college students under 24 years of age who usually live in the sampled
household but are currently living away from home and going to school.
These college students are considered key persons and are identified
and interviewed at their college address but linked to the sampled
household for family analyses. Some of these college students will
have been identified as living in the sampled household at the time
of the 1995 NHIS interview. The remainder are identified at the time
of the MEPS Round 1 interview.
Non-Key Persons
Persons who were not living in the original sampled dwelling unit
at the time of the 1995 NHIS interview and who had a nonzero probability
of selection for that survey are considered non-key. If such persons
happen to be living in sampled households in Round 1 or later rounds,
MEPS data are collected for the period of time they are part of the
sampled unit to permit family analyses. Non-key persons who leave
any sampled household are not recontacted for subsequent interviews.
Non-key individuals are not part of the target sample used to obtain
person-level national estimates.
A key person from the NHIS sampled household selected for MEPS may
move out in Round 1 or later rounds and join or create another family.
Data on all members of this new household who are related by blood,
marriage, adoption, or foster care to the person from the NHIS sampled
household are obtained from the time that the sampled person joined
the household. Similarly, data are collected in Round 1 and later
rounds on all related persons who join NHIS sampled households selected
into MEPS.
Persons in NHIS sampled households selected
in MEPS may subsequently enter an institution, thus no longer qualifying
as a member of the
U.S. civilian noninstitutionalized population. For those who enter
nursing homes, data collection continues during the nursing home
stay. For those who enter other institutions, data collection is
suspended while they are institutionalized, but their whereabouts
are monitored during the field period. If they rejoin the U.S. civilian
noninstitutionalized population, HC data collection resumes. (This
is also the procedure for those entering military service away from
home or moving out of the United States.)
MEPS Data Collection Eligibility
In order for a MEPS reporting unit to be eligible for data collection,
it must include at least one individual who is key and in-scope for
some period of time during the reference period for a given round
of data collection. If this condition holds, the persons who are
key and in-scope and all other individuals who are members of the
reporting unit (living together and related by blood, marriage, adoption,
or other family associations) are eligible for data collection in
a given round of MEPS.
Sample Size Targets and Precision Requirements
The 1996 MEPS sample size targets require approximately 9,000 reporting
units yielding the complete series of core interviews (Rounds 1-3)
to obtain use and expenditure data for calendar year 1996. The expected
yield at each stage of data collection for each new MEPS sample linked
to the NHIS (Table 1) is as follows:
- An NHIS response rate of 94 percent at the household level.
- A response rate of 85 percent (83 percent achieved for the 1996
MEPS) among reporting units at Round 1 (conditional on a completed
NHIS interview).
- A round-specific response rate of 95 percent among reporting
units at Round 2.
- A round-specific response rate of 97.5 percent among reporting
units at Round 3.
- A round-specific response rate of 97 percent among reporting
units at Rounds 4 and 5.
- A round-specific response rate among reporting units of 98 percent
at Round 6.
Consequently, the targeted response rate for obtaining calendar
year 1996 data on health care use and expenditures from the 1996
MEPS sample is 77 percent, conditional on response to NHIS (interviews
for Rounds 1-3), or 72 percent overall.
The response rate target for the MEPS core interviews for obtaining
calendar year 1997 data on health care use and expenditures from
the new 1997 MEPS sample is 79 percent, conditional on response to
NHIS (interviews for Rounds 1-3), or 74 percent overall (Table
1).
The minimum acceptable response rate target for the MEPS core interviews
within a PSU is 65 percent for calendar year 1997 data from the new
MEPS panel, conditional on NHIS response (interviews for Rounds 1-3),
and is 60 percent for calendar years 1996 and 1997 for the 1996 MEPS
panel (interviews for Rounds 1-5, conditional on response to NHIS).
The 1995 NHIS response rate achieved for MEPS-eligible households
was 94 percent. Of 10,639 responding NHIS dwelling units eligible
for MEPS, 99.6 percent were identified with enough information to
allow MEPS data collection. Of the 11,424 eligible reporting units
targeted for interviews in Round 1, 9,488 (83.1 percent) responded.
Overall, the joint NHIS-Round 1 response rate for the 1996 MEPS household
survey was 77.7 percent (.939 x .996 x .831).
The sample size specifications were set to meet precision requirements
developed for MEPS. The precision requirements for the first year
of MEPS were relaxed relative to the original design specifications
of NMES-3 because of major changes in the survey design as a consequence
of the DHHS Survey Integration Plan. These changes included sample
size constraints (restricting the sample to the 195-PSU NHIS subsample),
and inclusion of the first quarter of the 1995 NHIS sample in a disability
survey sponsored by the Assistant Secretary of Planning and Evaluation,
DHHS (Cohen, 1996; DiGaetano, 1994).
For the 1996 MEPS sample, the relative standard
error for a population estimate of 20 percent for the overall population
at the family level
was specified to be no more than 2.7 percent, and the relative standard
error for a population estimate of 20 percent for the overall population
at the person level was specified to be no more than 1.7 percent.
For example, if the estimate of the percentage of the national population
uninsured at any time during 1996 were 20 percent, the standard error
of the estimate should not exceed 0.34 percent. That would translate
to a 95-percent confidence interval (19.33 percent, 20.67 percent)
for the insurance coverage estimate characterizing the Nation at
the person level. The 1996 MEPS sample is selected from a nationally
representative 1995 NHIS subsample characterized by 195 PSUs, 1,675
segments, and approximately 9,000 responding households at the end
of Round 3, with disproportionate sampling rates ranging from 1.0
to 0.5. Preliminary design work suggests that these conditions should
yield average design effects for MEPS survey estimates of annual
use and expenditures in the 1.5-1.6 range.
The 1996 MEPS sample linked to NHIS was designed
to produce unbiased estimates for the four Census regions, with oversampling
of Hispanics
and blacks. The expected sample yield after three rounds of data
collection at the person level is approximately 22,000 overall, with
3,400 black non-Hispanic individuals and 4,200 Hispanic individuals.
The average design effect target for survey estimates for the 1996
MEPS is 1.6. The sample design should satisfy the following precision
requirements for mean estimates of the following measures of health
care use and expenditures at the person level: total health expenditures,
use, and expenditure for inpatient hospital stays, physician visits,
dental visits, and prescribed medicines.
| Demographic group |
Persons at the end of Round 3 |
Average relative standard error |
| Black non-hispanic |
3,400 |
.065 |
| Hispanic |
4,200 |
.055 |
| Overall Population |
22,000 |
.025 |
Procedures for Data Collection
The preliminary contact with households responding to NHIS and subsampled
as part of a MEPS panel is described in Cohen (1997). Procedures
in the rounds of data collection are described below.
Rounds 1-5
Five interviews are conducted with each NHIS panel selected for
MEPS at 3- to 4-month intervals over an approximately 24-month field
period. The first three rounds (Rounds 1A-3A) define the 1996 MEPS
Household Component and collect the main body of annual use and expenditure
data for calendar year 1996. Rounds 3A-5A of the 1996 MEPS panel
are combined with Rounds 1B-3B of the 1997 MEPS panel to yield the
sample base for the 1997 MEPS Household Component and the source
of annual estimates for that calendar year. All interviews are conducted
in person through a computer-assisted personal interview (CAPI).
Round 1 asks about the period from January 1 of the MEPS year to
the date of that interview; Round 2 will ask about the time from
the Round 1 interview through the date of the Round 2 interview,
and Round 3 asks about the time from the date of the Round 2 interview
through the date of the Round 3 interview in 1997.
Questionnaires for these field rounds parallel those used in the
1987 NMES but include some modifications implemented for a 1992 feasibility
study and further changes stemming from the feasibility study and
the NMES-3 pretest. The instruments contain items that are asked
once in the life of the study, items that are asked repeatedly in
each round, and items that are updated in later rounds. Questions
asked only once include basic sociodemographic characteristics. Core
questions asked repeatedly include health status, health insurance
coverage, employment status, days of restricted activity due to health
problems, medical use, hospital admissions, and purchase of medicines.
For each health encounter identified, data are obtained on the nature
of health conditions, characteristics of the provider, services provided,
associated charges, and sources and amounts of payment.
Permission forms for medical providers and for sources of employment
and private health insurance coverage are collected in the field.
Anyone who reports being employed but not covered by private health
insurance is asked to sign a permission form that allows contact
with the employer. A sample of medical providers identified by MEPS
respondents is contacted in the survey of medical providers, MPC,
to verify and supplement information provided by the family respondent
in the household interview. Employers and other health insurance
providers are contacted in the survey of health insurance providers,
IC, to verify analogous insurance information and collect other information
on insurance characteristics that household respondents would not
typically know.
As a consequence of a successful test in the feasibility study,
copies of policies for the private insurance coverage of sampled
persons are collected from household respondents. The requests for
insurance policies are initiated in Round 1 and followed up in Round
2 for eligible individuals who did not provide copies of their policies
at the time of the first request. A description of the type of documents
to be collected, a list of the policies identified by the respondent,
and request forms to be given to providers are given to interviewing
staff to assist in this effort.
Round 6
Round 6 is concerned with obtaining valuable ancillary information
before a MEPS panel is retired. For the 1996 MEPS panel, it takes
place after April 15, 1998, and asks for details on tax filing information.
The majority of Round 6 interviews are administered by telephone
from the interviewers' homes. In-person interviews are conducted
for respondents without access to a telephone or for whom telephone
administration is not feasible (e.g., respondents with hearing or
comprehension problems).
Return to Top
Summary
The benefits of the redesigns incorporated in MEPS include significant
cost savings, enhanced analytic capacities, increased opportunities
for longitudinal analyses, reduction of major data gaps, and major
improvements in providing timely data access to the research community
at large. MEPS will provide information to help understand how the
dramatic growth of managed care, changes in private health insurance,
and other dynamics of today's market-driven health care delivery
system have affected, and are likely to affect, the kinds, amounts,
and costs of health care that Americans use. The survey will also
provide necessary data for projecting who benefits from and who bears
the cost of changes to existing health policy and the creation of
new policies.
The MEPS data will serve as the primary source of information for
research efforts examining how health care use and expenditures vary
among different sectors of the population (such as the elderly, veterans,
children, disabled persons, minorities, the poor, and the uninsured)
and how the health insurance of households varies by demographic
characteristics, employment status and characteristics, geographic
locale, and other factors. The MEPS data will provide answers to
questions about private health insurance costs and coverage, such
as how employers' costs vary by region, and help evaluate the growing
impact of managed care and of enrollment in different types of managed
care plans.
The first MEPS data became available on public use data tapes in
spring 1997. MEPS data also will be used in a series of studies to
be published by AHRQ and by AHRQ researchers and others publishing
in the scientific literature. As a consequence of the shift to a
continuous ongoing annual survey, additional efficiencies in survey
data collection, data editing, and imputation tasks will be realized,
as well as further improvements in the timely release of MEPS data
products to the research community.
Return to Top
References
Arnett RA, Hunter E, Cohen S, et al. The Department of Health and
Human Services' Survey Integration Plan. In: Proceedings of the American
Statistical Association (ASA). Section on Government Statistics.
Chicago: 1996 Aug.
Cohen J. 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. AHRQ
Pub. No. 97-0026.
Cohen SB. The redesign of the Medical Expenditure Panel Survey,
a component of the DHHS Survey Integration Plan. Proceedings of the
Council of Professional Associations on Federal Statistics (COPAFS)
Seminar on Statistical Methodology in the Public Service, Bethesda
(MD); 1996 Nov.
DiGaetano R. Sample design of the Household Component of the National
Medical Expenditure Survey (NMES-3). Unpublished report. Rockville
(MD): Westat, Inc.; 1994. Contract No. 282-94-200.
Hunter E, Arnett R, Cohen S, et al. HHS Survey Integration Plan:
Background materials. Agency for Health Care Policy and Research,
Rockville (MD), and National Center for Health Statistics, Hyattsville
(MD); 1995.
Judkins D, Marker D, Waksberg J. National Health Interview Survey:
research for the 1995 redesign. Unpublished report. Prepared under
contract for the National Center for Health Statistics. Rockville
(MD): Westat, Inc.; 1994.
Return to Top
|
Back
Email Updates
