MEPS HC-006R: 1996 Medical Conditions

Individual identifiers have been removed from the micro-data contained in the files on this CD-ROM. 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 it was 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:

By using this 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 18 U.S.C. 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.

This documentation describes one in a series of public use files from the Medical Expenditure Panel Survey (MEPS). The survey provides a new and extensive data set on the use of health services and health care in the United States.

The Medical Expenditure Panel Survey (MEPS) is conducted to provide nationally representative estimates of health care use, expenditures, sources of payment, and insurance coverage for the U.S. civilian non-institutionalized population. MEPS also includes a nationally representative survey of nursing homes and their residents. MEPS is cosponsored by the Agency for Healthcare Research and Quality (AHRQ) and the National Center for Health Statistics (NCHS).

MEPS comprises four component surveys: the Household Component (HC), the Medical Provider Component (MPC), the Insurance Component (IC), and the Nursing Home Component (NHC). The HC is the core survey, and it forms the basis for the MPC sample and part of the IC sample. The separate NHC sample supplements the other MEPS components. Together these surveys yield comprehensive data that provide national estimates of the level and distribution of health care use and expenditures, support health services research, and can be used to assess health care policy implications.

MEPS is the third in a series of national probability surveys conducted by AHRQ on the financing and use of medical care in the United States. The National Medical Care Expenditure Survey (NMCES, also known as NMES-1) was conducted in 1977, the National Medical Expenditure Survey (NMES-2) in 1987. Beginning in 1996, MEPS continues this series with design enhancements and efficiencies that provide a more current data resource to capture the changing dynamics of the health care delivery and insurance system.

The design efficiencies incorporated into MEPS are in accordance with the Department of Health and Human Services (DHHS) Survey Integration Plan of June 1995, which focused on consolidating DHHS surveys, achieving cost efficiencies, reducing respondent burden, and enhancing analytical capacities. To accommodate these goals, new MEPS design features include linkage with the National Health Interview Survey (NHIS), from which the sampling frame for the MEPS HC is drawn, and continuous longitudinal data collection for core survey components. The MEPS HC augments NHIS by selecting a sample of NHIS respondents, collecting additional data on their health care expenditures, and linking these data with additional information collected from the respondents' medical providers, employers, and insurance providers.

The MEPS HC, a nationally representative survey of the U.S. civilian non-institutionalized population, collects medical expenditure data at both the person and household levels. The HC collects detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment.

The HC uses an overlapping panel design in which data are collected through a preliminary contact followed by a series of five rounds of interviews over a 2 ½-year period. Using computer-assisted personal interviewing (CAPI) technology, data on medical expenditures and use for 2 calendar years are collected from each household. This series of data collection rounds is launched each subsequent year on a new sample of households to provide overlapping panels of survey data and, when combined with other ongoing panels, will provide continuous and current estimates of health care expenditures.

The sampling frame for the MEPS HC is drawn from respondents to NHIS, conducted by NCHS. NHIS provides a nationally representative sample of the U.S. civilian non-institutionalized population, with oversampling of Hispanics and blacks.

The MEPS MPC supplements and validates information on medical care events reported in the MEPS HC by contacting medical providers and pharmacies identified by household respondents. The MPC sample includes all hospitals, hospital physicians, home health agencies, and pharmacies reported in the HC. Also included in the MPC are all office-based physicians:

Data are collected on medical and financial characteristics of medical and pharmacy events reported by HC respondents, including:

The MEPS IC collects data on health insurance plans obtained through employers, unions, and other sources of private health insurance. Data obtained in the IC include the number and types of private insurance plans offered, benefits associated with these plans, premiums, contributions by employers and employees, eligibility requirements, and employer characteristics.

Establishments participating in the MEPS IC are selected through four sampling frames:

To provide an integrated picture of health insurance, data collected from the first sampling frame (employers and insurance providers) are linked back to data provided by the MEPS HC respondents. Data from the other three sampling frames are collected to provide annual national and State estimates of the supply of private health insurance available to American workers and to evaluate policy issues pertaining to health insurance.

The MEPS IC is an annual panel survey. Data are collected from the selected organizations through a prescreening telephone interview, a mailed questionnaire, and a telephone followup for nonrespondents.

The 1996 MEPS NHC was a survey of nursing homes and persons residing in or admitted to nursing homes at any time during calendar year 1996. The NHC gathered information on the demographic characteristics, residence history, health and functional status, use of services, use of prescription medications, and health care expenditures of nursing home residents. Nursing home administrators and designated staff also provided information on facility size, ownership, certification status, services provided, revenues and expenses, and other facility characteristics. Data on the income, assets, family relationships, and care-giving services for sampled nursing home residents were obtained from next-of-kin or other knowledgeable persons in the community.

The 1996 MEPS NHC sample was selected using a two-stage stratified probability design. In the first stage, facilities were selected; in the second stage, facility residents were sampled, selecting both persons in residence on January 1, 1996, and those admitted during the period January 1 through December 31.

The sample frame for facilities was derived from the National Health Provider Inventory, which is updated periodically by NCHS. The MEPS NHC data were collected in person in three rounds of data collection over a 1 ½-year period using the CAPI system. Community data were collected by telephone using computer-assisted telephone interviewing (CATI) technology. At the end of three rounds of data collection, the sample consists of approximately 815 responding facilities, 3,100 residents in the facility on January 1, and 2,200 eligible residents admitted during 1996.

MEPS data are collected under the authority of the Public Health Service Act. They are edited and published in accordance with the confidentiality provisions of this act and the Privacy Act. 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 and microdata files. Summary reports are released as printed documents and electronic files. Microdata files are released on CD-ROM and/or as electronic files. A catalog of all MEPS products released to date is provided in Section F of this document.

Printed documents and CD-ROMs are available through the AHRQ Publications Clearinghouse. Write or call:

AHRQ Publications Clearinghouse
Attn: (publication number)
P.O. Box 8547
Silver Spring, MD 20907
800/358-9295
410/381-3150 (callers outside the United States only)
888/586-6340 (toll-free TDD service; hearing impaired only)

Be sure to specify the AHRQ number of the document or CD-ROM you are requesting. Selected electronic files are available from the Internet on the MEPS home page: http://www.meps.AHRQ.gov/

Additional information on MEPS is available from the MEPS project manager or the MEPS public use data manager at the Center for Cost and Financing Studies, Agency for Healthcare Research and Quality.

This documentation describes the data contained in MEPS Public Use Release HC-006R, which is one in a series of public use data file to be released from the 1996 Medical Expenditure Panel Survey Household Component (MEPS HC). HC-006R is a revised version of HC-006 (1996 Medical Conditions Public Use File) released in July 1999. Revisions in the current file include the following:

Released in ASCII and SAS formats, this public use file provides information on household-reported medical conditions collected on a nationally representative sample of the civilian noninstitutionalized population of the United States for rounds 1, 2, and 3 of the 1996 MEPS HC. (See Section 2.5.3.)

This file contains 76,426 records. Each record represents one household-reported medical condition reported during rounds 1, 2, or 3 regardless of whether or not the condition was associated with a medical provider event. Conditions reported in Round 3 and known to have begun after December 31, 1996 are not included on this file.

These data are being released prior to final data cleaning and editing in order to provide the research and policy community prompt access to MEPS data. Analysts should consider these data as preliminary, as they have not been subject to the same level of quality control procedures that are usually performed on products of this type.

The following documentation offers a brief overview of the types and levels of data provided, the content and structure of the files and the codebook, and programming information. It contains the following sections:

For more information on MEPS survey design see Cohen , 1997; Cohen, 1997; and Cohen 1996. A copy of the survey instrument used to collect this information on this file is available on the MEPS web site: http://www.meps.ahrq.gov.

This public use data set contains variables and frequency distributions for a total of 76,426 medical conditions reported during rounds 1, 2, and 3 of the MEPS Household Component regardless of whether or not the condition was associated with a medical provider event. This count includes condition records for all household survey respondents who resided in eligible responding households and reported at least one condition. Records where the condition or injury was known to have begun after December 31, 1996 are not included on this file. Of these records 74,567 were associated with persons having a positive person-level weight: (WTDPER96). For each variable on the file, both weighted and unweighted frequencies are provided in the codebook. Because the conditions identified in this file are derived from self-reports, this data set cannot be used to make estimates of disease, prevalence of health conditions, or mortality/morbidity.

Data from this file can be merged with 1996 MEPS person-level data using DUPERSID to append person-level characteristics such as demographic or health insurance characteristics to each record (see Section 4.0 for details). Data from this file can also be merged to 1996 MEPS Medical Provider Event Files (HC-010A, HC-010B, HC-010D through HC-010H) by using the the link files provided on HC-010I, Files 1 and 2 (see HC-010I for details). Since each record represents a single condition reported by household respondents, some household respondents may have multiple medical conditions and thus will be represented in multiple records on this file. Other household respondents may have reported no medical conditions and thus will have no records on this file.

Generally, -1,-7, -8, and -9 have not been edited on this file. The values of -1 and -9 can be edited by analysts by following the skip patterns in the questionnaire.

This codebook describes an ASCII data set and provides the following programing identifiers for each variable:

In general, variable names reflect the content of the variable, with an 8 character limitation.

For questions asked in a specific Round, the end digit in the variable name reflects the Round in which the question was asked. Edited variables end in an "X"and are so noted in the variable label.

Variables contained in this delivery were derived either from the questionnaire itself or from the CAPI. The source of each variable is identified in Appendix 1 entitled "Variable to Source Crosswalk." Sources for each variable are indicated in one of four ways: (1) variables which are derived from CAPI or assigned in sampling are so indicated; (2) variables derived from complex algorithms associated with re-enumeration are labeled "RE Section"; (3) variables which come from one or more specific questions have those numbers and questionnaire section indicated in the "Source" column; (4) variables constructed from multiple questions using complex algorithms are labeled "Constructed" in the "SOURCE" column.

The definitions of Dwelling Units (DUs) and Group Quarters in the MEPS-HC is generally consistent with the definitions employed for the National Health Interview Survey (NHIS). The dwelling unit ID (DUID) is a five-digit random number assigned after the case was sampled for MEPS. The person number (PID) uniquely identifies each person within the dwelling unit. The variable DUPERSID uniquely identifies each person represented on the file, and is the combination of the variables DUID and PID. CONDN indicates the condition number of each condition for an individual respondent (e.g., condition number 1, 2, 3, etc.) plus a control digit. The number of conditions for persons represented on this file ranges from 1 to 46. CONDIDX uniquely identifies each condition (i.e., each record on the file), and is the combination of DUPERSID and CONDN.

CONDRN indicates the round in which the condition was first reported. For a small number of cases, conditions that actually began in an earlier round were not reported by respondents until subsequent rounds of data collection. For these cases no editing was performed to reconcile the round in which a condition began and the round that the condition was first reported.

The round-specific variables PSTATUS1, PSTATUS2 and PSTATUS3 indicate a person's response and eligibility status for each round of interviewing. The PSTATUS variables indicate the reasons for either continuing data collection for a person or terminating data collection for each person in the MEPS. Using this variable, one could identify persons who moved during the reference period, died, were born, institutionalized, or who were in the military. A value of "-1 Inapplicable" indicates that the person was not fielded during the round or the RU was non-responsive. Analysts should note that PSTATUS3 provides a summary for all of Round 3, including transitions that occurred after 1996. However, PSTATUS3 is still a useful guide to follow transitions that occur over time.

The reference period is the period of time for which data were collected in each round for each person. The Round 3 beginning reference period dates (BEGREFD3, BEGREFM3, and BEGREFY3) and the Round 3 ending reference period dates (ENDREFD3, ENDREFM3 and ENDREFY3) are included on each record. The reference period dates were determined during the interview for each person by the CAPI program. For most persons in the sample, the date of the interview is the reference period end date.

This file contains variables describing medical conditions reported by respondents in several sections of the MEPS questionnaire, including the Condition Enumeration Section, Health Status Section, and all questionnaire sections collecting information about health provider visits, prescription medications, and disability days (see Variable-Source Crosswalk in Appendix 1 for details).

Certain conditions were a priori designated as "priority conditions" (PRIOLIST=1) due to their prevalence, expense, or relevance to policy. Some were long-term life-threatening conditions, such as cancer, diabetes, emphysema, high cholesterol, HIV/AIDS, hypertension, ischemic heart disease, and stroke. Others were chronic manageable conditions, including arthritis, asthma, gall bladder disease, stomach ulcers, and back problems of any kind. In addition, Alzheimer's disease or other dementias, as well as depression and anxiety disorders, were included in the priority list. For a complete listing of "priority conditions" see Appendix 4.

When a condition was first mentioned, respondents were asked whether it was due to an accident or an injury (INJURY= 1).

The date a condition began (CONDBEGD, CONDBEGM, CONDBEGY) or an accident or injury occurred (ACCDENTW, ACCDENTM, ACCDENTY) is collected only for conditions that appear on the priority list or are the result of an accident or injury. For confidentiality purposes, the day the accident occurred has been converted to the day of the week that the accident occurred (ACCDENTW). Thus, ACCDENTW cannot be used in conjunction with ACCDENTM and ACCDENTY to determine the exact date of the accident or injury.

For other conditions, whether the condition was present in 1996 has to be inferred. The reference periods for Rounds 1 and 2 both occurred in 1996; conditions that were first mentioned in these rounds thus can be assumed to be present in 1996. However, the reference period for Round 3 was from the date of the second interview (August December 1996) to the date of the third interview, which occurred from February through July 1997. Conditions reported during Round 3 that were not on the priority list, the result of an accident or injury, or associated to a medical provider event (HHNUM, DNNUM, HSNUM, OPNUM, OBNUM, ERNUM, and RXNUM ) are not associated with a beginning date and may have started in 1997.

The beginning and end dates of the Round 3 reference period (BEGREFD3, BEGREFM3, BEGREFY3, ENDREFD3, ENDREFM3, ENDREFY3-- see Section 2.5.2) are included on this file. These dates can be used to calculate how much of the Round 3 reference period occurred in 1997. When conditions are reported in Round 3 (CONDRN=3) and do not have a beginning date (CONDBEGY <0 and ACCDENTY <0) or are not associated with a medical provider event (HHNUM, DNNUM, HSNUM, OPNUM, OBNUM, ERNUM, and RXNUM <1) and a large proportion of the reference period occurred in 1997, analysts may want to consider whether or not the condition should be included in estimates for 1996.

When a respondent reported a condition on the priority list (PRIOLIST=1) or a condition caused by an injury (INJURY=1) a series of questions regarding health care utilization for that condition and the effect of that condition on the person's overall health was asked. The names of these variables end in 1, 2, or 3 indicating the round in which they were asked. After a priority condition was first reported, if a respondent reported a provider visit, a prescribed medicine, or a disability day for that same condition in subsequent rounds some of the questions were asked again. The following questions were asked if the respondent reported a priority condition:

The variables SELECTR2 and SELECTR3 indicate whether or not a priority condition reported

in a previous round was associated with a medical provider event or a disability day and therefore "selected" for follow-up questions for priority conditions in Rounds 2 and/or 3, respectively.

When a respondent reported a condition that resulted from an accident or injury (INJURY=1) the following information was obtained from respondents during the round in which the injury was first reported:

A set of constructed variables (CRND1, CRND2, CRND3) indicates the round in which the condition was first reported, and for subsequent rounds, the round(s) in which a medical provider event, prescription medication, or disability day occurred due that condition. For example, consider a condition for which CRND1 = 0, CRND2=1, and CRND3 = 1; this sequence of CRND indicators implies that the condition was not present during Round 1 (CRND1=0), was first mentioned during Round 2, and was associated with a medical event during Round 3. These round indicators have not been reconciled with CONDRN. CRND1, CRND2, and CRND3 are not applicable for most pregnancies, prenatal visits, or deliveries due to the questionnaire design.

This file contains 3 flag variables indicating whether or not a condition is associated with a missed workday (MISSWORK), a missed school day (MISSSCHL), or a bed day (INBEDFLG).

The medical conditions and procedures reported by the Household Component respondent were recorded by the interviewer as verbatim text, which were then coded to fully-specified 1996 ICD-9-CM codes, including medical condition and V codes (see Health Care Financing Administration, 1980), by professional coders. Although codes were verified and error rates did not exceed 2.5 percent for any coder, analysts should not presume this level of precision in the data; the ability of household respondents to report condition data that can be coded accurately should not be assumed (see Cox and Cohen, 1985; Cox and Iachan, 1987; Edwards, et al, 1994; and Johnson and Sanchez, 1993).

In order to preserve respondent confidentiality, nearly all of the condition codes provided on this file (ICD9CODX) have been collapsed from fully-specified codes to 3-digit code categories. Table 1 in Appendix 2 provides a table of unweighted and weighted frequencies for all ICD-9 condition code values reported on the file. In this table, values which reflect this collapsing have an asterisk in the label indicating that the 3-digit category includes all the subclassifications within that category. For example, the ICD9CODX value of 034 "Strep Throat /Scarlet Fev *" includes the fully-specified subclassifications 034.0 and 034.1; the value 296 "Affective Disorders *" includes the fully-specified subclassifications 296.0 through 296.99. Approximately 10 percent of the records on this file were edited further by collapsing two or more 3-digit codes into one 3-digit code; this second type of collapsing is also indicated in the labels in Table xx. For example, the label for the value 005 "Intestinal Infect 001-005" indicates that the ICD-9 3-digit code categories 001, 002, 003, 004, and 005 were collapsed and are represented by the single code "005". ICD-9 V-codes are included in ICD9CODX and have been edited (i.e., collapsed) in a similar manner.

Similarly, most of the procedure codes (ICD9PROX) were collapsed from fully-specified codes to 2-digit category codes. Table 2 in Appendix 2 provides unweighted and weighted frequencies for ICD9PROX, and this type of collapsing is identified by an asterisk in the variable label. For example, the ICD9PROX value of 81 "Joint Repair*" includes subclassifications 81.0 through 81.99. Some records were further edited to combine 2 or more 2-digit categories, which is also indicated in the ICD9PROX value label - e.g., the label for the value 03 "Skull/Cord/Canal Ops (02,03)" indicates that this value includes the 2-digit categories 02 and 03.

Users should note that because of the design of the survey, most deliveries (i.e. births) are coded as pregnancies. For more accurate estimates for deliveries analysts should use RSINHOS "Reason Entered Hospital" found on the Hospital Inpatient Stays Public Use File (HC-010D).

Conditions and procedures were reported in the same sections of the HC questionnaire (see Variable-Source Crosswalk in Appendix 1). Labels for all values of the variables ICD9CODX and ICD9PROX, as shown in Tables 1 and 2, are provided in the SAS programming statements included in this release (see the HC006SU.TXT file).

ICD-9-CM condition codes have been aggregated into clinically meaningful categories that group similar conditions (CCCODEX). CCCODEX was generated using Clinical Classification Software (formerly known as Clinical Classifications for Health Care Policy Research (CCHPR)), (Elixhauser, et al., 1998), which aggregates conditions and V-codes into 260 mutually exclusive categories, most of which are clinically homogeneous. Appendix 3 lists the ICD-9-CM codes that have been aggregated for each clinical classification category. Note that the reported ICD-9-CM code values were mapped to the appropriate clinical classification category prior to being collapsed to 3-digit ICD-9 codes. For confidentiality purposes a small number (less than 2 percent) of clinical classification codes have been edited. Table 3 in Appendix 2 provides weighted and unweighted frequencies for CCCODEX. Labels for all values of the variable CCCODEX, as shown in Table 3, are provided in the SAS programming statements included in this release (see the HC006SU.TXT file).

In Round 3 respondents were asked whether or not alternative care was received for a condition (APCARE3). Alternative care includes the use of treatments such as acupuncture, nutritional advice, massage therapy, herbal remedies, bio-feedback, imagery or relaxation techniques, homeopathic treatments, spiritual healing or prayer, hypnosis, or traditional medicine such as Chinese or American Indian medicine. APCARE3 has three possible values: "0" if the person received no alternative care for any condition , "1" if alternative care was received for this condition, and "2" if alternative care was not received for this condition, but was received for another condition on the file.

The variables are OBNUM, OPNUM, HHNUM, DVNUM, HSNUM, ERNUM, and RXNUM indicate the total number of 1996 medical provider events that can be linked to each condition record on the current file for each event type, i.e., office-based, outpatient, home health, dental, hospital stays, emergency room visits and prescribed medicines, respectively.

These counts of events were derived from Medical Provider Event Public Use Files (HC-010A, HC-010B, and HC-010D- HC-010H). Medical provider events associated with conditions include all utilization that occurred between January 1, 1996 and December 31, 1996.

Because persons can be seen for more than one condition per visit, these frequencies will not match the person- or event-level utilization counts. For example, if a person had one hospital stay and was treated for a fractured hip and a fractured shoulder and a concussion, each of these conditions has a unique record and HSNUM=1 for each record. If you sum HSNUM for these records, then the total hospital stays would be 3 when actually there was only 1 hospital stay for that person and 3 conditions were treated. These variables are useful if you wanted to know the number of hospital stays for head injuries, hip fractures, etc.

There is a single full year person-level weight (WTDPER96) included on this file. A person-level weight was assigned to each condition reported by a key, in-scope person who responded to MEPS for the full period of time that he or she was in scope during 1996. A key person either was a member of an NHIS household at the time of the NHIS interview, or became a member of such a household after being out-of-scope at the time of the 1995 NHIS (examples of the latter situation include newborns and 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.

The person-level weight WTDPER96 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 RU weight served as a base weight). The weighting process included an adjustment for nonresponse over Round 2 and the 1996 portion of Round 3, as well as poststratification to population control figures for December 1996 (these figures were derived by scaling the population totals obtained from the March 1997 Current Population Survey (CPS) to reflect the Census Bureau estimated population distribution across age and sex categories as of December, 1996). Variables used in the establishment of person-level poststratification 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, black but non-Hispanic, and other); sex; and age. Overall, the weighted population estimate for the civilian non-institutionalized population for December 31, 1996 is 265,439,511 persons. The inclusion of key, in scope persons who were not in scope on December 31,1996 brings the estimated total number of persons represented by the MEPS respondents over the course of the year up to 268,905,490 (WTDPER96 > 0). The weighting process included poststratification to population totals obtained from the 1996 Medicare Current Beneficiary Survey (MCBS) for the number of deaths among Medicare beneficiaries in 1996, and poststratification to population totals obtained from the 1996 MEPS Nursing Home Component for the number of individuals admitted to nursing homes.

The MEPS Round 1 weights incorporated the following components: the original household probability of selection for the NHIS; ratio-adjustment to NHIS 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 1996 CPS database.

To obtain estimates of variability (such as the standard error of sample estimates or corresponding confidence intervals) for estimates based on MEPS survey data, one needs to take into account the complex sample design of MEPS. Various approaches can be used to develop such estimates of variance including use of the Taylor series or various replication methodologies. Replicate weights have not been developed for the MEPS 1996 data. We will describe the variables needed to implement a Taylor series estimation approach.

Using a Taylor Series approach, variance estimation strata and the variance estimation PSUs within these strata must be specified. The corresponding variables on the MEPS full year utilization database are VARSTR96 and VARPSU96, respectively. Specifying a "with replacement" design in a computer software package such as SUDAAN (Shah,1996) should provide 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), there are over 100 degrees of freedom associated with the corresponding estimates of variance.

Data from the current file can be used alone or in conjunction with other files. Merging characteristics of interest from person-level files expands the scope of potential estimates. Person-level characteristics can be merged to the condition file using the following procedure:

1. Sort the person-level file by person identifier, DUPERSID. Keep only variables to be merged on to the conditions file and DUPERSID.

4. If PERS contains the person-level variables, and COND is the conditions file, the following code can be used to add person-level variables to the person's conditions in condition-level file.

Cohen, S. B. (1997). A Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Healthcare Research and Quality; 1997. MEPS Methodology Report, No. 2. AHCPR Pub. No. 97-0027.

Cohen, J. W. (1997). A Design and Methods of the Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Healthcare Research and Quality; 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 S.B. Cohen (1985). "A Comparison of Household and provider Reports of Medical Conditions." In Methodological Issues for Health Care Surveys. Marcel Dekker, New York.

Cox, B. and Iachan, R. (1987). A Comparison of Household and Provider Reports of Medical Conditions. Journal of the American Statistical Association 82(400):1013-18.

Edwards, W.S. Winn, D.M., Kurlantzick V., et al. Evaluation of National Health Interview Survey Diagnostic Reporting. National Center for Health Statistics, Vital Health 2(120). 1994.

Elixhauser A., Steiner CA, Whittington CA, and McCarthy E. Clinical Classifications for health policy research: Hospital inpatient statistics, 1995. Healthcare Cost and Utilization project, HCUP-3 research Note. Rockville, MD: Agency for Healthcare Research and Quality; 1998. AHCPR Pub. No. 98-0049

Health Care Financing Administration (1980). International Classification of Diseases, 9^th Revision, Clinical Modification (ICD-CM). Vol. 1. (DHHS Pub. No. (PHS) 80-1260). DHHS: U.S. Public Health Services.

Shah, B.V., B. G. Barnwell, G.S. Bieler, K.E. Boyle, R.E. Folsom, L. Lavange, S.C. Wheeless, and R. Williams (1996). Technical Manual: Statistical Methods and Algorithms Used in SUDAAN Release 7.0, Research Triangle Park, NC: Research Triangle Institute.

VARIABLE	LABEL	SOURCE⁽¹⁾
DUID	Dwelling Unit ID	Assigned in Sampling
PID	Person Number (PN)	Assigned in Sampling
DUPERSID	Sample person ID (DU + PN)	Assigned in Sampling
CONDN	Condition Number	CAPI Derived
CONDIDX	Cond ID Key: Persid + Counter (3) + CONDN	CAPI Derived
CONDRN	Round Number	CAPI Derived
PSTATUS1	Person Disposition Status R1	RE Section
PSTATUS2	Person Disposition Status R2	RE Section
PSTATUS3	Person Disposition Status R3	RE Section
BEGREFD3	R1 Reference Period Begin Date: Day	CAPI Derived
BEGREFM3	R1 Reference Period Begin Date: Month	CAPI Derived
BEGREFY3	R1 Reference Period Begin Date: Year	CAPI Derived
ENDRFD3	1996 Reference Period End Date: Day	RE Section
ENDRFM3	1996 Reference Period End Date: Month	RE Section
ENDRFY3	1996 Reference Period End Date: Year	RE Section

⁽¹⁾ See the README file in the Survey Instruments section of the MEPS home page, for information on the1MEPS HC questionnaire sections (e.g., RE, CN) shown in the Source column.

VARIABLE	LABEL	SOURCE
PRIOLIST	Is Condition On Priority List	CN02
CONDBEGD	Date Condition Started --Day	CN05
CONDBEGM	Date Condition Started Month	CN05
CONDBEGY	Date Condition Started --Year	CN05
SEEDREV1	RD1: Ever See/Talk to Dr. About Condition	CN03, CN07
SEEDREV2	RD2: Ever See/Talk to Dr. About Condition	CN03, CN07
SEEDREV3	RD3: Ever See/Talk to Dr. About Condition	CN03, CN07
LSTSAW1X	RD1: When Was Last Time Dr. Was Seen	CN04 (Edited)
LSTSAW2X	RD2: When Was Last Time Dr. Was Seen	CN04 (Edited)
LSTSAW3X	RD3: When Was Last Time Dr. Was Seen	CN04 (Edited)
STILTR1X	RD1: Is Person Still Treated For Condition	CN11, CN18 (Edited)
STILTR2X	RD2: Is Person Still Treated For Condition	CN11, CN18 (Edited)
STILTR3X	RD3: Is Person Still Treated For Condition	CN11, CN18 (Edited)
OVRALL1X	RD1: How Did Condition Affect Overall Health	CN13, CN19 (Edited)
OVRALL2X	RD2: How Did Condition Affect Overall Health	CN13, CN19 (Edited)
OVRALL3X	RD3: How Did Condition Affect Overall Health	CN13, CN19 (Edited)
WHOTYP1X	RD1: Who Reported Affect	CN13OV, CN19OV (Edited)
WHOTYP2X	RD2: Who Reported Affect	CN13OV, CN19OV (Edited)
WHOTYP3X	RD3: Who Reported Affect	CN13OV, CN19OV (Edited)
FURTCA1X	RD1: Was Future Treatment Recommended	CN14 (Edited)
FURTCA2X	RD2: Was Future Treatment Recommended	CN14 (Edited)
FURTCA3X	RD3: Was Future Treatment Recommended	CN14 (Edited)
FOLOCA1X	RD1: Receive Follow-Up Care for Condition	CN15 (Edited)
FOLOCA2X	RD2: Receive Follow-Up Care for Condition	CN15 (Edited)
FOLOCA3X	RD3: Receive Follow-Up Care for Condition	CN15 (Edited)
SEEDREF1	RD1: Saw Doctor in Reference Period	CN17
SEEDREF2	RD2: Saw Doctor in Reference Period	CN17
SEEDREF3	RD3: Saw Doctor in Reference Period	CN17
CRND1	RD 1: Detail Information Collected	Constructed
CRND2	RD 2: Detail Information Collected	Constructed
CRND3	RD 3: Detail Information Collected	Constructed
SELECTR2	Previously Reported Priority Condition Selected in Round 2	Constructed
SELECTR3	Previously Reported Priority Condition Selected in Round 3	Constructed
INJURY	Was Condition Due To Accident/Injury	CN02
ACCDENTW	Date Of Accident -- Day	CN06
ACCDENTM	Date Of Accident Month	CN06
ACCDENTY	Date Of Accident Year	CN06
ACCDNWRK	Did Accident Occur At Work	CN07
ACDNTLOC	Where Did Accident Happen	CN08
INOUTHH	Was Accident inside/Outside House	CN09
VEHICLE	Was A Motor Vehicle Involved	CN10
GUN	Was A Gun Involved	CN10
WEAPON	Was Some Other Weapon Involved	CN10
POISON	Was Poison/Poisonous Substance Involved	CN10
FIREBURN	Was Fire/Burning Involved	CN10
DROWN	Was Drowning/Near Drowning Involved	CN10
SPORTS	Was It A Sports Injury	CN10
FALL	Was It A Fall	CN10
ACDNTOTH	Was Something Else Involved	CN10
RECOVER	Fully Recovered From Condition	CN12
MISSWRK	Flag Associated With Missed Work days	DD04
MISSCHL	Flag Associated With Missed School Days	DD08
INBEDFLG	Flag Associated With Bed Days	DD12
PREGFLAG	Pregnancy Flag	CE05-CE09
ICD9CODX	ICD-9 Code for Condition	CE05, HS03, ER04, OP09, MV09, DN02, HH05, PM09 (Edited)
ICD9PROX	ICD-9 Code for Procedure	CE05, HS03, ER04, OP09, MV09, DN02, HH05, PM09 (Edited)
CCCODEX	Clinical Classification Code	Constructed/Edited
APCARE3	RD3: Was Alternative Caregiver Consulted	AP06
HHNUM	# Home Health Events Assoc. w/ Condition	Constructed
DNNUM	# Dental Events Assoc. w/ Condition	Constructed
HSNUM	# Hospital Stays Assoc. w/ Condition	Constructed
OPNUM	# Out-Patient Events Assoc. w/ Condition	Constructed
OBNUM	# Office-Based Events Assoc. w/ Condition	Constructed
ERNUM	# ER Assoc. w/ Condition	Constructed
RXNUM	# Prescribed Medicines Associations W/ Condition	Constructed

Cancer (of any body part)
cancer
tumor
malignancy
malignant tumor
carcinoma
sarcoma
lymphoma
Hodgkin's disease
leukemia
melanoma
metastasis
neuroma
adenoma

Diabetes
diabetes
diabetes mellitus
high blood sugar
juvenile diabetes
(Type I diabetes)
adult-onset diabetes
(Type II diabetes)
diabetic neuropathy

Emphysema
emphysema
chronic obstructive pulmonary
disease (COPD)
chronic bronchitis (MUST use the
word 'chronic', only for adults)
Chonic obstructive bronchitis (MUST use the word 'chronic', only for adults)
smokers cough

High Cholesterol
high cholesterol
high or elevated triglycerides
hyperlipidemia
hypercholesterolemia

Ischemic Heart Disease
ischemic heart disease (MUST use the word 'ischemic')
angina
angina pectoris
coronary artery disease
blocked, obstructed, or occluded
coronary arteries
arteriosclerosis
myocardial infarction
heart attack

Stroke
stroke
cerebral hemorrhage
cerebral aneurysm
transient ischemic accident
transient ischemic attack
apoplexy
carotid artery blockage
arterial thrombosis in brain
blood clot in brain

Arthritis
anything with the word 'arthritis'
rheumatoid arthritis
degenerative arthritis
osteoarthritis
bursitis
rheumatism

Gall Bladder Disease
gall bladder disease, trouble,
attacks, infection, or problems
gallstones

Stomach Ulcers
stomach ulcer
duodenal ulcer
peptic ulcer
bleeding ulcer
ulcerated stomach
perforated ulcer

Back Problems of Any Kind
back problems or pain of any kind
(lower or upper back)
sore, hurt, injured, or stiff back
backache
anything with the words 'vertebra',
'vertebrae', 'lumbar', 'spine', or 'spinal'
strained or pulled muscle in back
sprained back
muscle spasms
back spasms
bad back
lumbago
sciatica or sciatic nerve problems
disc problems: herniated, ruptured, slipped, compressed, extruded, dislocated, deteriorated, or misaligned discs

Alzheimer's Disease and Other Dementias
anything with the words 'Alzheimer's' or 'dementia'
organic brain syndrome

Depression and Anxiety Disorders
depression (including severe, chronic, or major depression)
dysthymia
dysthymic disorder
bipolar disorder
manic depression or manic depressive illness
anxiety attacks
panic attacks
anxiety
nerves
nervous condition
nervous breakdown

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