Skip to main content
U.S. flag
Health and Human Services Logo

An official website of the Department of Health & Human Services

menu-iconMore mobile-close-icon
mobile-back-btn-icon Back
  • menu-iconMenu
  • mobile-search-icon
AHRQ: Agency for Healthcare Research and Quality
  • Search All AHRQ Sites
  • Careers
  • Contact Us
  • Español
  • FAQs
  • Email Updates
MEPS Home Medical Expenditure Panel Survey
Font Size:
Contact MEPS FAQ Site Map  
S
M
L
XL
 

MEPS HC-010H:  1996 Home Health File
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406


Table of Contents

A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Insurance Component
4.0 Nursing Home Component
5.0 Survey Management
C. Technical and Programming Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Naming
2.4.1 General
2.4.2 Expenditure and Sources of Payment Variables
2.5 File 1 Contents
2.5.1 Survey Administration
2.5.1.1 Person Identifiers (DUID, PID, DUPERSID)
2.5.1.2 Record Identifiers (EVNTIDX, FFID11X, EVENTRN)
2.5.2 Characteristics of Home Health Events
2.5.2.1 Date Home Health Event Started (HHBEGYR, HHBEGMM)
2.5.2.2 Characteristics of Home Health Events (SELFAGEN-OTHCWOS)
2.5.2.3 Treatments, Therapies and Services (HOSPITAL-OTHSVCOS))
2.5.2.4 Frequency of Home Health Events (FREQCY-HHDAYS)
2.5.3 Condition and Procedure Codes and Clinical Classification Codes
2.5.3.1 Record Count Variable (NUMCOND)
2.5.4 Flat Fee Variables
2.5.4.1 Definition of Flat Fee Payments
2.5.4.2 Flat Fee Variable Descriptions
2.5.4.3 Total Number of 1996 Events in Group (FFTOT96)
2.5.4.4 Counts of Flat Fee Events that Cross Years (FFBEF96 ­ FFTOT97)
2.5.4.5 Caveats of Flat Fee Groups
2.5.5 Expenditure Data
2.5.5.1 Definition of Expenditures
2.5.5.2 Data Editing/Imputation Methodologies of Expenditure Variables
2.6 File 2 Contents: Un-imputed Expenditure Variables
3.0 Sample Weights and Variance Estimation Variables (WTDPER96-VARPSU96)
3.1 Details on Person Weights Construction
4.0 Strategies for Estimation
4.1 Variables with Missing Values
4.2 Basic Estimates of Utilization, Expenditure and Source of Payment
4.3 Estimates of the Number of Persons with Home Health Events Due to a Hospitalization
4.4 Person-Based Ratio Estimates
4.4.1 Person-Based Ratio Estimates Relative to Persons with Home Health Events by Independent Providers
4.4.2 Person-Based Ratio Estimates Relative to the Entire Population
4.5 Sampling Weights for Merging Previous Releases of MEPS Household Data with the Current Data File
4.6 Variance Estimation
5.0 Merging/Linking MEPS Data Files
5.1 Linking a Person-Level File to the Home Health Provider Event File
5.2 Linking the Home Health Provider Event file (HC-010H) to the Medical Conditions File (HC-00
and/or the Prescribed Medicines File (HC-010A)
5.3 Limitations/Caveats of RXLK (the Prescribed Medicine Link File)
5.4 Limitations/Caveats of CLNK (the Medical Conditions Link File)
6.0 Programming Information
References
Attachment 1
D. Codebook (link to separate file)
E. Variable-Source Crosswalk 

A. Data Use Agreement

Individual identifiers have been removed from the microdata 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 they were supplied; any effort to determine the identity of any reported cases, is prohibited by law.

Therefore in accordance with the above referenced Federal statute, it is understood that:

  1. No one is to use the data in this data set in any way except for statistical reporting and analysis. If the identity of any person or establishment should be discovered inadvertently, then (a) no use will be made of this knowledge, (b) the Director, Office of Management, AHRQ will be advised of this incident, (c) the information that would identify any individual or establishment will be safeguarded or destroyed, as requested by AHRQ, and (d) no one else will be informed of the discovered identity.
  2. No one will attempt to link this data set with individually identifiable records from any data sets other than the Medical Expenditure Panel Survey or the National Health Interview Survey.

By using these data you signify your agreement to comply with the above-stated statutorily based requirements, with the knowledge that deliberately making a false statement in any matter within the jurisdiction of any department or agency of the Federal Government violates 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.  

Return To Table Of Contents

B. Background

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.

MEPS is conducted to provide nationally representative estimates of health care use, expenditures, sources of payment, and insurance coverage for the U.S. civilian noninstitutionalized 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) (formerly the Agency for Health Care Policy and Research (AHCPR)) 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) was conducted 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.  

Return To Table Of Contents

1.0 Household Component

The MEPS HC, a nationally representative survey of the U.S. civilian noninstitutionalized 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 2½-year period. Using computer-assisted personal interviewing (CAPI) technology, data on medical expenditures and use for two 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 noninstitutionalized population, with oversampling of Hispanics and blacks.  

Return To Table Of Contents

2.0 Medical Provider Component

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 who:

  • were identified by the household respondent as providing care for HC respondents receiving Medicaid.
  • were selected through a 75-percent sample of HC households receiving care through an HMO (health maintenance organization) or managed care plan.
  • were selected through a 25-percent sample of the remaining HC households.

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

Diagnoses coded according to ICD-9-CM (9th Revision, International Classification of Diseases) and DSM-IV (Fourth Edition, Diagnostic and Statistical Manual of Mental Disorders).

  • Physician procedure codes classified by CPT-4 (Common Procedure Terminology, Version 4).
  • Inpatient stay codes classified by DRGs (diagnosis-related groups).
  • Prescriptions coded by national drug code (NDC), medication name, strength, and quantity dispensed.
  • Charges, payments, and the reasons for any difference between charges and payments.

The MPC is conducted through telephone interviews and mailed survey materials. In some instances, providers sent medical and billing records which were abstracted into the survey instruments.

Return To Table Of Contents

  3.0 Insurance Component

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:

  • A list of employers or other insurance providers identified by MEPS HC respondents who report having private health insurance at the Round 1 interview.
  • A Bureau of the Census list frame of private-sector business establishments.
  • The Census of Governments from Bureau of the Census.
  • An Internal Revenue Service list of the self-employed.

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 survey. Data are collected from the selected organizations through a prescreening telephone interview, a mailed questionnaire, and a telephone follow-up for nonrespondents.  

Return To Table Of Contents

4.0 Nursing Home Component

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 medicines, 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 1½-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 consisted of 815 responding facilities, 3,209 residents in the facility on January 1, and 2,690 eligible residents admitted during 1996.  

Return To Table Of Contents

5.0 Survey Management

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.

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 web site: <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.  

Return To Table Of Contents

C. Technical and Programming Information

1.0 General Information

This documentation describes one in a series of public use event files from the 1996 Medical Expenditure Panel Survey Household (HC) and Medical Provider Components (MPC). Released as an ASCII data file and SAS transport file, this public use file provides detailed information on home health events for a nationally representative sample of the civilian noninstitutionalized population of the United States and can be used to make estimates of home health utilization and expenditures for calendar year 1996.

Each record represents a household-reported home health event. A home health event is a MONTH of similar service provided by the same PROVIDER -- a month of home health services from a single provider entity (i.e., paid independent informal or agency). For example, if a person received 4 events from a nurse, 10 events from a homemaker and 4 events from a physical therapist all from the same provider every month for 3 months, then there will be 3 event records on the file, one for each month (NOT 54 records). Data were collected in this manner because agencies, hospitals, and nursing homes provide expenditure data in this manner. In order to be consistent with the definition of what is considered a home health event on this file, this same definition (i.e., a month of similar services) was applied to all types of providers. Persons with more than one event are represented on this file more than once. Likewise, persons who do not have a home health event are not represented on the file.

Counts of home health events are based entirely on household reports. Agency home health providers were sampled into the MEPS MPC (see Section B.2.0). Only those providers for whom the respondent signed a permission form were included in MPC. Information from MPC was used to supplement expenditure and payment data reported by the household.

Data from this event file can be merged with other 1996 MEPS HC data files for purposes of appending person characteristics, such as demographic or health insurance coverage to each home health record.

This file can be also used to construct summary variables of expenditures, sources of payment, and related aspects of home health events. Aggregate annual person-level information on the use of home health providers and other health services use is provided on public use file HC-011, where each record represents a MEPS sampled person.

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

Data File Information

Sample Weights and Variance Estimation Variables

Merging MEPS Data Files

Programming Information

References

Codebook

Variable to Source Crosswalk

For more information on MEPS HC survey design see S. Cohen, 1997; J. Cohen, 1997; and S. Cohen, 1996. For information on the MEPS MPC design, see S. Cohen, 1998. A copy of the survey instruments used to collect the information on this file is available on the MEPS web site at the following address: <http://www.meps.ahrq.gov>. 

Return To Table Of Contents

2.0 Data File Information

This public use data set consists of two event-level data files. File 1 contains characteristics associated with the home health event and imputed expenditure data. File 2 contains un-imputed expenditure data from both the Household and Medical Provider Components for all home health events on File 1.

Each record represents a household-reported home health event. A home health event is a MONTH of similar service provided by the same PROVIDER -- a month of home health services from a single provider entity (i.e., paid independent informal or agency). For example, if a person received 4 events from a nurse, 10 events from a homemaker and 4 events from a physical therapist all from the same provider every month for 3 months, then there will be 3 event records on the file, one for each month (NOT 54 records). Data were collected in this manner because agencies, hospitals, and nursing homes provide expenditure data in this manner. In order to be consistent with the definition of what is considered a home health event on this file, this same definition (i.e., a month of similar services) was applied to all types of providers. Persons with more than one event are represented on this file more than once. Likewise, persons who do not have a home health event are not represented on the file.

Both File 1 and File 2 of this public use data set contain 4,240 home health records. Of the 4,240 records, 4,205 are associated with persons having a positive person-level weight (WTDPER96). Both files include all records related to home health events for all household survey respondents who resided in eligible responding households and reported at least one home health event. Each record represents one household-reported home health event that occurred during calender year 1996. Some household respondents may have multiple events and thus will be represented in multiple records on the file. Other household respondents may have reported no events and thus will have no records on this file. These data were collected during rounds 1, 2, and 3 of the MEPS HC. The persons represented on this file had to meet either (a) or (b):

(a) Be classified as a key in-scope person who responded for his or her entire period of 1996 eligibility (i.e., persons with a positive 1996 full-year person-level sampling weight (WTDPER96>0)), or

(b) Be classified as either an eligible non-key person or an eligible out-of-scope person who responded for his or her entire period of 1996 eligibility, and belonged to a family (i.e., all persons with the same value for a particular FAMID variables) in which all eligible family members responded for their entire period of 1996 eligibility, and at least one family member has a positive 1996 full-year person weight (i.e., eligible non-key or eligible out-of-scope persons who are members of a family all of whose members have a positive 1996 full-year MEPS family-level weight (WTFAM96>0)).

Please refer to Attachment 1 for definitions of key, non-key, inscope and eligible. Persons with no home health events for 1996 are not included on this file (but are represented on MEPS person-level files). A codebook for the data file is provided.

Home health providers include formal or paid, and informal or unpaid providers. Formal or paid providers include: home health agency, hospital, or nursing home, and other independent paid providers. Informal or unpaid providers include family and friends.

For home health agencies, hospitals, and nursing homes, it is important to distinguish between the provider and the home health worker. In these cases, the provider is the agency or the facility that employs the workers. The home health workers are the people who administer the care. Examples of home health care workers are the following: nurses, physical therapists, home health aides, homemakers, and hospice workers, among others. These examples are generally the types of workers associated with agencies, hospitals, and nursing homes. Paid independent providers generally include companions, nursing assistants, physicians, etc. For each record on File 1, one or more types of workers can be reported. The respondent is asked to mention all of the types of home health workers who provided home health care (since records represent a month of service, there can be more than one type of worker on a single record). For example, an agency that provides two types of aides that provide home health care to the same person during a specific month is represented as one event on the file (even though two workers employed at the same agency provided care) -- when using this file analysts must keep in mind that a record on the file corresponds to a provider entity not an individual or particular worker.

Expenditure data for home health agency events are collected exclusively in the MPC. Other paid independent home health care event expenditure data are collected from the household. These types of events are not included in the MPC. Friends, family and volunteers providing home health care to a person are considered unpaid and are not included in the MPC (no expenditure information is available for them).

Each home health record on File 1 also includes the following: date the provider started seeing the respondent; type of provider; types of services provided and if this was a repeat event; if care was received due to hospitalization; whether or not a person was taught how to use medical equipment; flat fee information; imputed sources of payment, total payment and total charge of the home health event expenditure; and a full-year person-level weight.

File 2 of this public use data set is intended for analysts who want to perform their own imputations to handle missing data. This file contains one set of un-imputed expenditure information from the MPC (if home health provider was sampled in the MPC) as well as one set of pre-imputed expenditure information from the HC. Both sets of expenditure data have been subject to minimal logical editing that accounted for outliers, copayments or charges reported as total payments, and reimbursed amounts that were reported as out of pocket payments. In addition, edits were implemented to correct for mis-classifications between Medicare and Medicaid and between Medicare HMO's and private HMO's as payment sources. However, missing data were not imputed.

Data from these files can be merged with previously released 1996 MEPS HC person-level data using the unique person identifier, DUPERSID, to append person-level characteristics such as demographic or health insurance coverage to each record. The home health event file (HC-010H) can also be linked to the MEPS 1996 Medical Conditions File (HC-006) and MEPS 1996 Prescribed Medicines File (HC-010A). Please see Section 5.0 and the Appendix File (HC-010I) for details on how to link MEPS data files.  

Return To Table Of Contents

2.1 Codebook Structure

For each variable on these files, both weighted and unweighted frequencies are provided. The codebook and data file sequence list variables in the following order:

File 1

Unique person identifiers

Unique home health event identifier

Other survey administration variables

Home health characteristic variables

Imputed expenditure variables

Weight and variance estimation variables

File 2

Unique person identifiers

Unique home health event identifier

Pre-imputed expenditure variables

Return To Table Of Contents

2.2 Reserved Codes

The following reserved code values are used:

VALUE DEFINITION

-1 INAPPLICABLE Question was not asked due to skip pattern.

-7 REFUSED Question was asked and respondent refused to answer question.

-8 DK Question was asked and respondent did not know answer.

-9 NOT ASCERTAINED Interviewer did not record the data.

Generally, -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.  

Return To Table Of Contents

2.3 Codebook Format

This codebook describes an ASCII data set (although the data are also being provided in a SAS transport file). The following codebook items are provided for each variable:

IDENTIFIER  DESCRIPTION
Name  Variable name (maximum of 8 characters)
Description  Variable descriptor (maximum 40 characters)
Format  Number of bytes
Type  Type of data: numeric (indicated by NUM) or character (indicated by CHAR)
Start  Beginning column position of variable in record
End  Ending column position of variable in record

Return To Table Of Contents

2.4 Variable Naming

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. All imputed/edited variables end with an "X."

2.4.1 General

Variables contained on Files 1 and 2 were derived either from the HC questionnaire itself, the MPC data collection instrument, or from the CAPI. The source of each variable is identified in Section E, entitled, "Variable - 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 which come from one or more specific questions have those numbers and the questionnaire section indicated in the "Source" column; (3) variables constructed from multiple questions using complex algorithms are labeled "Constructed" in the "Source" column; and (4) variables which have been imputed are so indicated.  

Return To Table Of Contents

2.4.2 Expenditure and Sources of Payment Variables

The pre-imputed and imputed versions of the expenditure and sources of payment variables are provided on the 2 separate files. Variables on Files 1 and 2 follow a standard naming convention and are 7 characters in length. Please note that pre-imputed means that a series of logical edits have been performed on the variable but missing data remains. The imputed versions incorporate the same edits but have also undergone an imputation process to account for missing data.

The pre-imputed/unimputed expenditure variables on File 2 end with an "H." All imputed variables on File 1 end with an "X."

The total sum of payments, 12 sources of payment variables and total charge variables are named consistently in the following way:

The first two characters indicate the type of event:

IP - inpatient stay 

OB - office-based visit

ER - emergency room visit 

OP - outpatient visit

HH - home health event 

DV - dental visit

OM - other medical equipment 

RX - prescribed medicine

In the case of sources of payment variables, the third and fourth characters indicate:

SF - self or family 

OF - other Federal Government 

XP - sum of payments

MR - Medicare 

SL - State/local government

MD - Medicaid 

WC - Worker's Compensation

PV - private insurance 

OT - other insurance

VA - Veterans 

OR - other private

CH - CHAMPUS/CHAMPVA 

OU - other public

The fifth and sixth characters indicate the year (96). The last character indicates whether it is edited/imputed (X) or came from household (H).

For example, HHSF96X is the edited/imputed amount paid by self or family for a home health event expenditure incurred in 1996.  

Return To Table Of Contents

2.5 File 1 Contents

2.5.1 Survey Administration

2.5.1.1 Person Identifiers (DUID, PID, DUPERSID)

The dwelling unit ID (DUID) is a 5-digit random number assigned after the case was sampled for MEPS. The 3-digit person number (PID) uniquely identifies each person within the dwelling unit. The 8-character variable DUPERSID uniquely identifies each person represented on the file and is the combination of the variables DUID and PID. For detailed information on dwelling units and families, please refer to the documentation on public use file HC-008.

Return To Table Of Contents

2.5.1.2 Record Identifiers (EVNTIDX, FFID11X, EVENTRN)

EVNTIDX uniquely identifies each event (i.e., each record on the file).

FFID11X uniquely identifies a flat fee group, that is, all events that were part of a flat fee payment situation. For example, pregnancy is typically covered in a flat fee arrangement where the prenatal visits, the delivery, and the postpartum visits are all covered under one flat fee dollar amount. These three events (the prenatal visit, the delivery, and the postpartum visits) have the same value for FFID11X. Please note that FFID11X should be used to link up all MEPS event files (excluding prescribed medicines) in order to determine the full set of events that are part of a flat fee group.

EVNTRN indicates the round in which the home health event was first reported.

Return To Table Of Contents

2.5.2 Characteristics of Home Health Events

File 1 contains 43 variables describing home health events reported by respondents in the Home Health section of the MEPS-HC questionnaire. The questionnaire contains specific probes for determining specific details about the home health event.

2.5.2.1 Date Home Health Event Started (HHBEGYR, HHBEGMM)

The start date variables (HHBEGYR and HHBEGMM) indicate the year and month that the household respondent reported as the start date (or the first time) for this type of home health event. An artifact of the data collection for the variable HHBEGYR is that all events are reported as having started in 1996 even though a person could have started receiving that type of home health care from that provider year(s) before 1996. These variables should not be interpreted as "true"start dates.

2.5.2.2 Characteristics of Home Health Events (SELFAGEN-OTHCWOS)

The HC questionnaire determines whether the home health provider event(s) for each month's services was an agency or whether the provider was an independent paid provider (SELFAGEN). Respondents were also asked if the provider was paid or whether services were provided by a friend, relative, or volunteer (HHTYPE). All respondents receiving care from an agency, hospital or nursing home were asked to identify the type of home health worker they saw (CNA-SPEECTHP) -- for example, certified nursing assistant, home health aide, registered nurse, etc. Analysts should keep in mind that these identifications by household respondents are subjective in nature, are not mutually exclusive or collectively exhaustive, and should not be used to make certain estimates. For example, a person on one type of insurance may identify an individual providing home health care services to them as a personal care attendant while an individual having a different type of insurance coverage may identify that same worker as a home care aide. To make estimates of personal care attendants or home health aides based on the their identification by household respondents and by treating these types of workers as mutually exclusive groups will result in inaccurate estimates. Respondents may also have indicated that they were seen by more than one home health care worker during a single event. For example, since an event is a month of services a respondent may have reported being seen by a nurse, a physical therapist, or a home health aide during a single event. Respondents were also asked to identify other non-skilled and skilled workers seen during that month of care (NONSKILL-OTHCWOS).

Return To Table Of Contents

2.5.2.3 Treatments, Therapies and Services (HOSPITAL-OTHSVCOS))

Regardless of the type of provider, all respondents were asked if the home health services they received were due to a hospitalization (HOSPITAL), whether it was due to a medical condition (VSTRELCN), if the person was helped with daily activities (DAILYACT), if the person received companionship services (COMPANY), and whether or not the person received any other type of services (OTHSVCE and OTHSVCOS). Only persons receiving care from an agency, hospital, or nursing home were asked if they were taught how to use medical equipment (MEDEQUIP) and whether or not they received a medical treatment (TREATMT).

Return To Table Of Contents

2.5.2.4 Frequency of Home Health Events (FREQCY-HHDAYS)

Several variables identify the frequency and length of home health events (FREQCY-MINLONG) and whether or not the same services were received during each month (SAMESVCE). Frequency of event variables (FREQCY- TMSPDAY) were used as building blocks to construct HHDAYS. HHDAYS indicates the number of days the respondent received care during that event (i.e., month of care). HHDAYS has not been reconciled with DAYSPMO. Frequency variables can be combined to get a measure of the intensity of care. For example, HHDAYS used in conjunction with HRSLONG and TMSPDAY, can be used to form a measure of intensity of care -- that is, how many hours of care was provided in one month.

Return To Table Of Contents

2.5.3 Condition and Procedure Codes and Clinical Classification Codes

Information on household reported medical conditions and procedures (including condition codes, procedure codes, and clinical classification codes) associated with each home health event are NOT provided on this file. To obtain complete condition information associated with an event, the analyst must link to the HC-006 Medical Conditions File. Details on how to link to the MEPS Medical Conditions File (HC-006) are provided in the Appendix File (HC-010I).

Return To Table Of Contents

2.5.3.1 Record Count Variable (NUMCOND)

The variable NUMCOND indicates the total number of condition and procedure records that can be linked from HC-006: Medical Conditions File to each home health record. For events where no condition records linked, NUMCOND=0. In order to obtain complete condition information for events with NUMCOND greater than 0, the analyst must link to the MEPS Condition Files (HC-006). See Section 5.0 for details on linking MEPS data files.

Return To Table Of Contents

2.5.4 Flat Fee Variables

User's Note: For home health events, use flat fee variables with caution. Flat fees are not common with respect to home health events (only 18 home health provider events are identified as being part of a flat fee) and should not be a focus of an analysis.

Return To Table Of Contents

2.5.4.1 Definition of Flat Fee Payments

A flat fee is the fixed dollar amount a person is charged for a package of health care services. An example is obstetrician's fee covering a normal delivery, as well as pre- and post-natal care. A flat fee group is the set of medical services (i.e., events) that are covered under the same flat fee payment situation. The flat fee groups represented on this file (and all of the other 1996 MEPS event files), include flat fee groups where at least one of the health care events, as reported by the HC respondent, occurred during 1996. By definition a flat fee group can span multiple years and/or event types (e.g., hospital stay, physician office visit), and a single person can have multiple flat fee groups.

Return To Table Of Contents

2.5.4.2 Flat Fee Variable Descriptions

There are several variables on this file that describe a flat fee payment situation and the number of medical events that are part of a flat fee group.

FFHHTYPX indicates whether the 1996 home health provider event is the "stem" or "leaf" of a flat fee group. A stem (records with FFHHTYPX = 1) is the initial medical service (event) which is followed by other medical events that are covered under the same flat fee payment. The leaf of the flat fee group (records with FFHHTYPX = 2) are those medical events that are tied back to the initial medical event (the stem) in the flat fee group.

Return To Table Of Contents

2.5.4.3 Total Number of 1996 Events in Group (FFTOT96)

If a home health provider event is part of a flat fee group, the variable FFTOT96 counts the total number of all known events (that occurred during 1996) covered under a single flat fee payment situation. This count includes the home health provider event record in the count.

Return To Table Of Contents

2.5.4.4 Counts of Flat Fee Events that Cross Years (FFBEF96 ­ FFTOT97)

As described above, a flat fee payment situation covers multiple events and the multiple events could span multiple years. For situations where a 1996 home health provider event is part of a group of events, and some of the events occurred before 1996, counts of the known events are provided on the home health provider event file record. An indicator variable is provided if some of the events occurred after 1996. These variables are:

FFBEF96 -- total number of pre-1996 events in the same flat fee group as the 1996 home health provider event record. This count would not include 1996 home health provider event.

FFHH97 ­ indicates whether or not there are 1997 home health provider events in the same flat fee group as the 1996 home health provider event record.

FFTOT97 -- indicates whether or not there any 1997 medical events in the same flat fee group as the 1996 home health provider event record.

Return To Table Of Contents

2.5.4.5 Caveats of Flat Fee Groups

The user should note that flat fee payment situations are not common with respect to home health provider events. There are 18 home health provider events that are identified as being part of a flat fee payment group.

In general, every flat fee group should have an initial event (stem) and at least one subsequent event (leaf). There are some situations where this is not true. For some of these flat fee groups, the initial event reported occurred in 1996 but the remaining events that were part of this flat fee group occurred in 1997. In this case, the 1996 flat fee group represented on this file would consist of one event (the stem). The 1997 events that are part of this flat fee group are not represented on this file. Similarly, the household respondent may have reported a flat fee group where the initial event began in 1995 but subsequent events occurred during 1996. In this case, the initial event would not be represented on the file. This 1996 flat fee group would then only consist of one or more leaf records and no stem. Another reason for which a flat fee group would not have a stem and a leaf record is that the stems or leaves could have been reported as different event types.

Return To Table Of Contents

2.5.5 Expenditure Data

2.5.5.1 Definition of Expenditures

Expenditures on this file refer to what is paid for health care services. More specifically, expenditures in MEPS are defined as the sum of payments for care received, including out of pocket payments and payments made by private insurance, Medicaid, Medicare and other sources. The definition of expenditures used in MEPS differs slightly from its predecessors, the 1987 NMES and 1977 NMCES surveys, where "charges" rather than sum of payments were used to measure expenditures. This change was adopted because charges became a less appropriate proxy for medical expenditures during the 1990's due to the increasingly common practice of discounting. Although measuring expenditures as the sum of payments incorporates discounts in the MEPS expenditure estimates, these estimates do not incorporate any payment not directly tied to specific medical care events, such as bonuses or retrospective payment adjustments paid by third party payers. Another general change from the two prior surveys is that charges associated with uncollected liability, bad debt, and charitable care (unless provided by a public clinic or hospital) are not counted as expenditures because there are no payments associated with those classifications. For details on expenditure definitions, please reference the following, "Informing American Health Care Policy" (Monheit et al., 1999).

Return To Table Of Contents

2.5.5.2 Data Editing/Imputation Methodologies of Expenditure Variables

General Imputation Methodology

The general methodology used for editing and imputing expenditure data is described below. However, please note, home health events provided by an agency, hospital or nursing home were included in the MPC, and home health provided by paid independent events were not followed in the MPC. Although the general procedures remain the same for all home health events, there were some differences in the editing and imputation methodologies applied to those events followed in the MPC and those events not followed in the MPC. Analysts should note that home health care provided by friends, family, or volunteers were assumed to be free and were not included in any imputation process. Please see below for details on the differences between these editing/imputation methodologies.

Home health expenditure data for agency, hospital, and nursing home providers were collected exclusively from the MPC (i.e., household respondents were not asked to report home health expenditures from these types of providers). The MPC contacted 100 percent of the agency, hospital, and nursing home health providers identified by household respondents. Since paid independent home health providers were not included in the MPC, all expenditure data from these providers were collected from household respondents.

Logical edits were used to resolve internal inconsistencies and other problems in the HC and MPC survey-reported data. The edits were designed to preserve partial payment data from households and providers, and to identify actual and potential sources of payment for each household-reported event. In general, these edits accounted for outliers, co-payments or charges reported as total payments, and reimbursed amounts that were reported as out of pocket payments. In addition, edits were implemented to correct for mis-classifications between Medicare and Medicaid and between Medicare HMO's and private HMO's as payment sources. These edits produced a complete vector of expenditures for some events, and provided the starting point for imputing missing expenditures in the remaining events.

A weighted sequential hot-deck procedure was used to impute for missing expenditures as well as total charge. The procedure uses survey data from respondents to replace missing data, while taking into account the respondents' weighted distribution in the imputation process. Classification variables vary by event type in the hot-deck imputations, but total charge and insurance coverage are key variables in all of the imputations.

Return To Table Of Contents

Imputation Methodology for Home Health Events

Expenditures for home health events were developed in a sequence of logical edits and imputations. Analysts should note that home health care provided by friends, family, or volunteers were assumed to be free and were not included in any imputation process. "Household" edits were applied to sources and amounts of payment for all events reported for paid independent providers by HC respondents. "MPC" edits were applied to provider-reported sources and amounts of payment for records matched to household-reported events for all agency, hospital, and nursing home home health providers. Both sets of edits were used to correct obvious errors in the reporting of expenditures. Imputations for independent paid providers and for agencies, hospitals, and nursing homes were conducted separately. Separate imputations also were performed for flat fee and simple events.

Logical edits were used to sort each event into a specific category for the imputations. Events with complete expenditures were flagged as potential donors for the hot-deck imputations while events with missing expenditure data were assigned to various recipient categories. Each event was assigned to a recipient category based on its pattern of missing data. For example, an event with a known total charge but no expenditure information was assigned to one category, while an event with a known total charge and some expenditure information was assigned to a different category. Similarly, events without a known total charge were assigned to various recipient categories based on the amount of missing data.

The logical edits produced eight recipient categories for events with missing data. Expenditures were imputed through separate hot-deck imputations for each of the eight recipient categories. The donor pool in these imputations was restricted to events with complete expenditures from either the HC or the MPC.

The donor pool included "free events" because, in some instances, providers are not paid for their services. These events represent charity care, bad debt, provider failure to bill, and third party payer restrictions on reimbursement in certain circumstances. If free events were excluded from the donor pool, total expenditures would be over-counted because the cost of free care would be implicitly included in paid events and explicitly included in events that should have been treated as free from provider. Analysts should note that home health care provided by friends, family, or volunteers were assumed to be free and were not included in any imputation process.

Return To Table Of Contents

Flat Fee Expenditures

The approach used to count expenditures for flat fees was to place the expenditure on the first event of the flat fee group. The remaining events have zero payments. Thus, if the first event in the flat fee group occurred prior to 1996, all of the events that occurred in 1996 will have zero payments. Conversely, if the first event in the flat fee group occurred at the end of 1996, the total expenditure for the entire flat fee group will be on that event, regardless of the number of events it covered after 1996.

Zero Expenditures

There are some medical events reported by respondents where the payments were zero. This could occur for several reasons including (1) free care was provided, (2) bad debt was incurred, (3) care was covered under a flat fee arrangement beginning in an earlier year, or (4) follow-up events were provided without a separate charge (e.g. after a surgical procedure). If all of the medical events for a person fell into one of these categories, then the total annual expenditures for that person would be zero. Home health care provided by family, friends or a volunteer were considered free care and have zero dollars associated with them.

Discount Adjustment Factor

An adjustment was also applied to some HC reported expenditure data because an evaluation of matched HC/MPC data showed that respondents who reported that charges and payments were equal were often unaware that insurance payments for the care had been based on a discounted charge. To compensate for this systematic reporting error, a weighted sequential hot-deck imputation procedure was implemented to determine an adjustment factor for HC reported insurance payments when charges and payments were reported to be equal. As for the other imputations, selected predictor variables were used to form groups of donor and recipient events for the imputation process.

Sources of Payment

In addition to total expenditures, variables are provided which itemize expenditures according to major sources of payment categories. These categories are:

1. Out of pocket by user or family

2. Medicare

3. Medicaid

4. Private Insurance

5. Veteran's Administration, excluding CHAMPVA

6. CHAMPUS or CHAMPVA

7. Other Federal sources - includes Indian Health Service, Military Treatment Facilities, and other care by the Federal government

8. Other State and Local Sources - includes community and neighborhood clinics, State and local health departments, and State programs other than Medicaid.

9. Worker's Compensation

10. Other Unclassified Sources - includes sources such as automobile, homeowner's, liability, and other miscellaneous or unknown sources.

Two additional sources of payment variables were created to classify payments for events with apparent inconsistencies between insurance coverage and sources of payment based on data collected in the survey. These variables include:

11. Other Private - any type of private insurance payments reported for persons not reported to have any private health insurance coverage during the year as defined in MEPS; and

12. Other Public - Medicaid payments reported for persons who were not reported to be enrolled in the Medicaid program at any time during the year.

Though relatively small in magnitude, users should exercise caution when interpreting the expenditures associated with these two additional sources of payment. While these payments stem from apparent inconsistent responses to health insurance and sources of payment questions in the survey, some of these inconsistencies may have logical explanations. For example, private insurance coverage in MEPS is defined as having a major medical plan covering hospital and physician services. If a MEPS sampled person did not have such coverage but had a single service type insurance plan (e.g., dental insurance) that paid for a particular episode of care, those payments may be classified as "other private." Some of the "other public" payments may stem from confusion between Medicaid and other state and local programs or may be persons who were not enrolled in Medicaid, but were presumed eligible by a provider who ultimately received payments from the program.

Users should also note that the Other Public and Other Private sources of payment categories only exist on File 1 for imputed expenditure data since they were created through the editing/imputation process. File 2 reflect 10 sources of payment as they were collected through the MEPS HC and MPC survey instruments.

Imputed Home Health Expenditure Variables (HHSF96X - HHXP96X and HHSF96H-HHUC96H)

There are 12 expenditure variables specific to paid independent home health events and 14 expenditure variables specific to agency home health events. Home health agency, hospital, and nursing home events are sampled at a rate of 100% for the MPC. Households were not asked any expenditure-related questions in regards to these types of events, therefore, there are no household reported expenditure data for these events. Independent paid providers are not included in the MPC. Household reported responses are the only data available for these types of events. All expenditure data for paid independent providers are fully imputed from household reported expenditures. There are no expenditure data for informal care providers. It was assumes that these events were free. Informal care (unpaid care provided by family, friends, or volunteers) results in a -1 in all expenditure categories.

All of these expenditures have gone through an editing and imputation process and have been rounded to the second decimal place. There is a sum of payments variable (HHXP96X) which for each home health event sums all the expenditures from the various sources of payment. The 12 sources of payment expenditure variables for each home health event are the following: amount paid by self or family (HHSF96X), amount paid by Medicare (HHMR96X), amount paid by Medicaid (HHMD96X), amount paid by private insurance (HHPV96X), amount paid by Veterans Administration (HHVA96X), amount paid by CHAMPUS/CHAMPVA (HHCH96X), amount paid other federal sources (HHOF96X), amount paid by state and local (non-federal) government sources (HHSL96X), amount paid by Worker's Compensation (HHWC96X), and amount paid by some other source of insurance (HHOT96X). As mentioned previously, there are two additional expenditure variables called HHOR96X and HHOU96X (other private and other public respectively). These two expenditure variables were created to maintain consistency between what the household reported as their private and public insurance status for hospitalization and physician coverage. Analysts can determine if a home health event was paid by an agency or some other paid independent provider by subsetting the variable SELFAGEN to the appropriate and desired value.

Return To Table Of Contents

Rounding

Expenditure variables on file, HC-010H, have been rounded to the nearest penny. Person-level expenditure information released on HC-011 were rounded to the nearest dollar. It should be noted that using the MEPS event files HC-010A through HC-010H to create person-level totals will yield slightly different totals than that those found on HC-011. These differences are due to rounding only. Moreover, in some instances, the number of persons having expenditures on the event files (HC-010A - HC-010H) for a particular source of payment may differ from the number of persons with expenditures on the person-level expenditure file (HC-011) for that source of payment. This difference is also an artifact of rounding only. Please see the Appendix File (HC-010I) for details on such rounding differences.

Imputation Flags

The variables IMPHHSLF-IMPHHCHG identify records where the home health provider expense has been imputed using the methodologies outlined in this document. When a record was identified as being the leaf of a flat fee, the values of all imputation flags were set to "0" (not imputed) since they we are not included in the imputation process.

Return To Table Of Contents

2.6 File 2 Contents: Un-imputed Expenditure Variables

Both imputed and pre-imputed expenditure data are provided on this file. Pre-imputed means that only a series of logical edits were applied to both the HC and MPC data to correct for several problems including outliers, co-payments or charges reported as total payments, and reimbursed amounts counted as out-of-pocket payments. Edits were also implemented to correct for misclassifications between Medicare and Medicaid and between Medicare HMO's and private HMO's as payment sources, as well as number of other data inconsistencies that could be resolved through logical edits. Missing data were not imputed.

The user should note that there exist only 10 sources of payment variables in the pre-imputed expenditure data, while the imputed expenditure data on File 1 contains 12 sources of payment variables. The additional two sources of payments (which are not reported as separate sources of payment through the data collection) are Other Private and Other Public. These sources of payment categories were constructed to resolve apparent inconsistencies between individuals' reported insurance coverage and their sources of payment for specific events.

The user should also note that the variable HHSFFIDX, which is the original flat fee identifier that was derived during the household interview, should be used only if user is interested in performing their own expenditure imputation.

Return To Table Of Contents

3.0 Sample Weights and Variance Estimation Variables (WTDPER96-VARPSU96)

Overview

There is a single full year person-level weight (WTDPER96) included on this file. A person-level weight was assigned to each home health provider event 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.

Return To Table Of Contents

3.1 Details on Person Weights Construction

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.

Return To Table Of Contents

4.0 Strategies for Estimation

This file is constructed for efficient estimation of utilization, expenditure, and sources of payment for home health provider events and to allow for estimates of number of persons with home health provider events for 1996.

Return To Table Of Contents

4.1 Variables with Missing Values

It is essential that the analyst examine all variables for the presence of negative values used to represent missing values. For example, a record with a value of -8 for the variable HOSPITAL indicates that whether or not this home health event was due to a hospitalization was reported as unknown.

For continuous or discrete variables, where means or totals may be taken, it may be necessary to set minus values to values appropriate to the analytic needs. That is, the analyst should either impute a value or set the value to one that will be interpreted as missing by the computing language used. For categorical and dichotomous variables, the analyst may want to consider whether to recode or impute a value for cases with negative values or whether to exclude or include such cases in the numerator and/or denominator when calculating proportions.

Methodologies used for the editing/imputation of expenditure variables (e.g., sources of payment, flat fee, and zero expenditures) are described in Section 2.5.5.

Return To Table Of Contents

4.2 Basic Estimates of Utilization, Expenditure and Source of Payment

While the examples described below illustrate the use of event level data in constructing person-level total expenditures, these estimates can also be derived from the person-level expenditure file unless the characteristic of interest is event specific.

In order to produce national estimates related to home health independent provider events (SELFAGEN=2), expenditure and sources of payment, the value in each record contributing to the estimates must be multiplied by the weight (WTDPER96) contained on that record.

Example 1:

For example, the total number of home health independent provider events, for the civilian non-institutionalized population of the U.S. in 1996, is estimated as the sum of the weight (WTDPER96) across all home health independent provider records. That is,

Sum of Wj=8,438,022                                       (1)

Example 2:

Various estimates can be produced based on specific variables and subsets of records. For example, the estimate for the mean out-of-pocket payment per independent home health provider event should be calculated as the weighted average of the independent home health provider's bill paid by self/family. That is,

X bar =(Sum of WjXj) / (Sum of Wj)= $481.27                        (2)

where Xj = HHSF96Xj and Sum of Wj=8,177,126

for all independent home health provider records (SELFAGEN=2) with HHXP96Xj > 0 .

This gives $481.27 as the estimated mean amount of out-of-pocket payment of expenditures associated with home health events by independent providers and 8,177,126 as an estimate of the total number of home health events by independent providers with expenditure. Both of these estimates are for the civilian non-institutionalized population of the U.S. in 1996.

Example 3:

Another example would be to estimate the average proportion of total expenditures paid by private insurance for home health events by independent providers. This should be calculated as the weighted average of proportion of total expenditures paid by private insurance. That is

Y bar =(Sum of WjYj) / (Sum of Wj)=0.077                              (3)

where Yj= HHPV96Xj / HHXP96Xj and Sum of Wj=8,177,126

for all independent home health provider recorders (SELFAGEN=2) with HHXP96Xj > 0.

This gives 0.077 as the estimated mean proportion of total expenditures paid by private insurance for home health events by independent providers with expenditures for the civilian non-institutionalized population of the U.S. in 1996.

Return To Table Of Contents

4.3 Estimates of the Number of Persons with Home Health Events Due to a Hospitalization

When calculating an estimate of the total number of persons with home health events by independent providers, users can use a person-level file (MEPS HC-011: Person-level Expenditures and Utilization) or the current file. However, the current file must be used, when the measure of interest is defined at the event level. For example, to estimate the number of home health events where services were provided due to a hospitalization, the current file must be used. This would be estimated as,

Sum of WiXi across all unique persons i on this file, (4)

where

Wi is the sampling weight (WTDPER96) for person i

and

Xi = 1 if HOSPITAL EQ 1 for any events for person i

= 0 otherwise.

Prior to estimation users will need to take into consideration that 116 records have a missing value for HOSPITAL.

Return To Table Of Contents

4.4 Person-Based Ratio Estimates

4.4.1 Person-Based Ratio Estimates Relative to Persons with Home Health Events by Independent Providers

This file may be used to derive person-based ratio estimates. However, when calculating ratio estimates where the denominator is persons, care should be taken to properly define the unit of analysis up to person-level. For example, the mean expense for persons with home health events by independent providers (SELFAGEN=2) is estimated as,

(Sum of Wi Zi) / (Sum of Wi) across all unique persons i on this file,                         (5)

where

Wi is the sampling weight(WTDPER96) for person i

and

SELFAGEN=2

and

Zi = Sum of HHXP96Xj across all events for person i.

Return To Table Of Contents

  4.4.2 Person-Based Ratio Estimates Relative to the Entire Population

If the ratio relates to the entire population, this file cannot be used to calculate the denominator, as only those persons with at least one home health provider event are represented on this data file. In this case MEPS File HC-011, which has data for all sampled persons, must be used to estimate the total number of persons (i.e. those with events and those without events). For example, to estimate the proportion of civilian non-institutionalized population of the U.S. with at least one home health event by an independent provider, the numerator would be derived from data on the current file, and the denominator should be derived from data on the MEPS HC-011 person-level file. That is,

(Sum of Wi Zi) / (Sum of Wi) across all unique persons i on the MEPS HC-011 file,     (6)

where

Wi is the sampling weight(WTDPER96) for person i

and

Zi = 1 if SELFAGENj EQ 2 for any events of person i on the home health provider events file

= 0 otherwise for all remaining persons on the MEPS HC-011 file.

Prior to estimation users will need to take into consideration that 704 records have a missing value for SELFAGEN.

Return To Table Of Contents

4.5 Sampling Weights for Merging Previous Releases of MEPS Household Data with the Current Data File

There have been several previous releases of MEPS Household Survey public use data. Unless a variable name common to several tapes is provided, the sampling weights contained on these data files are file-specific. The file-specific weights reflect minor adjustments to eligibility and response indicators due to birth, death, or institutionalization among respondents.

For estimates from a MEPS data file that do not require merging with variables from other MEPS data files, the sampling weight(s) provided on that data file are the appropriate weight(s). When merging a MEPS Household data file to another, the major analytical variable (i.e., the dependent variable) determines the correct sampling weight to use.

Return To Table Of Contents

4.6 Variance Estimation

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. Variables needed to implement a Taylor series estimation approach are described in the paragraph below.

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. The following illustrates these concepts using two examples from Section 4.2.

Example 2 from Section 4.2

Using a Taylor series approach, specifying VARSTR96 and VARPSU96 as the variance estimation strata and PSUs (within these strata) respectively and specifying a "with replacement" design in the computer software package SUDAAN will yield an estimate of standard error of $136 for the estimated mean of out-of-pocket payment.

Example 3 from Section 4.2

Using a Taylor Series approach, specifying VARSTR96 and VARPSU96 as the variance estimation strata and PSUs (within these strata) respectively and specifying a "with replacement" design in the computer software package SUDAAN will yield an estimate of standard error of 0.0463 for the weighted mean proportion of total expenditures paid by private insurance.

Return To Table Of Contents

5.0 Merging/Linking MEPS Data Files

Data from this file can be used alone or in conjunction with other files. This section provides instructions for linking the home health provider events with other MEPS public use files, including the conditions file, the prescribed medicines file, and a person-level file.

Return To Table Of Contents

5.1 Linking a Person-Level File to the Home Health Provider Event File

Merging characteristics of interest from other MEPS files (e.g., HC-008: 1996 Full Year Population Characteristics File or HC-010: 1996 Prescribed Medicines File) expands the scope of potential estimates. For example, to estimate the total number of home health provider events of persons with specific characteristics (e.g., age, race, and sex), population characteristics from a person-level file need to be merged onto the home health provider file. This procedure is illustrated below. The Appendix File (HC-010I) provides additional details on how to merge MEPS data files.

1. Create data set PERS by sorting the person-level file, HC003, by the person identifier, DUPERSID. Keep only variables to be merged on to the home health provider event file and DUPERSID.

2. Create data set HVIS by sorting the home health provider event file by person identifier, DUPERSID.

3. Create final date set NEWHVIS by merging these two files by DUPERSID, keeping only records on the home health provider event file.

The following is an example of SAS code which completes these steps:

PROC SORT DATA=HC003(KEEP=DUPERSID AGE SEX RACEX) OUT=PERSX;
BY DUPERSID;
RUN;

PROC SORT DATA=HVIS;
BY DUPERSID;
RUN;

DATA NEWHVIS;
MERGE HVIS (IN=A) PERSX(IN=B);
BY DUPERSID;
IF A;
RUN;

Return To Table Of Contents

5.2 Linking the Home Health Provider Event file (HC-010H) to the Medical Conditions File (HC-006) and/or the Prescribed Medicines File (HC-010A)

Due to survey design issues, there are limitations/caveats that an analyst must keep in mind when linking the different files. This limitations/caveats are listed below. For detailed linking examples including SAS code, analyst should refer to HC-010I: The Appendix file.  

Return To Table Of Contents

5.3 Limitations/Caveats of RXLK (the Prescribed Medicine Link File)

The RXLK file provides a link from the prescribed medicine records on HC-010A to the other event files (HC010B - HC010H). When using RXLK, analysts should keep in mind that one home health event can link to more than one prescribed medicine record. Conversely, a prescribed medicine event may link to more than one home health event or different types of events. When this occurs, it is up to the analyst to determine how the prescribed medicine expenditures should be allocated among those medical events.

Return To Table Of Contents

5.4 Limitations/Caveats of CLNK (the Medical Conditions Link File)

The CLNK provides a link from MEPS event files to the Medical Conditions File (HC-006). When using the CLNK, analysts should keep in mind that (1) conditions are self-reported and (2) there may be multiple conditions associated with a home health provider event. Users should also note that not all home health provider events link to the condition file.

Return To Table Of Contents

6.0 Programming Information

The following are the technical specifications for the HC-010H data files, which are provided in ASCII and SAS transport formats.

ASCII versions:

File Name: HC10HF1.DAT

Number of Observations: 4,240

Number of Variables: 86

Record Length: 329

Record Format: fixed

Record Identifier and Sort Key: EVNTIDX

File Name: HC10HF2.DAT

Number of Observations: 4,240

Number of Variables: 20

Record Length: 129

Record Format: fixed

Record Identifier and Sort Key: EVNTIDX

SAS Transport versions:

File Name: HC10HF1.SSP

SAS Name: HC10HF1

Number of Observations: 4,240

Number of Variables: 86

Record Identifier and Sort Key: EVNTIDX

File Name: HC10HF2.SSP

SAS Name: HC10HF2

Number of Observations: 4,240

Number of Variables: 20

Record Identifier and Sort Key: EVNTIDX

Return To Table Of Contents

References

Cohen, S.B. (1998). Sample Design of the 1996 Medical Expenditure Panel Survey Medical Provider Component. Journal of Economic and Social Measurement. Vol 24, 25-53.

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

Cohen, J.W. (1997). Design and Methods of the Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report, No. 1. AHCPR Pub. No. 97-0026.

Cohen, S.B. (1996). The Redesign of the Medical Expenditure Panel Survey: A Component of the DHHS Survey Integration Plan. Proceedings of the COPAFS Seminar on Statistical Methodology in the Public Service.

Cox, B.G. and Cohen, S.B. (1985). Chapter 6: A Comparison of Household and Provider Reports of Medical Conditions. In Methodological Issues for Health Care Surveys. Marcel Dekker, New York.

Cox, B.G. and Cohen, S.B. (1985). Chapter 8: Imputation Procedures to Compensate for Missing Responses to Data Items. In Methodological Issues for Health Care Surveys. Marcel Dekker, New York.

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. (1994). Evaluation of National Health Interview Survey Diagnostic Reporting. National Center for Health Statistics, Vital Health 2(120).

Elixhauser A., Steiner C.A., Whittington C.A., 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 Health Care Policy and Research; 1998. AHCPR Pub. No. 98-0049.

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

Johnson, A.E. and Sanchez, M.E. (1993). Household and Medical Provider Reports on Medical Conditions: National Medical Expenditure Survey, 1987. Journal of Economic and Social Measurement. Vol. 19, 199-233.

Moeller J.F., Stagnitti, M., Horan, E., et al. Data Collection and Editing Procedures for Prescribed Medicines in the 1996 Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Healthcare Research and Quality; 2000. MEPS Methodology Report (forthcoming).

Monheit, A.C., Wilson, R., and Arnett, III, R.H. (Editors). Informing American Health Care Policy. (1999). Jossey-Bass Inc, San Francisco.

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

Return To Table Of Contents

Attachment 1

Definitions

Dwelling Units, Reporting Units, Families, and Persons - The definitions of Dwelling Units (DUs) and Group Quarters in the MEPS Household Survey are generally consistent with the definitions employed for the National Health Interview Survey. The dwelling unit ID (DUID) is a five-digit random ID number assigned after the case was sampled for MEPS. The person number (PID) uniquely identifies all persons within the dwelling unit. The variable DUPERSID is the combination of the variables DUID and PID.

A Reporting Unit (RU) is a person or a group of persons in the sampled dwelling unit who is related by blood, marriage, adoption or other family association, and who is to be interviewed as a group in MEPS. Thus, the RU serves chiefly as a family-based "survey operations" unit rather than an analytic unit. Regardless of the legal status of their association, two persons living together as a "family" unit were treated as a single reporting unit if they chose to be so identified.

Unmarried college students under 24 years of age, who usually live in the sampled household but were living away from home and going to school at the time of the Round 1 MEPS interview, were treated as a Reporting Unit separate from that of their parents for the purpose of data collection. These variables can be found on MEPS person-level files.

In-Scope - A person was classified as in-scope (INSCOPE) if he or she was a member of the U.S. civilian, non-institutionalized population at some time during the Round 1 interview. This variable can be found on MEPS person-level files.

Keyness - The term "keyness" is related to an individual's chance of being included in MEPS. A person is key if that person is appropriately linked to the set of 1995 NHIS sampled households designated for inclusion in MEPS. Specifically, 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 prior to joining that household (examples of the latter situation include newborns and persons returning from military service, persons returning from an institution, or persons living outside the United States).

A non-key person is one whose chance of selection for the NHIS (and MEPS) was associated with a household that was eligible but not sampled for the NHIS, who happened to have become a member of a MEPS reporting unit by the time of the MEPS Round 1 interview. MEPS data, (e.g., utilization and income) were collected for the period of time a non-key person was part of the sampled unit to permit family level analyses. However, non-key persons who leave a sample household would not be recontacted for subsequent interviews. Non-key individuals are not part of the target sample used to obtain person-level national estimates.

It should be pointed out that a person may be key even though not part of the civilian, non-institutionalized portion of the U.S population. For example, a person in the military may be living with his or her civilian spouse and children in a household sampled for the 1995 NHIS. The person in the military would be considered a key person for MEPS. However, such a person would not receive a person-level sample weight so long as he or she was in the military. All key persons who participated in the first round of the 1996 MEPS received a person-level sample weight except those who were in the military. The variable indicating "keyness" is KEYNESS. This variable can be found on MEPS person-level files.

Eligibility - The eligibility of a person for MEPS pertains to whether or not data were to be collected for that person. All key, in-scope persons of a sampled RU were eligible for data collection. The only non-key persons eligible for data collection were those who happened to be living in the same RU as one or more key persons, and their eligibility continued only for the time that they were living with a key person. The only out-of-scope persons eligible for data collection were those who were living with key in-scope persons, again only for the time they were living with a key person. Only military persons meet this description. A person was considered eligible if they were eligible at any time during Round 1. The variable indicating "eligibility" is ELIGRND1, where 1 is coded for persons eligible for data collection for at least a portion of the Round 1 reference period, and 2 is coded for persons not eligible for data collection at any time during the first round reference period. This variable can be found on MEPS person-level files.

Pre-imputed - This means that only a series of logical edits were applied to the HC data to correct for several problems including outliers, co-payments or charges reported as total payments, and reimbursed amounts counted as out-of-pocket payments. Missing data remains.

Unimputed - This means that only a series of logical edits were applied to the MPC data to correct for several problems including outliers, co-payments or charges reported as total payments, and reimbursed amounts counted as out-of-pocket payments. These data were used as the imputation source to account for missing HC data.

Imputation - A method of estimating values for cases with missing data. Hot-deck imputation creates a data set with complete data for all nonrespondent cases, by substituting the data from a respondent case that resembles the nonrespondent on certain known variables.

Return To Table Of Contents

D. Codebooks (link to separate file)

E. Variable-Source Crosswalk

FOR MEPS HC-010H: 1996 HOME HEALTH EVENTS PUBLIC USE FILE RELEASE

File 1:

Survey Administration Variables - Public Use

Variable

Description

Source

DUID

Dwelling unit ID (encrypted)

Assigned in sampling

PID

Person number (encrypted)

Assigned in sampling

DUPERSID

Sample person ID (DUID + PID) (encrypted)

Assigned in sampling

EVNTIDX

Event ID (encrypted)

Assigned in Sampling

EVENTRN

Event round number

CAPI derived

FFID11X

Flat fee ID – 11 characters (encrypted)

CAPI Derived

 

Return To Table Of Contents

 

Home Health Events Variables - Public Use

Variable

Description

Source

HHBEGYR

Event start date – year

EV04/EV05

HHBEGMM

Event start date – month

EV04/EV05

SELFAGEN

Does provider work for agency or self

EV06A

HHTYPE

Home health event type

EV06

CNA

Type of health care worker – certified nurse assistant

HH01

COMPANN

Type of health care worker – companion

HH01

DIETICN

Type of health care worker – dietitian/nutritionist

HH01

HHAIDE

Type of health care worker – home health/home care aide

HH01

HOSPICE

Type of health care worker – hospice worker

HH01

HMEMAKER

Type of health care worker- homemaker

HH01

IVTHP

Type of health care worker – IV or infusion therapist

HH01

MEDLDOC

Type of health care worker – medical doctor

HH01

NURPRACT

Type of health care worker – nurse/nurse practitioner

HH01

NURAIDE

Type of health care worker – nurse’s aide

HH01

OCCUPTHP

Type of health care worker – occupational therapist

HH01

PERSONAL

Type of health care worker – personal care attendant

HH01

PHYSLTHP

Type of health care worker – physical therapist

HH01

RESPTHP

Type of health care worker – respiratory therapist

HH01

SOCIALW

Type of health care worker – social worker

HH01

SPEECTHP

Type of health care worker – speech therapist

HH01

OTHRHCW

Type of health care worker – other

HH01

NONSKILL

Type of health care worker – non-skilled

HH02

SKILLED

Type of health care worker – skilled

HH02

SKILLWOS

Specify type of skilled worker

HH02

OTHCW

Type of health care worker – some other type of health care worker

HH02

OTHCWOS

Specify other type of health care worker

HH02

HOSPITAL

Any home health care provider event due to hospitalization

HH03

VSTRELCN

Any home health care provider event related to a health condition

HH04

TREATMT

Person received medical treatment

HH06

MEDEQUIP

Person was taught how to use medical equipment

HH07

DAILYACT

Person was helped with daily activities

HH08

COMPANY

Person received companionship services

HH09

OTHSVCE

Person received other home health care services

HH10

OTHSVCOS

Specify other home health care service received

HH10

FREQCY

Provider helped person every week/some weeks

HH11

DAYSPWK

Number of days per week provider came (agency events only)

HH12

DAYSPMO

Number of days per month provider came (agency events only)

HH13

HOWOFTEN

Provider came once per day or more than once per day

HH14

TMSPDAY

Times per day provider came to home to help

HH15

HRSLONG

Hours each visit lasted

HH16

MINLONG

Minutes each visit lasted

HH16

SAMESVCE

Any other months person received services

HH17

HHDAYS

Number of days person received care per month for that event

Constructed

NUMCOND

Number of condition records linked to this event

Constructed

Return To Table Of Contents

 

Imputed Expenditure Variables – Public Use

Variable

Description

Source

FFHHTYPX

Flat fee bundle - stem or leaf indicator (edited)

FF01 or FF02 (edited)

FFHH96

# of home health events in flat fee - 1996

FF02 (edited)

FFTOT96

Total # of visits in flat fee - 1996

FF02 (edited)

FFBEF96

Total number of pre-1996 events in the same flat fee group as the 1996 home health provider event record

FF05

FFHH97

Indicates whether or not there are 1997 (through Round 3) home health provider events in the same flat fee group as the 1996 home health provider event record

FF10 (edited)

FFTOT97

Indicates whether or not there any 1997 (through Round 3) medical events in the same flat fee group as the 1996 home health provider event record

FF10

HHSF96X

Amount paid, family
note: rounded to cents

CP11
 (Edited/Imputed)

HHMR96X

Amount paid, Medicare
note: rounded to cents

CP09
(Edited/Imputed)

HHMD96X

Amount paid, Medicaid
note: rounded to cents

CP07 (Edited/Imputed)

HHPV96X

Amount paid, private insurance
note: rounded to cents

CP07
(Edited/Imputed)

HHVA96X

Amount paid, Veterans
note: rounded to cents

CP07
(Edited/Imputed)

HHCH96X

Amount paid, CHAMPUS/CHAMPVA
note: rounded to cents

CP07
(Edited/Imputed)

HHOF96X

Amount paid, other federal
note: rounded to cents

CP07
(Edited/Imputed)

HHSL96X

Amount paid, non-federal government
note: rounded to cents

CP07
(Edited/Imputed)

HHWC96X

Amount paid, worker’s compensation
note: rounded to cents

CP07
(Edited/Imputed)

HHOR96X

Amount paid, other private
note: rounded to cents

Constructed

HHOU96X

Amount paid, other public
note: rounded to cents

Constructed

HHOT96X

Amount paid, other insurance
note: rounded to cents

CP07
(Edited/Imputed)

HHXP96X

Sum of payments HHSF96X – HHOT96X
note: rounded to cents

Constructed

HHTC96X

Total charge for visit
note: rounded to cents

CP09 (Edited/Imputed)

IMPHHSLF

Imputation flag for HHSF96X

Constructed

IMPHHMCR

Imputation flag for HHMR96X

Constructed

IMPHHMCD

Imputation flag for HHMD96X

Constructed

IMPHHPRV

Imputation flag for HHPV96X

Constructed

IMPHHVA

Imputation flag for HHVA96X

Constructed

IMPHHCHM

Imputation flag for HHCH96X

Constructed

IMPHHOFD

Imputation flag for HHOF96X

Constructed

IMPHHSTL

Imputation flag for HHSL96X

Constructed

IMPHHWCP

Imputation flag for HHWC96X

Constructed

IMPHHOPR

Imputation flag for HHOR96X

Constructed

IMPHHOPU

Imputation flag for HHOU96X

Constructed

IMPHHOTH

Imputation flag for HHOT96X

Constructed

IMPHHCHG

Imputation flag for HHTC96X

Constructed

Return To Table Of Contents

 

Weights - Public Use

Variable

Description

Source

WTDPER96

Person weight full-year 1996 (poverty/mortality adjusted)

Constructed

VARPSU96

Variance estimation PSU 1996

Constructed

VARSTR96

Variance estimation stratum, 1996

Constructed

Return To Table Of Contents

 

File 2:

Survey Administration Variables - Public Use

Variable

Description

Source

DUID

Dwelling unit ID (encrypted)

Assigned in sampling

PID

Person number (encrypted)

Assigned in sampling

DUPERSID

Sample person ID (DUID + PID) (encrypted)

Assigned in sampling

EVNTIDX

Event ID (encrypted)

Assigned in sampling

HHSFFIDX

Household reported flat fee id (encrypted)

CAPI Derived

Return To Table Of Contents

 

Pre-imputed Expenditure Variables

Variable

Description

Source

HHSF96H

Household reported amount paid, family (pre-imputed)
note: rounded to cents

CP11 (Edited)

HHMR96H

Household reported amount paid, Medicare (pre-imputed)
note: rounded to cents

CP09 (Edited)

HHMD96H

Household reported amount paid, Medicaid (pre-imputed)
note: rounded to cents

CP07 (Edited)

HHPV96H

Household reported amount paid, private insurance (pre-imputed)
note: rounded to cents

CP07 (Edited)

HHVA96H

Household reported amount paid, Veterans (pre-imputed)
note: rounded to cents

CP07 (Edited)

HHCH96H

Household reported amount paid, CHAMPUS/CHAMPVA (pre-imputed)
note: rounded to cents

CP07 (Edited)

HHOF96H

Household reported amount paid, other federal (pre-imputed)
note: rounded to cents

CP07 (Edited)

HHSL96H

Household reported amount paid, non-federal government (pre-imputed)
note: rounded to cents

CP07 (Edited)

HHWC96H

Household reported amount paid, worker’s compensation (pre-imputed)
note: rounded to cents

CP07 (Edited)

HHOT96H

Household reported amount paid, other insurance (pre-imputed) 
note: rounded to cents

CP07 (Edited)

HHUC96H

Household reported amount paid, uncollected liability (pre-imputed)

CP07 (Edited)

HHTC96H

Household reported total charge (pre-imputed)
note: rounded to cents

CP09 (Edited)

Return To Table Of Contents

 

Weights – Public Use

Variable

Description

Source

WTDPER96

Person weight full-year 1996 (poverty/mortality adjusted)

Constructed

VARSTR96

Variance estimation stratum, 1996

Constructed

VARPSU96

Variance estimation PSU 1996

Constructed

Return To Table Of Contents

Return To MEPS Homepage

MEPS HOME . CONTACT MEPS . MEPS FAQ . MEPS SITE MAP . MEPS PRIVACY POLICY . ACCESSIBILITY . VIEWERS & PLAYERS . COPYRIGHT
Back to topGo back to top
Back to Top Go back to top

Connect With Us

Facebook Twitter You Tube LinkedIn

Sign up for Email Updates

To sign up for updates or to access your subscriber preferences, please enter your email address below.

Agency for Healthcare Research and Quality

5600 Fishers Lane
Rockville, MD 20857
Telephone: (301) 427-1364

  • Careers
  • Contact Us
  • Español
  • FAQs
  • Accessibility
  • Disclaimers
  • EEO
  • Electronic Policies
  • FOIA
  • HHS Digital Strategy
  • HHS Nondiscrimination Notice
  • Inspector General
  • Plain Writing Act
  • Privacy Policy
  • Viewers & Players
  • U.S. Department of Health & Human Services
  • The White House
  • USA.gov