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July 2015
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406
Table of Contents
A Data Use Agreement
B Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Survey Management and Data Collection
C. Technical and Programming Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Source and Naming Conventions
2.4.1 General
2.4.2 Expenditure and Source of Payment Variables
2.5 File Contents
2.5.1 Survey Administration Variables
2.5.1.1 Person Identifiers (DUID, PID, DUPERSID)
2.5.1.2 Record Identifiers (EVNTIDX, ERHEVIDX, FFEEIDX)
2.5.1.3 Round Indicator (EVENTRN)
2.5.1.4 Panel Indicator (PANEL)
2.5.2 MPC Data Indicator (MPCDATA)
2.5.3 Emergency Room Visit Event Variables
2.5.3.1 Visit Details (ERDATEYR-VSTRELCN)
2.5.3.2 Services, Procedures, and Prescription Medicines (LABTEST-MEDPRESC)
2.5.4 Clinical Classification Codes (ERCCC1X-ERCCC3X)
2.5.5 Flat Fee Variables (FFEEIDX, FFERTYPE, FFBEF13, FFTOT14)
2.5.5.1 Definition of Flat Fee Payments
2.5.5.2 Flat Fee Variable Descriptions
2.5.5.2.1 Flat Fee ID (FFEEIDX)
2.5.5.2.2 Flat Fee Type (FFERTYPE)
2.5.5.2.3 Counts of Flat Fee Events that Cross Years (FFBEF13, FFTOT14)
2.5.5.3 Caveats of Flat Fee Groups
2.5.6 Expenditure Data
2.5.6.1 Definition of Expenditures
2.5.6.2 Data Editing and Imputation Methodologies of Expenditure Variables
2.5.6.2.1 General Data Editing Methodology
2.5.6.2.2 Imputation Methodologies
2.5.6.2.3 Emergency Room Visit Data Editing and Imputation
2.5.6.3 Imputation Flag (IMPFLAG)
2.5.6.4 Flat Fee Expenditures
2.5.6.5 Zero Expenditures
2.5.6.6 Discount Adjustment Factor
2.5.6.7 Emergency Room/Hospital Inpatient Stay Expenditures
2.5.6.8 Sources of Payment
2.5.6.9 Imputed Emergency Room Expenditure Variables
2.5.6.9.1 Emergency Room Facility Expenditures (ERFSF13X-ERFOT13X, ERFXP13X, ERFTC13X)
2.5.6.9.2 Emergency Room Physician Expenditures (ERDSF13X-ERDOT13X, ERDXP13X, ERDTC13X)
2.5.6.9.3 Total Expenditures and Charges for Emergency Room Visits (ERXP13X, ERTC13X)
2.5.7 Rounding
3.0 Sample Weight (PERWT13F)
3.1 Overview
3.2 Details on Person Weight Construction
3.2.1 MEPS Panel 17 Weight Development Process
3.2.2 MEPS Panel 18 Weight Development Process
3.2.3 The Final Weight for 2013
3.2.4 Coverage
3.3 Using MEPS Data for Trend Analysis
4.0 Strategies for Estimation
4.1 Developing Event-Level Estimates
4.2 Person-Based Estimates for Emergency Room Visits
4.3 Variables with Missing Values
4.4 Variance Estimation (VARPSU, VARSTR)
5.0 Merging/Linking MEPS Data Files
5.1 Linking to the Person-Level File
5.2 Linking to the Prescribed Medicines File
5.3 Linking to the Medical Conditions File
References
D Variable-Source Crosswalk
Individual identifiers have been removed from the
micro-data contained in these files. Nevertheless, under sections 308 (d) and
903 (c) of the Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1),
data collected by the Agency for Healthcare Research and Quality (AHRQ) and/or
the National Center for Health Statistics (NCHS) may not be used for any purpose
other than for the purpose for which they were supplied; any effort to determine
the identity of any reported cases is prohibited by law.
Therefore in accordance with the above referenced
Federal Statute, it is understood that:
- No one is to use the data in this dataset in any way except
for statistical reporting and analysis; and
- If the identity of any person or establishment should be
discovered inadvertently, then (a) no use will be made of this
knowledge, (b) the Director Office of Management AHRQ will be
advised of this incident, (c) the information that would
identify any individual or establishment will be safeguarded or
destroyed, as requested by AHRQ, and (d) no one else will be
informed of the discovered identity; and
- No one will attempt to link this dataset with individually
identifiable records from any datasets other than the Medical
Expenditure Panel Survey or the National Health Interview
Survey.
By using these data you signify your agreement to
comply with the above stated statutorily based requirements with the knowledge
that deliberately making a false statement in any matter within the jurisdiction
of any department or agency of the Federal Government violates Title 18 part 1
Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5
years in prison.
The Agency for Healthcare Research and Quality
requests that users cite AHRQ and the Medical Expenditure Panel Survey as the
data source in any publications or research based upon these data.
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The Medical Expenditure Panel Survey (MEPS) provides
nationally representative estimates of health care use, expenditures, sources of
payment, and health insurance coverage for the U.S. civilian
non-institutionalized population. The MEPS Household Component (HC) also
provides estimates of respondents’ health status, demographic and socio-economic
characteristics, employment, access to care, and satisfaction with health care.
Estimates can be produced for individuals, families, and selected population
subgroups. The panel design of the survey, which includes 5 Rounds of interviews
covering 2 full calendar years, provides data for examining person-level changes
in selected variables such as expenditures, health insurance coverage, and
health status. Using computer assisted personal interviewing (CAPI) technology,
information about each household member is collected, and the survey builds on
this information from interview to interview. All data for a sampled household
are reported by a single household respondent.
The MEPS-HC was initiated in 1996. Each year a new
panel of sample households is selected. Because the data collected are
comparable to those from earlier medical expenditure surveys conducted in 1977
and 1987, it is possible to analyze long-term trends. Each annual MEPS-HC sample
size is about 15,000 households. Data can be analyzed at either the person or
event level. Data must be weighted to produce national
estimates.
The set of households selected for each panel of the
MEPS HC is a subsample of households participating in the previous year’s
National Health Interview Survey (NHIS) conducted by the National Center for
Health Statistics. The NHIS sampling frame provides a nationally representative
sample of the U.S. civilian non-institutionalized population and reflects an
oversample of Blacks and Hispanics. In 2006, the NHIS implemented a new sample
design, which included Asian persons in addition to households with Black and
Hispanic persons in the oversampling of minority populations. MEPS further
oversamples additional policy relevant sub-groups such as low income households.
The linkage of the MEPS to the previous year’s NHIS provides additional data for
longitudinal analytic purposes.
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Upon completion of the household CAPI interview and
obtaining permission from the household survey respondents, a sample of medical
providers are contacted by telephone to obtain information that household
respondents can not accurately provide. This part of the MEPS is called the
Medical Provider Component (MPC) and information is collected on dates of visit,
diagnosis and procedure codes, charges and payments. The Pharmacy Component
(PC), a subcomponent of the MPC, does not collect charges or diagnosis and
procedure codes but does collect drug detail information, including National
Drug Code (NDC) and medicine name, as well as date filled and sources and
amounts of payment. The MPC is not designed to yield national estimates. It is
primarily used as an imputation source to supplement/replace household reported
expenditure information.
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MEPS HC and MPC data are collected under the authority
of the Public Health Service Act. Data are collected under contract with Westat,
Inc. (MEPS HC) and Research Triangle Institute (MEPS MPC). Datasets and summary
statistics are edited and published in accordance with the confidentiality
provisions of the Public Health Service Act and the Privacy Act. The National
Center for Health statistics (NCHS) provides consultation and technical
assistance.
As soon as data collection and editing are completed,
the MEPS survey data are released to the public in staged releases of summary
reports, micro data files, and tables via the MEPS Web site:
meps.ahrq.gov.
Selected data can be analyzed through MEPSnet, an on-line interactive tool
designed to give data users the capability to statistically analyze MEPS data in
a menu-driven environment.
Additional information on MEPS is available from the
MEPS project manager or the MEPS public use data manager at the Center for
Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality,
540 Gaither Road, Rockville, MD 20850 (301-427-1406).
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This documentation describes one in a series of public
use event files from the 2013 Medical Expenditure Panel Survey (MEPS) Household
Component (HC) and Medical Provider Component (MPC). Released as an ASCII data
file (with related SAS, Stata, and SPSS programming statements) and a SAS
transport file, the 2013 Emergency Room Visits (EROM) public use event file
provides detailed information on emergency room visits for a nationally
representative sample of the civilian noninstitutionalized population of the
United States. Data from the EROM event file can be used to make estimates of
emergency room utilization and expenditures for calendar year 2013. The file
contains 64 variables and has a logical record length of 337 with an additional
2-byte carriage return/line feed at the end of each record. As illustrated
below, this file consists of MEPS survey data from the 2013 portion of Round 3,
and Rounds 4 and 5 for Panel 17, as well as Rounds 1, 2 and the 2013 portion of
Round 3 for Panel 18 (i.e., the rounds for the MEPS panels covering calendar year 2013).
Emergency room events reported in Panel 18 Round 3 and
known to have occurred after December 31, 2013 are not included on this file. In
addition to expenditures, each record contains household-reported medical
conditions associated with the emergency room visit.
Annual counts of emergency room visits are based
entirely on household reports. Information from the MEPS MPC is used to
supplement expenditure and payment data reported by the household and does not
affect use estimates.
Data from the Emergency Room event file can be merged
with other 2013 MEPS HC data files for purposes of appending person-level data
such as demographic characteristics or health insurance coverage to each
emergency room record.
This file can also be used to construct summary
variables of expenditures, sources of payment, and related aspects of emergency
room visits. Aggregate annual person-level information on the use of emergency
rooms and other health services is provided on the MEPS 2013 Full Year
Consolidated Data file, where each record represents a MEPS sampled person.
This documentation offers an overview of the types and
levels of data provided, and the content and structure of the file and the
codebook. It contains the following sections:
- Data File Information
- Sample Weight
- Strategies for Estimation
- Merging/Linking MEPS Data Files
- References
- Variable - Source Crosswalk
Any variables not found on this file but released on
previous years’ files may have been excluded because they contained only missing
data.
For more information on MEPS HC survey design, see T.
Ezzati-Rice, et al. (1998-2007) and
S. Cohen, 1996. For information on the MEPS MPC design, see S. Cohen, 1998.
Copies of the HC and the MPC survey instruments used to collect the
information on the EROM file are available in the Survey Questionnaires
section of the MEPS Web site at the following address:
meps.ahrq.gov.
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The 2013 Emergency Room Visits public use dataset
consists of one event-level data file. The file contains characteristics
associated with the EROM event and imputed expenditure data.
The 2013 EROM public use dataset contains variables
and frequency distributions for 7,510 emergency room visits reported during the
2013 portion of Round 3 and Rounds 4 and 5 for Panel 17, as well as Rounds 1, 2,
and the 2013 portion of Round 3 for Panel 18 of the MEPS Household Component.
This file includes emergency room visit records for all household survey members
who resided in eligible responding households and reported at least one
emergency room visit. Records where the emergency room visit was known to have
occurred after December 31, 2013 are not included on this file. Of these 7,510
records, 7,248 were associated with persons having positive person-level weights
(PERWT13F). The persons represented on this file had to meet either a) or b):
- Be classified as a key in-scope person who responded for his
or her entire period of 2013 eligibility (i.e., persons with a
positive 2013 full-year person-level weight (PERWT13F > 0)), or
- Be an eligible member of a family all of whose key in-scope
members have a positive person-level weight (PERWT13F > 0).
(Such a family consists of all persons with the same value for
FAMIDYR.) That is, the person must have a positive
full-year family-level weight (FAMWT13F>0). Note that FAMIDYR
and FAMWT13F are variables on the 2013 Full Year Consolidated
Data File.
Persons with no emergency room visit events for 2013
are not included on this event-level ER file but are represented on the
person-level 2013 Full Year Population Characteristics file.
Each emergency room visit record includes the
following: date of the visit; whether or not person saw doctor; type of care
received; type of services (i.e., lab test, sonogram or ultrasound, x-rays,
etc.) received; medicines prescribed during the visit; flat fee information;
imputed sources of payment; total payment and total charge; a full-year
person-level weight; variance strata; and variance PSU.
To append person-level information such as demographic
or health insurance coverage to each event record, data from this file can be
merged with 2013 MEPS HC person-level data (e.g. Full Year Consolidated or Full
Year Population Characteristics file) using the person identifier, DUPERSID.
Emergency room visit events can also be linked to the MEPS 2013 Medical
Conditions File and the MEPS 2013 Prescribed Medicines File. Please see Section
5.0 and the 2013 Appendix File, HC-160I for details on how to merge MEPS data
files.
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For most variables on the Emergency Room Visits event
file, both weighted and unweighted frequencies are provided in the accompanying
codebook. The exceptions to this are weight variables and variance
estimation variables. Only unweighted frequencies of these variables are
included in the accompanying codebook file. See the Weights Variables list in
section D, Variable-Source Crosswalk. The codebook and data file sequence list
variables in the following order:
- Unique person identifiers
- Unique emergency room event identifiers
- Emergency room characteristic variables
- Clinical Classification Software (CCS) codes
- Imputed expenditure variables
- Weight and variance estimation variables
Note that the person identifier is unique within this
data year.
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The following reserved code values are used:
| Value |
Definition |
| -1 INAPPLICABLE |
Question was not asked due to skip pattern |
| -7 REFUSED |
Question was asked and respondent refused to answer question |
| -8 DK |
Question was asked and respondent did not know answer |
| -9 NOT ASCERTAINED |
Interviewer did not record the data |
Generally, values of -1, -7, -8, and -9 for
non-expenditure variables have not been edited on this file. The values of -1
and -9 can be edited by the data users/analysts by following the skip patterns
in the HC survey questionnaire (located on the MEPS Web site:
meps.ahrq.gov/survey_comp/survey_questionnaires.jsp).
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The EROM codebook describes an ASCII dataset (although the data are also being provided in a SAS transport file). The following
codebook items are provided for each variable:
| Identifier |
Description |
| Name |
Variable name (maximum of 8 characters) |
| Description |
Variable descriptor (maximum 40 characters) |
| Format |
Number of bytes |
| Type |
Type of data: numeric (indicated by NUM) or character (indicated by CHAR) |
| Start |
Beginning column position of variable in record |
| End |
Ending column position of variable in record |
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In general, variable names reflect the content of the
variable, with an eight-character limitation. All imputed/edited variables end
with an “X”.
Variables on this file were derived from the HC
questionnaire itself, derived from the MPC data collection instrument, derived
from CAPI, or assigned in sampling. The source of each variable is identified in
Section D “Variable - Source Crosswalk” in one of four ways:
- Variables derived from CAPI or assigned in sampling are
indicated as “CAPI derived” or “Assigned in sampling,”
respectively;
- Variables which come from one or more specific questions
have those questionnaire sections and question numbers indicated
in the “Source” column; questionnaire sections are identified
as:
- ER - Emergency Room section
- FF - Flat Fee section
- CP - Charge Payment section;
- Variables constructed from multiple questions using complex
algorithms are labeled “Constructed” in the “Source” column; and
- Variables which have been edited or imputed are so
indicated.
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The names of the expenditure and source of payment
variables follow a standard convention, are eight characters in length, and end
in an "X" indicating edited/imputed. Please note that imputed means that a
series of logical edits, as well as an imputation process to account for missing
data, have been performed on the variable.
The total sum of payments and the 12 source of payment
variables are named in the following way:
The first two characters indicate the type of event:
IP - inpatient stay
OB - office-based visit
ER - emergency room visit
OP - outpatient visit
HH - home health visit
DV - dental visit
OM - other medical equipment
RX - prescribed medicine
For expenditure variables on the ER file, the third
character indicates whether the expenditure is associated with the facility (F)
or the physician (D).
In the case of the source of payment variables, the
fourth and fifth characters indicate:
SF - self or family
OF - other federal government
MR - Medicare
SL - state/local government
MD - Medicaid
WC - Workers’ Compensation
PV - private insurance
OT - other insurance
VA - Veterans Administration/CHAMPVA
OR - other private
TR - TRICARE
OU - other public
XP - sum of payments
In addition, the total charge variable is indicated by
TC in the variable name.
The sixth and seventh characters indicate the year
(13). The eighth character, “X”, indicates whether the variable is
edited/imputed.
For example, ERFSF13X is the edited/imputed amount
paid by self or family for the facility portion of the expenditure associated
with an emergency room visit.
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The dwelling unit ID (DUID) is a five-digit random
number assigned after the case was sampled for MEPS. The three-digit person
number (PID) uniquely identifies each person within the dwelling unit. The
eight-character variable DUPERSID uniquely identifies each person represented on
the file and is the combination of the variables DUID and PID. For detailed
information on dwelling units and families, please refer to the documentation
for the 2013 Full Year Population Characteristics file.
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EVNTIDX uniquely identifies each emergency room
visit/event (i.e., each record on the Emergency Room Visits file) and is the
variable required to link emergency room events to data files containing details
on conditions and/or prescribed medicines (MEPS 2013 Medical Conditions File and
the MEPS 2013 Prescribed Medicines File, respectively). For details on linking,
see Section 5.0 or the MEPS 2013 Appendix File, HC-160I.
ERHEVIDX is a constructed variable identifying an EROM
record that has its facility expenditures represented on an associated hospital
inpatient stay record. This variable is derived from provider-reported
information on linked emergency room and inpatient stay events that matched to
corresponding events reported by the household. The variable ERHEVIDX contains
the EVNTIDX of the linked event. On the 2013 EROM file, there are 417 emergency
room events linked to subsequent hospital stays. Please note that where the
emergency room visit is associated with a hospital stay (and its expenditures
and charges are included with the hospital stay), the physician expenditures
associated with the emergency room visit remain on the Emergency Room Visits
file.
FFEEIDX is a constructed variable which uniquely
identifies a flat fee group, that is, all events that were a part of a flat fee
payment.
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EVENTRN indicates the round in which the emergency
room visit was reported. Please note: Rounds 3, 4, and 5 are associated with
MEPS survey data collected from Panel 17. Likewise, Round 1, 2, and 3 are
associated with data collected from Panel 18.
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PANEL is a constructed variable used to specify the
panel number for the person. PANEL will indicate either Panel 17 or Panel 18 for
each person on the file. Panel 17 is the panel that started in 2012, and Panel
18 is the panel that started in 2013.
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MPCDATA is a constructed variable which indicates
whether or not MPC data were collected for the emergency room visit. While all
emergency room events are sampled into the Medical Provider Component, not all
emergency room event records have MPC data associated with them. This is
dependent upon the cooperation of the household respondent to provide permission
forms to contact the emergency room facility as well as the cooperation of the
emergency room facility to participate in the survey.
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This file contains variables describing emergency room
visits/events reported by household respondents in the Emergency Room section of
the MEPS HC questionnaire. The questionnaire contains specific probes for
determining details about the emergency room event. These variables have not
been edited.
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When a person reported having had a visit to the
emergency room, the year and month of the emergency room visit was recorded
(ERDATEYR and ERDATEMM respectively). The type of care the person received
(VSTCTGRY) and whether or not the visit was related to a specific condition
(VSTRELCN) were also determined. Through 2012, whether or not the person saw a
medical doctor (SEEDOC) was included on the file. Beginning in 2013, SEEDOC was
removed because of design changes.
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Services received during the visit included whether or
not the person received lab tests (LABTEST), a sonogram or ultrasound
(SONOGRAM), x-rays (XRAYS), a mammogram (MAMMOG), an MRI or CAT scan (MRI), an
electrocardiogram (EKG), an electroencephalogram (EEG), a vaccination (RCVVAC),
anesthesia (ANESTH), throat swab (THRTSWAB), or other diagnostic tests or exams
(OTHSVCE). Whether or not a surgical procedure was performed during the visit
was asked (SURGPROC). The questionnaire determined if a medicine was prescribed
for the person during the emergency room visit (MEDPRESC). See Section 5.2 for
information on linking to the prescribed medicines events file.
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Information on household-reported medical conditions
associated with each emergency room visit is provided on this file. There are up
to three CCS codes (ERCCC1X-ERCCC3X) listed for each emergency room visit, as
shown in the crosswalk of this document. The file includes the number of CCS
codes reported in the data year, which may be fewer than the maximum three for
CCS codes. Because the maximum number of conditions associated with an event can
change from year to year, the number of reported CCS codes also can change from
year to year. Starting with the 2013 file, the ICD-9-CM condition and procedure
codes variables are omitted.
In order to obtain complete condition information
associated with an event, the data user/analyst must link to the MEPS 2013
Medical Conditions File. Details on how to link the 2013 EROM event file to the
MEPS 2013 Medical Conditions File are provided in Section 5.3 and in the MEPS
2013 Appendix File, HC-160I. The data user/analyst should note that
because of confidentiality restrictions, provider-reported condition information
is not publicly available.
The medical conditions reported by the Household
Component respondent were recorded by the interviewer as verbatim text, which
were then coded to fully-specified 2013 ICD-9-CM codes, including medical
conditions and V codes (Health Care Financing Administration, 1980) by
professional coders. Although codes were verified and error rates did not exceed
2 percent for any coder, data users/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 (Cox and Cohen, 1985;
Cox and Iachan, 1987; Edwards, et al, 1994; and Johnson and Sanchez, 1993). For
detailed information on how conditions were coded, please refer to the
documentation on the MEPS 2013 Medical Conditions File. For frequencies of
conditions by event type, please see the MEPS 2013 Appendix File, HC-160I.
The ICD-9-CM condition codes were aggregated into
clinically meaningful categories. These categories, included on the file as
ERCCC1X-ERCCC3X, were 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
mutually exclusive categories, most of which are clinically homogeneous.
The clinical classification codes linked to each
emergency room visit are sequenced in the order in which the conditions were
reported by the household respondent, which was in order of input into the
database and not in order of importance or severity. Data users/analysts who use
the MEPS 2013 Medical Conditions File in conjunction with this emergency room
visits file should note that the order of conditions on this file is not
identical to that on the Medical Conditions file.
Analysts should use the clinical classification codes
listed in the Conditions PUF document
(HC-162) and the Appendix to the Event Files (HC-160I) document when analyzing
MEPS conditions data. Although there is a list of clinical classification codes
and labels on the Healthcare Cost and Utilization Project (HCUP) Web site, if
updates to these codes and/or labels are made on the HCUP Web site after the
release of the 2013 MEPS PUFs, these updates will not be reflected in the 2013
MEPS data.
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A flat fee is the fixed dollar amount a person is
charged for a package of health care services provided during a defined period
of time. Examples would be: obstetrician’s fee covering a normal delivery, as
well as pre- and post-natal care; or a surgeon’s fee covering a surgical
procedure and post-surgical care. A flat fee group is the set of medical
services (i.e., events) that are covered under the same flat fee payment. The
flat fee groups represented on this file include flat fee groups where at least
one of the health care events, as reported by the HC respondent, occurred during
2013. By definition, a flat fee group can span multiple years. Furthermore, a
single person can have multiple flat fee groups.
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As noted earlier in Section 2.5.1.2 “Record
Identifiers,” the variable FFEEIDX uniquely identifies all events that are part
of the same flat fee group for a person. On any 2013 MEPS event file, every
event that was a part of a specific flat fee group will have the same value for
FFEEIDX. Note that prescribed medicine and home health events are never included
in a flat fee group and FFEEIDX is not a variable on those event files.
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FFERTYPE indicates whether the 2013 emergency room
visit is the “stem” or “leaf” of a flat fee group. A stem (records with FFERTYPE
= 1) is the initial medical service (event) which is followed by other medical
events that are covered under the same flat fee payment. The leaves of the flat
fee group (records with FFERTYPE = 2) are those medical events that are tied
back to the initial medical event (the stem) in the flat fee group. These “leaf”
records have their expenditure variables set to zero. For the emergency room
visits that are not part of a flat fee payment, the FFERTYPE is set to –1,
“INAPPLICABLE.”
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As described in Section 2.5.5.1, a flat fee payment
may cover multiple events, and the multiple events could span multiple years.
For situations where the emergency room event occurred in 2013 as part of a
group of events, and some event occurred before or after 2013, counts of the
known events are provided on the emergency room record. Variables indicating
events that occurred before or after 2013 are as follows:
FFBEF13 – total number of pre-2013 events in the same
flat fee group as the 2013 emergency room visit(s). This count would not include
the 2013 emergency room visit(s).
FFTOT14 –the number of 2014 emergency room visits,
expected to be in the same flat fee group as the emergency room event that
occurred in 2013.
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There are 23 emergency room visits that are identified
as being part of a flat fee payment group. In general, every flat fee group
should have an initial visit (stem) and at least one subsequent visit (leaf).
There are some situations where this is not true. For some flat fee groups, the
initial visit reported occurred in 2013, but the remaining visits that were part
of this flat fee group occurred in 2014. In this case, the 2013 flat fee group
represented on this file would consist of one event, the stem. The 2014 events
that are part of this flat fee group are not represented on the file. Similarly,
the household respondent may have reported a flat fee group where the initial
visit began in 2012 but subsequent visits occurred during 2013. In this case,
the initial visit would not be represented on the file. This 2013 flat fee group
would then only consist of one or more leaf records and no stem. Please note
that the crosswalk in this document lists all possible flat fee variables.
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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 for each emergency room visit, including
out-of-pocket payments and payments made by private insurance, Medicaid,
Medicare, and other sources. The definition of expenditures used in MEPS differs
slightly from its predecessors: the 1987 NMES and 1977 NMCES surveys where
“charges” rather than sum of payments were used to measure expenditures. This
change was adopted because charges became a less appropriate proxy for medical
expenditures during the 1990s due to the increasingly common practice of
discounting. Although measuring expenditures as the sum of payments incorporates
discounts in the MEPS expenditure estimates, the estimates do not incorporate
any payment not directly tied to specific medical care visits, such as bonuses
or retrospective payment adjustments by third party payers. Another general
change from the two prior surveys is that charges associated with uncollected
liability, bad debt, and charitable care (unless provided by a public clinic or
hospital) are not counted as expenditures because there are no payments
associated with those classifications. While charge data are provided on this
file, data users/analysts should use caution when working with these data
because a charge does not typically represent actual dollars exchanged for
services or the resource costs of those services; nor are they directly
comparable to the expenditures defined in the 1987 NMES. For details on
expenditure definitions, please reference “Informing American Health Care
Policy” (Monheit et al., 1999). AHRQ has developed factors to apply to the 1987
NMES expenditure data to facilitate longitudinal analysis. These factors can be
accessed via the CFACT data center. For more information, see the Data Center
section of the MEPS Web site
meps.ahrq.gov/data_stats/onsite_datacenter.jsp.
Expenditure data related to emergency room visits are
broken out by facility and separately billing doctor expenditures. This file
contains six categories of expenditure variables per visit: basic hospital
emergency room facility expenses; expenses for doctors who billed separately
from the hospital for any emergency room services provided during the emergency
room visit; total expenses, which is the sum of the facility and physician
expenses; facility charge; physician charge; and total charges, which is the sum
of the facility and physician charges. If examining trends in MEPS expenditures,
please refer to Section 3.3 for more information.
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The expenditure data included on this file were
derived from both the MEPS Household (HC) and Medical Provider Components (MPC).
The MPC contacted medical providers identified by household respondents. The
charge and payment data from medical providers were used in the expenditure
imputation process to supplement missing household data. For all emergency room
visits, MPC data were used if available; otherwise, HC data were used. Missing
data for emergency room visits, where HC data were not complete and MPC data
were not collected, or MPC data were not complete, were imputed through the
imputation process.
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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,
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 misclassifications between Medicare and Medicaid and between
Medicare HMOs and private HMOs as payment sources. These edits produced a
complete vector of expenditures for some events, and provided the starting point
for imputing missing expenditures in the remaining events.
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The predictive mean matching imputation method was
used to impute missing expenditures. This procedure uses regression models
(based on events with completely reported expenditure data) to predict total
expenses for each event. Then, for each event with missing payment information,
a donor event with the closest predicted payment with the same pattern of
expected payment sources as the event with missing payment was used to impute
the missing payment value. The imputations for the flat fee events were carried
out separately from the simple events.
The weighted sequential hot-deck procedure was used to
impute the missing total charges. This procedure uses survey data from
respondents to replace missing data while taking into account the persons’
weighted distribution in the imputation process.
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Facility expenditures for emergency room services were
developed in a sequence of logical edits and imputations. “Household” edits were
applied to sources and amounts of payment for all events reported by HC
respondents. “MPC” edits were applied to provider-reported sources and amounts
of payment for records matched to household-reported events. Both sets of edits
were used to correct obvious errors in the reporting of expenditures. After the
data from each source were edited, a decision was made as to whether household-
or MPC-reported information would be used in the final editing and predictive
mean matching imputations for missing expenditures. The general rule was that
MPC data would be used where a household-reported event corresponded to an
MPC-reported event (i.e., a matched event), since providers usually have more
complete and accurate data on sources and amounts of payment than households.
One of the more important edits separated flat fee
events from simple events. This edit was necessary because groups of events
covered by a flat fee (i.e., a flat fee bundle) were edited and imputed
separately from individual events covered by a single charge (i.e., simple
events). Most emergency room events were imputed as simple events because
hospital facility charges are rarely bundled with other events. (See Section
2.5.5 for more details on flat fee groups). However, some emergency room visits
were treated as free events because the person was admitted to a hospital
through its emergency room. In these cases, emergency room charges are included
in the charge for an inpatient hospital stay.
Logical edits also were used to sort each event into a
specific category for the imputations. Events with complete expenditures were
flagged as potential donors for the predictive mean matching imputations, while
events with missing expenditure data were assigned to various recipient
categories. Each event with missing expenditure data was assigned to a recipient
category based on the extent of its missing charge and expenditure data. For
example, an event with a known total charge but no expenditure information was
assigned to one category, while an event with a known total charge and partial
expenditure information was assigned to a different category. Similarly, events
without a known total charge and no or partial expenditure information were
assigned to various recipient categories.
The logical edits produced eight recipient categories
in which all events had a common extent of missing data. Separate predictive
mean matching imputations were performed on events in each recipient category.
For emergency room events, the donor pool was restricted to events with
complete expenditures from 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 distribution of free events among complete events (donors) would not be
represented among incomplete events (recipients).
Expenditures for some emergency room visits are not
shown because the person was admitted to the hospital through the emergency
room. These emergency room events are not free, but the expenditures are
included in the inpatient stay expenditures. The variable ERHEVIDX can be used
to differentiate between free emergency room care and situations where the
emergency room charges have been included in the inpatient hospital charges.
Expenditures for services provided by separately
billing doctors in hospital settings were also edited and imputed. These
expenditures are shown separately from hospital facility charges for hospital
inpatient, outpatient, and emergency room care.
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IMPFLAG is a six-category variable that indicates if
the event contains complete Household Component (HC) or Medical Provider
Component (MPC) data, was fully or partially imputed, or was imputed in the
capitated imputation process (for OP and OB events only). The following list
identifies how the imputation flag is coded; the categories are mutually
exclusive.
IMPFLAG = 0 not eligible for imputation (includes zeroed out and flat fee leaf events)
IMPFLAG = 1 complete HC data
IMPFLAG = 2 complete MPC data
IMPFLAG = 3 fully imputed
IMPFLAG = 4 partially imputed
IMPFLAG = 5 complete MPC data through capitation imputation (not applicable to ER events)
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The approach used to count expenditures for flat fees
was to place the expenditure on the first visit of the flat fee group. The
remaining visits have zero facility payments, while physician’s expenditures may
still be present. Thus, if the first visit in the flat fee group occurred prior
to 2013, all of the events that occurred in 2013 will have zero payments.
Conversely, if the first event in the flat fee group occurred at the end of
2013, the total expenditure for the entire flat fee group will be on that event,
regardless of the number of events it covered after 2013. See
Section 2.5.5 for details on the flat fee variables.
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There are some medical events reported by respondents
where the payments were zero. Zero payment events can occur in MEPS for the
following reasons: (1) the stay was covered under a flat fee arrangement (flat
fee payments are included only on the first event covered by the arrangement),
(2) there was no charge for a follow-up stay, (3) the provider was never paid by
an individual, insurance plan, or other source for services provided, (4)
charges were included in the bill for a subsequent hospital admission (emergency
room events only), or (5) the event was paid for through government or
privately-funded research or clinical trials.
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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.
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It is common for an emergency room visit to result in
a hospital stay. While it is true that all of the event files can be linked by
DUPERSID, there is no unique record link between hospital inpatient stays and
emergency room visits. However, wherever this relationship could be identified
(using the MPC start and end dates of the events as well as other information
from the provider), the facility expenditure associated with the emergency room
visit is included in the hospital facility expenditure. Hence, the expenditures
(and charges) for some emergency room visits are included in the resulting
hospitalization. In these situations, the emergency room record on this file
will have its expenditure (and charge) information zeroed out to avoid
double-counting while its corresponding hospital inpatient stay record on the
MEPS 2013 Hospital Inpatient Stays File will have the combined expenditures.
Please note that any physician expenditures associated with emergency room
events remain on the Emergency Room event file. The variable ERHEVIDX identifies
the emergency room visits whose facility expenditures are included in the
expenditures for the following hospital inpatient stay. It should also be noted
that for these cases there is only one emergency room stay associated with the
hospital room stay.
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In addition to total expenditures, variables are
provided which itemize expenditures according to major source of payment
categories. These categories are:
- Out-of-pocket by User or Family,
- Medicare,
- Medicaid,
- Private Insurance,
- Veterans Administration/CHAMPVA,
- TRICARE,
- Other Federal Sources – includes Indian Health Service,
military treatment facilities, and other care by the federal
government,
- Other State and Local Source – includes community and
neighborhood clinics, state and local health departments, and
state programs other than Medicaid,
- Workers’ Compensation, and
- Other Unclassified Sources – includes sources such as
automobile, homeowner’s, and liability insurance, and other
miscellaneous or unknown sources.
Two additional source of payment variables were created to classify payments for events with apparent inconsistencies between health insurance coverage and sources of payment based on data collected in the survey. These variables include:
- Other Private – any type of private insurance payments
reported for persons not reported to have any private health
insurance coverage during the year as defined in MEPS, and
- Other Public – Medicare/Medicaid payments reported for
persons who were not reported to be enrolled in the
Medicare/Medicaid program at any time during the year.
Though these two sources are relatively small in
magnitude, data users/analysts should exercise caution when interpreting the
expenditures associated with these two additional sources of payment. While
these payments stem from apparent inconsistent responses to health insurance and
source of payment questions in the survey, some of these inconsistencies may
have logical explanations. For example, private insurance coverage in MEPS is
defined as having a major medical plan covering hospital and physician services.
If a MEPS sampled person did not have such coverage but had a single service
type insurance plan (e.g., dental insurance) that paid for a particular episode
of care, those payments may be classified as “other private.” Some of the “other
public” payments may stem from confusion between Medicaid and other state and
local programs or may be from persons who were not enrolled in Medicaid, but
were presumed eligible by a provider who ultimately received payments from the
public payer.
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This file contains two sets of imputed expenditure
variables: facility expenditures and physician expenditures.
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Emergency room expenses include all expenses for
treatment, services, tests, diagnostic and laboratory work, x-rays, and similar
charges, as well as any physician services included in the emergency room
charge.
ERFSF13X - ERFOT13X are the 12 sources of
payment. The 13 sources of payment are: self/family (ERFSF13X), Medicare
(ERFMR13X), Medicaid (ERFMD13X), private insurance (ERFPV13X), Veterans
Administration/CHAMPVA (ERFVA13X), TRICARE (ERFTR13X), other federal sources
(ERFOF13X), state and local (non-federal) government sources (ERFSL13X),
Worker’s Compensation (ERFWC13X), other private insurance (ERFOR13X), other
public insurance (ERFOU13X), and other insurance (ERFOT13X). ERFXP13X is the sum
of the 12 sources of payment for the emergency room expenditures, and ERFTC13X
is the total charge. Please note that where an emergency room visit record is
linked to a hospital inpatient stay record, all facility sources of payment
variables, as well as ERFTC13X, have been zeroed out.
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Separately billing doctor (SBD) expenses typically
cover services provided to patients in hospital settings by providers like
anesthesiologists, radiologists, and pathologists, whose charges are often not
included in emergency room visit bills.
For physicians who bill separately (i.e., outside the
emergency room visit bill), a separate data collection effort within the Medical
Provider Component was performed to obtain this same set of expenditure
information from each separately billing doctor. It should be noted that there
could be several separately billing doctors associated with a medical event. For
example, an emergency room visit could have a radiologist and an internist
associated with it. If their services are not included in the emergency room
visit bill then this is one medical event with two separately billing doctors.
The imputed expenditure information associated with the separately billing
doctors was summed to the event level and is provided on the file. ERDSF13X -
ERDOT13X are the 12 sources of payment, ERDXP13X is the sum of the 12 sources of
payments, and ERDTC13X is the physician’s total charge.
Data users/analysts need to take into consideration
whether to analyze facility and SBD expenditures separately, combine them within
service categories, or collapse them across service categories (e.g., combine
SBD expenditures with expenditures for physician visits to offices and/or
outpatient departments).
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Data users/analysts interested in total expenditure
should use the variable ERXP13X, which includes both the facility and physician
amounts. Those interested in total charges should use the variable ERTC13X,
which includes both facility and physician charges (see Section 2.5.6.1 for an
explanation of the "charge" concept). However, please note that where the
emergency room visit is linked to a hospital inpatient stay record, ERFTC13X has
been zeroed out. Thus, ERTC13X may be equal to "0" or the doctor total charge
(ERDTC13X).
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The expenditure variables have been rounded to the
nearest penny. Person-level expenditure information released on the MEPS 2013
Person-Level Use and Expenditure File were rounded to the nearest dollar. It
should be noted that using the MEPS 2013 event files to create person-level
totals will yield slightly different totals than those found on the full year
consolidated file. These differences are due to rounding only. Moreover,
in some instances, the number of persons having expenditures on the event files
for a particular source of payment may differ from the number of persons with
expenditures on the person-level expenditures file for that source of payment.
This difference is also an artifact of rounding only.
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There is a single full year person-level weight
(PERWT13F) assigned to each record for each key, in-scope person who responded
to MEPS for the full period of time that he or she was in-scope during 2013. A
key person either was a member of a responding NHIS household at the time of
interview, or joined a family associated with such a household after being
out-of-scope at the time of the NHIS (the latter circumstance includes newborns
as well as those returning from military service, an institution, or residence
in a foreign country). A person is in-scope whenever he or she is a member of
the civilian noninstitutionalized portion of the U.S. population.
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The person-level weight PERWT13F was developed in
several stages. First, person-level weights for Panel 17 and Panel 18 were
created separately. The weighting process for each panel included adjustments
for nonresponse over time and calibration to independent population totals. The
calibration was initially accomplished separately for each panel by raking the
corresponding sample weights for those in-scope at the end of the calendar year
to Current Population Survey (CPS) population estimates based on five variables.
The five variables used in the establishment of the initial person-level control
figures were: census region (Northeast, Midwest, South, West); MSA status (MSA,
non-MSA); race/ethnicity (Hispanic; Black, non-Hispanic; Asian, non-Hispanic;
and other); sex; and age. A 2013 composite weight was then formed by
multiplying each weight from Panel 17 by the factor .506 and each weight from
Panel 18 by the factor .494. The choice of factors reflected the relative sample
sizes of the two panels, helping to limit the variance of estimates obtained
from pooling the two samples. The composite weight was raked to the same set of
CPS-based control totals. When the poverty status information derived from
income variables became available, a final raking was undertaken on the
previously established weight variable. Control totals were established using
poverty status (five categories: below poverty, from 100 to 125 percent of
poverty, from 125 to 200 percent of poverty, from 200 to 400 percent of poverty,
at least 400 percent of poverty), the other five variables previously used in
the weight calibration, and a variable associated with number of hospital stays
for those under the age of 65.
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The person-level weight for MEPS Panel 17 was
developed using the 2012 full year weight for an individual as a "base" weight
for survey participants present in 2012. For key, in-scope members who joined an
RU sometime in 2013 after being out-of-scope in 2012, the initially assigned
person-level weight was the corresponding 2012 family weight. The weighting
process included an adjustment for person-level nonresponse over Rounds 4 and 5
as well as raking to population control totals for December 2013 for key,
responding persons in-scope on December 31, 2013. These control totals were
derived by scaling back the population distribution obtained from the March 2014
CPS to reflect the December 31, 2013 estimated population total (estimated based
on Census projections for January 1, 2014). Variables used for person-level
raking included: census region (Northeast, Midwest, South, West); MSA status (MSA,
non-MSA); race/ethnicity (Hispanic; Black, non-Hispanic; Asian, non-Hispanic;
and other); sex; and age. (Poverty status is not included in this version
of the MEPS full year database because of the time required to process the
income data collected and then assign persons to a poverty status category). The
final weight for key, responding persons who were not in-scope on December 31,
2013 but were in-scope earlier in the year was the person weight after the
nonresponse adjustment.
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The person-level weight for MEPS Panel 18 was
developed using the MEPS Round 1 person-level weight as a "base" weight. For
key, in-scope members who joined an RU after Round 1, the Round 1 family weight
served as a "base" weight. The weighting process included an adjustment for
nonresponse over the remaining data collection rounds in 2013 as well as raking
to the same population control figures for December 2013 used for the MEPS Panel
17 weights for key, responding persons in-scope on December 31, 2013. The same
five variables employed for Panel 17 raking (census region, MSA status,
race/ethnicity, sex, and age) were used for Panel 18 raking. Again, the final
weight for key, responding persons who were not in-scope on December 31, 2013
but were in-scope earlier in the year was the person weight after the
nonresponse adjustment.
Note that the MEPS Round 1 weights for both panels
incorporated the following components: a weight reflecting the original
household probability of selection for the NHIS and an adjustment for NHIS
nonresponse; a factor representing the proportion of the 16 NHIS panel-quarter
combinations eligible for MEPS; the oversampling of certain subgroups for MEPS
among the NHIS household respondents eligible for MEPS; ratio-adjustment to NHIS-based
national population estimates at the household (occupied DU) level; adjustment
for nonresponse at the DU level for Round 1; and poststratification to U.S.
civilian noninstitutionalized population estimates at the family and person
level obtained from the corresponding March CPS databases.
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The final raking of those in-scope at the end of the
year has been described above. In addition, the composite weights of two groups
of persons who were out-of-scope on December 31, 2013 were poststratified.
Specifically, the weights of those who were in-scope sometime during the year,
out-of-scope on December 31, and entered a nursing home during the year were
poststratified to a corresponding control total obtained from the 1996 MEPS
Nursing Home Component. The weights of persons who died while in-scope during
2013 were poststratified to corresponding estimates derived using data obtained
from the Medicare Current Beneficiary Survey (MCBS) and Vital Statistics
information provided by the National Center for Health Statistics (NCHS).
Separate decedent control totals were developed for the “65 and older” and
“under 65” civilian noninstitutionalized decedent populations.
In developing the final person-level weight for 2013
(PERWT13F), an additional raking dimension was included to adjust the proportion
of persons under age 65 with at least one inpatient discharge based on
independent sources of data. The table below shows ratios of weighted numbers of
non-elderly persons that resulted from including this additional raking
dimension to that of corresponding estimates without the additional dimension.
Ratio of Adjusted to Unadjusted Weights
| Number of Inpatient Discharges (IPDIS13) |
Non-elderly (AGE13X < 65) |
| 0 |
0.98938 |
| 1+ |
1.21587 |
Overall, the weighted population estimate for the
civilian noninstitutionalized population for December 31, 2013 is 312,098,312
(PERWT13F>0 and INSC1231=1). The sum of the person-level weights across all
persons assigned a positive person-level weight is 315,721,982.
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The target population for MEPS in this file is the
2013 U.S. civilian noninstitutionalized population. However, the MEPS sampled
households are a subsample of the NHIS households interviewed in 2011 (Panel 17)
and 2012 (Panel 18). New households created after the NHIS interviews for the
respective panels and consisting exclusively of persons who entered the target
population after 2011 (Panel 17) or after 2012 (Panel 18) are not covered by
MEPS. Neither are previously out-of-scope persons who join an existing household
but are unrelated to the current household residents. Persons not covered by a
given MEPS panel thus include some members of the following groups: immigrants;
persons leaving the military; U.S. citizens returning from residence in another
country; and persons leaving institutions. The set of uncovered persons
constitutes only a small segment of the MEPS target population.
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MEPS began in 1996, and the utility of the survey for
analyzing health care trends expands with each additional year of data. However,
it is important to consider a variety of factors when examining trends over time
using MEPS. Statistical significance tests should be conducted to assess the
likelihood that observed trends may be attributable to sampling variation. The
adjustment to the weight described in 3.2.3 above based on inpatient discharges
potentially could affect some analyses of trends. The length of time being
analyzed should also be considered. In particular, large shifts in survey
estimates over short periods of time (e.g. from one year to the next) that are
statistically significant should be interpreted with caution, unless they are
attributable to known factors such as changes in public policy, economic
conditions, or MEPS survey methodology.
With respect to methodological considerations, in 2013
MEPS introduced an effort to obtain more complete information about health care
utilization from MEPS respondents with full implementation in early 2014 at the
start of the final rounds of data collection for 2013. This effort likely
resulted in improved data quality and a reduction in underreporting in 2013, but
could have some modest impact on analyses involving trends in utilization across
years.
There are also statistical factors to consider in
interpreting trend analyses. Looking at changes over longer periods of
time can provide a more complete picture of underlying trends. Analysts may wish
to consider using techniques to evaluate, smooth, or stabilize analyses of
trends using MEPS data such as comparing pooled time periods (e.g. 1996-97
versus 2012-13), working with moving averages, or using modeling techniques with
several consecutive years of MEPS data to test the fit of specified patterns
over time. Finally, researchers should be aware of the impact of multiple
comparisons on Type I error. Without making appropriate allowance for multiple
comparisons, undertaking numerous statistical significance tests of trends
increases the likelihood of concluding that a change has taken place when one
has not.
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The data in this file can be used to develop national
2013 event-level estimates for the U.S. civilian noninstitutionalized population
on emergency room visits as well as expenditures, and sources of payment for
these visits. Estimates of total visits are the sum of the weight variable
(PERWT13F) across relevant event records while estimates of other variables must
be weighted by PERWT13F to be nationally representative. The tables below
contain event-level estimates for selected variables.
Selected Event-Level Estimates
Emergency Room Visits
| Estimate of Interest |
Variable |
Estimate (SE) |
Estimate Excluding
Zero Payment Events (SE) |
| Total number of emergency room visits (in millions) |
PERWT13F |
64.0 (1.91) |
59.6 (1.80) |
Proportion of emergency room visits with expenditures > 0*
|
ERXP13X |
0.931 (0.0049) |
--------------- |
Emergency Room Expenditures
| Estimate of Interest |
Variable Name |
Estimate (SE) |
Estimate Excluding
Zero Payment Events (SE)* |
| Mean total payments per visit |
ERXP13X |
$939 ($27.8) |
$1,009 ($30.1) |
| Mean out-of-pocket payment per visit |
ERDSF13X +ERFSF13X
|
$101 ($7.6) |
$109 ($8.1) |
Mean proportion of
total expenditures paid
by private insurance per visit |
(ERDPV13X+ERFPV13X)/ERXP13X |
--------------- |
0.300 (0.0109) |
* Zero payment events can occur in MEPS for the
following reasons: (1) the stay was covered under a flat fee arrangement (flat
fee payments are included only on the first event covered by the arrangement),
(2) there was no charge for a follow-up stay, (3) the provider was never paid by
an individual, insurance plan, or other source for services provided, or (4)
charges were included in the bill for a subsequent hospital admission (emergency
room events only), or (5) the event was paid for through government or
privately-funded research or clinical trials.
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To enhance analyses of emergency room visits, analysts
may link information about emergency room visits by sample persons in this file
to the annual full year consolidated file (which has data for all MEPS sample
persons), or conversely, link person-level information from the full year
consolidated file to this event-level file (see Section 5 below for more
details). Both this file and the full year consolidated file may be used to
derive estimates for persons with emergency room care and annual estimates of
total expenditures. However, if the estimate relates to the entire population,
this file cannot be used to calculate the denominator, as only those persons
with at least one emergency room event are represented on this data file.
Therefore, the full year consolidated file must be used for person-level
analyses that include both persons with and without emergency room care.
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It is essential that the analyst examine all variables
for the presence of negative values used to represent missing values. For
continuous or discrete variables, where means or totals may be taken, it may be
necessary to set negative values to values appropriate to the analytic needs.
That is, the analyst should either impute a value or set the value to one that
will be interpreted as missing by the computing language used. For categorical
and dichotomous variables, the analyst may want to consider whether to recode or
impute a value for cases with negative values or whether to exclude or include
such cases in the numerator and/or denominator when calculating proportions.
Methodologies used for the editing/imputation of expenditure variables (e.g.,
sources of payment, flat fee, and zero expenditures) are described in Section
2.5.6.
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The MEPS is based on a complex sample design. To
obtain estimates of variability (such as the standard error of sample estimates
or corresponding confidence intervals) for MEPS estimates, analysts need to take
into account the complex sample design of MEPS for both person-level and
family-level analyses. Several methodologies have been developed for estimating
standard errors for surveys with a complex sample design, including the
Taylor-series linearization method, balanced repeated replication, and jackknife
replication. Various software packages provide analysts with the capability of
implementing these methodologies. Replicate weights have not been developed for
the MEPS data. Instead, the variables needed to calculate appropriate standard
errors based on the Taylor-series linearization method are included on this file
as well as all other MEPS public use files. Software packages that permit the
use of the Taylor-series linearization method include SUDAAN, Stata, SAS
(version 8.2 and higher), and SPSS (version 12.0 and higher). For complete
information on the capabilities of each package, analysts should refer to the
corresponding software user documentation.
Using the Taylor-series linearization method, variance
estimation strata and the variance estimation PSUs within these strata must be
specified. The variables VARSTR and VARPSU on this MEPS data file serve to
identify the sampling strata and primary sampling units required by the variance
estimation programs. Specifying a "with replacement" design in one of the
previously mentioned computer software packages will provide estimated 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
number available. For variables of interest distributed throughout the country
(and thus the MEPS sample PSUs), one can generally expect to have at least 100
degrees of freedom associated with the estimated standard errors for national
estimates based on this MEPS database.
Prior to 2002, MEPS variance strata and PSUs were
developed independently from year to year, and the last two characters of the
strata and PSU variable names denoted the year. However, beginning with the 2002
Point-in-Time PUF, the variance strata and PSUs were developed to be compatible
with all future PUFs until the NHIS design changed. Thus, when pooling data
across years 2002 through the Panel 11 component of the 2007 files, the variance
strata and PSU variables provided can be used without modification for variance
estimation purposes for estimates covering multiple years of data. There were
203 variance estimation strata, each stratum with either two or three variance
estimation PSUs.
From Panel 12 of the 2007 files, a new set of variance
strata and PSUs were developed because of the introduction of a new NHIS design.
There are 165 variance strata with either two or three variance estimation PSUs
per stratum, starting from Panel 12. Therefore, there are a total of 368
(203+165) variance strata in the 2007 Full Year file as it consists of two
panels that were selected under two independent NHIS sample designs. Since both
MEPS panels in the Full Year 2008 file and beyond are based on the new NHIS
design, there are only 165 variance strata. These variance strata (VARSTR
values) have been numbered from 1001 to 1165 so that they can be readily
distinguished from those developed under the former NHIS sample design in the
event that data are pooled for several years.
If analyses call for pooling MEPS data across several
years, in order to ensure that variance strata are identified appropriately for
variance estimation purposes, one can proceed as follows:
- When pooling any year from 2002 or later, one can use the
variance strata numbering as is.
- When pooling any year from 1996 to 2001 with any year from
2002 or later, use the H36 file.
- A new H36 file will be constructed in the future to allow
pooling of 2007 and later years with 1996 to 2006.
Return To Table Of Contents
Data from this file can be used alone or in
conjunction with other files for different analytic purposes. This section
summarizes various scenarios for merging/linking MEPS event files. Each MEPS
panel can also be linked back to the previous year’s National Health Interview
Survey public use data files. For information on obtaining MEPS/NHIS link files
please see
meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.
Return To Table Of Contents
Merging characteristics of interest from a
person-level file (e.g., MEPS 2013 Full Year Consolidated File) expands the
scope of potential estimates. For example, to estimate the total number of
emergency room visits for persons with specific demographic characteristics
(e.g., age, race, sex, and education), population characteristics from a
person-level file need to be merged onto the emergency room visit file. This
procedure is illustrated below. The MEPS 2013 Appendix File, HC-160I, provides
additional detail on how to merge MEPS data files.
- Create dataset PERSX by sorting the MEPS 2013 Full Year
Consolidated File by the person identifier, DUPERSID. Keep only
variables to be merged onto the emergency room visit file and
DUPERSID.
- Create dataset EROM by sorting the emergency room visit file
by person identifier, DUPERSID.
- Create final dataset NEWEROM by merging these two files by
DUPERSID, keeping only records on the emergency room visit file.
The following is an example of SAS code which
completes these steps:
PROC SORT DATA=HCXXX (KEEP=DUPERSID AGE31X AGE42X
AGE53X SEX RACEV1X EDUYRDG EDRECODE) OUT=PERSX;
BY DUPERSID;
RUN;
PROC SORT DATA=EROM;
BY DUPERSID;
RUN;
DATA NEWEROM;
MERGE EROM (IN=A) PERSX (IN=B);
BY DUPERSID;
IF A;
RUN;
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The prescribed medicines-event link (RXLK) file
provides a link from the MEPS event files to the 2013 Prescribed Medicines Event
File. When using RXLK, data users/analysts should keep in mind that one
inpatient stay can link to more than one prescribed medicine record. Conversely,
a prescribed medicine event may link to more than one inpatient stay visit or
different types of events. When this occurs, it is up to the data user/analyst
to determine how the prescribed medicine expenditures should be allocated among
those medical events. For detailed linking examples, including SAS code, data
users/analysts should refer to the MEPS 2013 Appendix File, HC-160I.
Return To Table Of Contents
The conditions-event link (CLNK) file provides a link
from MEPS event files to the 2013 Medical Conditions File. When using the CLNK,
data users/analysts should keep in mind that (1) conditions are
household-reported, (2) there may be multiple conditions associated with an
emergency room visit and (3) a condition may link to more than one emergency
room visit or any other type of visit. Data users/analysts should also note that
not all emergency room visits link to the medical conditions file.
Return To Table Of Contents
Cohen, S.B. (1998). Sample Design of the 1996 Medical
Expenditure Panel Survey Medical Provider Component. Journal of Economic
Social Measurement. Vol. 24, 25-53.
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. and Iachan, R. (1987). A Comparison of
Household and Provider Reports of Medical Conditions. Journal of Economic and
Social Measurement. 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.
Ezzati-Rice, T.M., Rohde, F., Greenblatt, J., Sample
Design of the Medical Expenditure Panel Survey Household Component, 1998–2007.
Methodology Report No. 22. March 2008. Agency for Healthcare Research and
Quality, Rockville, MD.
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.
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
VARIABLE-SOURCE CROSSWALK
FOR MEPS HC-160E: 2013 EMERGENCY ROOM VISITS
Survey Administration Variables
| Variable |
Description |
Source |
| DUID |
Dwelling unit ID |
Assigned in sampling |
| PID |
Person number |
Assigned in sampling |
| DUPERSID |
Person ID (DUID + PID) |
Assigned in sampling |
| EVNTIDX |
Event ID |
Assigned in sampling |
| EVENTRN |
Event round number |
CAPI derived |
| ERHEVIDX |
Event ID for corresponding hospital stay |
Constructed |
| FFEEIDX |
Flat fee ID |
CAPI derived |
| PANEL |
Panel Number |
Constructed |
| MPCDATA |
MPC data flag |
Constructed |
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Emergency Room Visit Event Variables
| Variable |
Description |
Source |
| ERDATEYR |
Event date – year |
CAPI derived |
| ERDATEMM |
Event date – month |
CAPI derived |
| VSTCTGRY |
Best category for care p recv on vst dt |
ER02 |
| VSTRELCN |
This vst related to spec condition |
ER03 |
| LABTEST |
This visit did p have lab tests |
ER05 |
| SONOGRAM |
This visit did p have sonogram or ultrsd |
ER05 |
| XRAYS |
This visit did p have x–rays |
ER05 |
| MAMMOG |
This visit did p have a mammogram |
ER05 |
| MRI |
This visit did p have an MRI/Catscan |
ER05 |
| EKG |
This visit did p have an EKG or ECG |
ER05 |
| EEG |
This visit did p have an EEG |
ER05 |
| RCVVAC |
This visit did p receive a vaccination |
ER05 |
| ANESTH |
This visit did p receive anesthesia |
ER05 |
| THRTSWAB |
This visit did p have a throat swab |
ER05 |
| OTHSVCE |
This visit did p have oth diag tests/exams |
ER05 |
| SURGPROC |
Was surg proc performed on p this visit |
ER06 |
| MEDPRESC |
Any medicine prescribed for p this visit |
ER08 |
| ERCCC1X |
Modified Clinical Classification Code |
Constructed/Edited |
| ERCCC2X |
Modified Clinical Classification Code |
Constructed/Edited |
| ERCCC3X |
Modified Clinical Classification Code |
Constructed/Edited |
Return To Table Of Contents
Flat Fee Variables
| Variable |
Description |
Source |
| FFERTYPE |
Flat fee bundle |
Constructed |
| FFBEF13 |
Total # of visits in FF before 2013 |
FF05 |
| FFTOT14 |
Total # of visits in FF after 2013 |
FF10 |
Return To Table Of Contents
Imputed Total Expenditure Variables
| Variable |
Description |
Source |
| ERXP13X |
Total exp for event (ERFXP13X + ERDXP13X) |
Constructed |
| ERTC13X |
Total chg for event (ERFTC13X + ERDTC13X) |
Constructed |
Return To Table Of Contents
Imputed Facility Expenditure Variables
| Variable |
Description |
Source |
| ERFSF13X |
Facility amt pd, family (Imputed) |
CP Section (Edited) |
| ERFMR13X |
Facility amt pd, Medicare (Imputed) |
CP Section (Edited) |
| ERFMD13X |
Facility amt pd, Medicaid (Imputed) |
CP Section (Edited) |
| ERFPV13X |
Facility amt pd, priv insur (Imputed) |
CP Section (Edited) |
| ERFVA13X |
Facility amt pd, Veterans/CHAMPVA (Imputed) |
CP Section (Edited) |
| ERFTR13X |
Facility amt pd, TRICARE (Imputed) |
CP Section (Edited) |
| ERFOF13X |
Facility amt pd, oth federal (Imputed) |
CP Section (Edited) |
| ERFSL13X |
Facility amt pd, state/local gov (Imputed) |
CP Section (Edited) |
| ERFWC13X |
Facility amt pd, Workers Comp (Imputed) |
CP Section (Edited) |
| ERFOR13X |
Facility amt pd, oth priv (Imputed) |
Constructed
|
| ERFOU13X |
Facility amt pd, oth pub (Imputed) |
Constructed |
| ERFOT13X |
Facility amt pd, oth insur (Imputed) |
CP Section (Edited) |
| ERFXP13X |
Facility sum payments ERFSF13X – ERFOT13X |
Constructed |
| ERFTC13X |
Total facility charge (Imputed) |
CP Section (Edited)
|
Return To Table Of Contents
Imputed Physician Expenditure Variables
| Variable |
Description |
Source |
| ERDSF13X |
Doctor amount paid, family (Imputed) |
Constructed |
| ERDMR13X |
Doctor amount pd, Medicare (Imputed) |
Constructed |
| ERDMD13X |
Doctor amount paid, Medicaid (Imputed) |
Constructed |
| ERDPV13X |
Doctor amt pd, priv insur (Imputed) |
Constructed |
| ERDVA13X |
Doctor amount paid, Veterans/CHAMPVA (Imputed) |
Constructed |
| ERDTR13X |
Doctor amount pd, TRICARE (Imputed) |
Constructed |
| ERDOF13X |
Doctor amt paid, oth federal (Imputed) |
Constructed |
| ERDSL13X |
Doctor amt pd, state/local gov (Imputed) |
Constructed |
| ERDWC13X |
Doctor amount pd, Workers Comp (Imputed) |
Constructed |
| ERDOR13X |
Doctor amt pd, oth private (Imputed) |
Constructed |
| ERDOU13X |
Doctor amt pd, oth pub (Imputed) |
Constructed |
| ERDOT13X |
Doctor amt pd, oth insur (Imputed) |
Constructed |
| ERDXP13X |
Doctor sum payments ERDSF13X – ERDOT13X |
Constructed |
| ERDTC13X |
Total doctor charge (Imputed) |
Constructed |
| IMPFLAG |
Imputation status |
Constructed |
Return To Table Of Contents
Weights
| Variable |
Description |
Source |
| PERWT13F |
Expenditure file person weight, 2013 |
Constructed |
| VARSTR |
Variance estimation stratum, 2013 |
Constructed |
| VARPSU |
Variance estimation PSU, 2013 |
Constructed |
Return To Table Of Contents
|
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