A. Data Use Agreement

B. Background

1.0 Household Component

2.0 Medical Provider Component

3.0 Insurance Component

4.0 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

2.5 File 1 Contents

2.5.1 Survey Administration Variables

2.5.2 Health Insurance Variables

2.5.2.1 Managed Care Variables  (MCDHMO31, MCDHMO42, MCDHMO97, MCDMC31, MCDMC42, MCDMC97, PRVHMO31, PRVHMO42, PRVHMO97, PRVMC31, PRVMC42, PRVMC97)

2.5.2.2 Unedited Health Insurance Variables (PREVCOVR-LIMITOT)

2.5.2.3 Health Insurance Coverage Variables (CHAMP31X-STPRAT97)

2.5.2.4 Dental Private Insurance Variables

2.5.2.5 Prescription Drug Private Insurance Variables

2.5.3 Disability Days Indicator Variables (DDNWRK31-OTHNDD53)

2.5.4 Access to Care Variables (ACCELIG2-OTHRPRO2)

2.5.5 Long Term Care (LTC) Variables (PANELRN - NUM_COND)

2.5.6 Alternative Care Utilization Variables (ALTCAR97-REFRMD97)

2.5.7 Preventive Care Variables (DENTCK97-MAMGRM97)

2.5.8 Child Care Arrangements Variables (WHRCAR97-DAYCAR97)

2.6 File 2 Contents: Outpatient Department Visit Variable

2.6.1 Visit Details (SEETLKPV)

2.7 File 3 Contents: Care Giver Variables

2.7.1 Caregiver Supplement

2.7.2 File Structure (CGVRIDX - HOWLNGMX)

D. Variable-Source CROSSWALK

Attachment 1: Sample SAS Program for Merging the LTC file with the Condition file Example

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Individual identifiers have been removed from the micro-data contained in the files that are part of this Public Use Release. 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 data set 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.

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 this data you signify your agreement to comply with the above stated statutorily based requirements with the knowledge that deliberately making a false statement in any matter within the jurisdiction of any department or agency of the Federal Government violates 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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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 non-institutionalized population. 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 three component surveys: the Household Component (HC), the Medical Provider Component (MPC), and the Insurance Component (IC). The HC is the core survey, and it forms the basis for the MPC sample and part of the IC sample. Together these surveys yield comprehensive data that provide national estimates of the level and distribution of health care use and expenditures, support health services research, and can be used to assess health care policy implications.

MEPS is the third in a series of national probability surveys conducted by AHRQ on the financing and use of medical care in the United States. The National Medical Care Expenditure Survey (NMCES, also known as NMES-1) was conducted in 1977, the National Medical Expenditure Survey (NMES-2) in 1977. 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 sampled households for the MEPS HC are 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.
 

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1.0 Household Component

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

The HC uses an overlapping panel design in which data are collected through a preliminary contact followed by a series of five rounds of interviews over a 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 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 sample of households selected for the MEPS HC is drawn from among respondents to the NHIS, conducted by NCHS. The NHIS provides a nationally representative sample of the U.S. civilian non-institutionalized population, with oversampling of Hispanics and blacks.
 

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2.0 Medical Provider Component

The MEPS MPC supplements and/or replaces 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 home health agencies and pharmacies reported by HC respondents. Office-based physicians, hospitals, and hospital physicians are also included in the MPC but may be sub-sampled at various rates, depending on burden and resources, in certain years.

Data are collected on medical and financial characteristics of medical and pharmacy events reported by HC respondents. The MPC is conducted through telephone interviews and record abstraction.
 

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

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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/or electronic files on the MEPS web site (www.meps.ahrq.gov). All microdata files are available for download from the MEPS web site in compressed formats (zip and self-extracting executable files.) Selected data files are available on CD-ROM from the MEPS Clearinghouse.

For printed documents and CD-ROMs that 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.

Additional information on MEPS is available from the MEPS project manager, mepspd@ahrq.gov.
 

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C. Technical and Programming Information

This documentation describes a series of MEPS variables that were obtained for calendar year 1997. These data include managed care variables, insurance status variables, disability days, long term care, access to care, language of interview, and alternative/ preventive care variables. This data release is intended to supplement the MEPS variables previously released for 1997. In order to use these variables, researchers will need to link them to the 1997 Consolidated Full-year Use and Expenditure File (HC-020) which contains all previously released 1997 person level data including demographic and socio-economic information. Please refer to the HC-020 documentation for further information.

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

• Data File Information
• Variable-Source Crosswalk (Section D)

Codebooks of all the variables included in these 1997 Supplemental Files are provided in separate files (H42F1CB.PDF, H42F2CB.PDF, H42F3CB.PDF). The person-level, event-level and caregiver-level variables will be in separate files.

A database of all MEPS products released to date and a variable locator indicating the major MEPS HC data items on public use files (including weights) that have been released to date can be found at the following link on the MEPS website: www.meps.ahrq.gov/Data_Public.htm.

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This 1997 supplemental variable public use data set consists of one person-level file (File 1), one event-level file (File 2), and one caregiver-level file (File 3). Unweighted frequencies are provided for each variable on the files. In conjunction with the weight variable (WTDPER97) provided on MEPS HC-020: 1997 Full Year Consolidated Data File, data for these persons can be used to make estimates for the civilian non-institutionalized U. S. population for 1997. The records on this data release can be linked to all other 1997 MEPS-HC public use data files by using the sample person identifier (DUPERSID). Panel 1 cases (Panel 97=1) can be linked back to the 1996 MEPS-HC public use data files. A longitudinal weight to facilitate Panel 1 96-97 analysis can be found on HC-023. Panel 2 cases (Panel 97 = 2) can be linked to the 1998 MEPS-HC public use data files. A longitudinal weight to facilitate Panel 2 97-98 analysis can be found on HC- 035.

File 2 contains a variable (SEETLKPV) which was inadvertently omitted from the 1997 Outpatient Department Visits File (HC-016 F).
 

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The codebook and data file sequence lists variables in the following order:

• Unique person identifiers
• Survey administration variables
• Health insurance variables
• Disability variables
• Access to care variables
 

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The following reserved code values are used:

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

In general, variable names reflect the content of the variable, with an eight-character limitation. Edited variables end in an X, and are so noted in the variable label. The last two characters in round-specific variables denote the rounds of data collection, Round 3, 4, or 5 of Panel 1 and Round 1, 2, or 3 of Panel 2. Unless otherwise noted, variables that end in 97 represent status as of December 31, 1997.

Variables contained in this delivery were derived either from the questionnaire itself or from the CAPI. The source of each variable is identified in the section of the documentation entitled “Section D. Variable-Source Crosswalk.” Sources for each variable are indicated in one of four ways: (1) variables derived from CAPI or assigned in sampling are so indicated; (2) variables derived from complex algorithms associated with re-enumeration are labeled “RE Section”; (3) variables that are collected by one or more specific questions in the instrument have those question numbers listed in the Source column; (4) variables constructed from multiple questions using complex algorithms are labeled “Constructed.”
 

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The definitions of Dwelling Units (DUs) 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. A person number (PID) uniquely identifies each person within the dwelling unit. The variable DUPERSID is the combination of the variables DUID and PID.

Health Insurance Eligibility Units (HIEUs) are sub-family relationship units constructed to include adults plus those family members who would typically be eligible for coverage under the adults' private health insurance family plans. To construct the HIEUIDX variable which links persons into a common HIEU, we begin with the family identification variable CPSFAMID. Working with this family ID, we define HIEUIDX using family relationships as of the end of 1996. Persons missing end of year relationship information are assigned to an HIEUIDX using relationship information from the last round in which they provided such information. HIEUs comprise adults, their spouses, and their unmarried natural/adoptive children age 18 and under. We also include children under age 24 who are full-time students who are living with their parents in their parents' homes; and full-time students under age 24 living away from home who are included in the CPSFAMID. Children who do not live with their natural/adoptive adult parents are placed in an HIEU as follows:

• Foster children always comprise a separate HIEU.

• Other unmarried children are placed in a stepparent HIEU, grandparent HIEU, great-grandparent HIEU, or aunt/uncle HIEU.

• Children of unmarried minors are placed (along with their minor parents) in the HIEUIDX of their adult grandparents (if possible). Married minors are placed into separate HIEUs along with any spouses and children they might have.

• Some HIEUs are headed by unmarried minors, when there is no adult family member present in the CPSFAMID.

HIEUs do not, in general, comprise adult (nonmarital) partnerships, because unmarried adult partners are rarely eligible for dependent coverage under each other's insurance. The exception to this rule is that we include adult partners in the same HIEU if there is at least one (out-of-wedlock) child in the family that links to both adult partners. In cases of missing or contradictory relationship codes, HIEUs are edited by hand, with the presumption being that the adults and children form a nuclear family.

To construct a weight for use in analysis using HIEUs:
 

1. Identify the HIEU head by your analytic intent, i.e. if only studying health insurance unit with female heads of households, choose the female adult as head of household.

2. If the weight of the HIEU head is non-zero, use the weight of the HIEU head for all members of that HIEU; or

3. If the weight of the HIEU head is zero, delete the case.
 

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The language of interview (INTVLANG) was recorded in the closing section of the interview, and has the following possible values:

1 ENGLISH
2 SPANISH
3 ENGLISH & SPANISH
91 OTHER LANGUAGE

Although this question is round-specific, the responses were summarized to the person-level variable, INTVLANG. The hierarchy used in determining the value is as follows: 1) assign the value from the first round with a reported value recorded for each person; 2) if one is not recorded at the person level, then assign the first recorded value within the reporting unit (RU); 3) if one is not available at that level, then assign the first recorded value of the dwelling unit (DU).

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2.5.2 Health Insurance Variables

HMO or gatekeeper plan variables have been constructed from information on health insurance coverage at any time in a reference period and the characteristics of the plan. A separate set of managed care variables has been constructed for private insurance and Medicaid coverage. The purpose of these variables is to provide information on managed care participation during the portion of the three rounds (i.e., reference periods) that fall within the same calendar year.

Managed care variables for calendar year 1997 are based on responses to health insurance questions asked during the round 3, 4, and 5 interviews of panel 1, and the round 1, 2, and 3 interviews of panel 2. Each variable ends in “xy” where x and y denote the interview round for panels 1 and 2, respectively. The variables ending in “31” and “42” correspond to the first two interviews of each panel in the calendar year. Because round 3 interviews typically overlap the final months of one year and the beginning months of the next year, the “31” variables for panel 1 have been restricted to the 1997 portion of the reference period. Similarly, the panel1/round 5 and panel 2/round 3 interviews have been restricted to the 1997 portion of these reference periods, and the corresponding managed care variables have been given the suffix “97” (as opposed to “53”) to emphasize the restricted time frame.

Construction of the managed care variables is straightforward, but three caveats are appropriate. First, MEPS estimates of the number of persons in HMOs are higher than figures reported by other sources, particularly those based on HMO industry data. The differences stem from the use of household-reported information, which may include respondent error, to determine HMO coverage in MEPS.

Second, the managed care questions are asked about the last plan held by a respondent through his or her establishment even though the person could have had a different plan through the establishment at an earlier point in the reference period. As a result, in instances where a respondent changed his or her establishment-related insurance, the managed care variables describe the characteristics of the last plan held in the round.

Third, the “97” versions of the HMO and gatekeeper variables for panel 2 are developed from round 3 variables that cover different time frames. The health insurance variable for round 3 is restricted to the same calendar year as the round 1 and 2 data. The round 3 variables describing plan type, on the other hand, overlap the next calendar year. As a consequence, the round 3 managed care variables may not describe the characteristics of the last plan held in the calendar year if the person changed plans after the first of the year.

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Persons were assigned Medicaid or State Children’s Health Insurance Program (SCHIP) coverage based on their responses to the health insurance questions or through logical editing of the survey data. The number of persons who were edited to have Medicaid or SCHIP coverage is small, but they are comprised of two distinct groups of individuals. The first group includes persons in Other Government programs that were identified as being in a Medicaid HMO or gatekeeper plan that did not require premium payment from the insured party. By definition, this group was asked about the managed care characteristics of their insurance coverage. The second group includes a small number of persons who did not report public insurance, but were classified as Medicaid recipients because they reported receiving AFDC, SSI, or WIC. The health insurance plan type questions were not asked of this group. As a consequence, the plan type could be determined for some, but not all, respondents who were assigned Medicaid or SCHIP coverage through logical editing of the data.

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If Medicaid or Other Government program were identified as the source of hospital/physician insurance coverage, the respondent was asked about the characteristics of the plan. The variable MCDHMO has been set to "yes" if the plan was identified from a list of state names or programs for Medicaid HMOs in the area, or if an affirmative response was provided to the following question:

1. Under {{Medicaid/{STATE NAME FOR MEDICAID}/the program sponsored by a state or local government agency which provides hospital and physician benefits} (are/is) (READ NAME(S) FROM BELOW) signed up with an HMO, that is a Health Maintenance Organization?

[With an HMO, you must generally receive care from HMO physicians. If another doctor is seen, the expense is not covered unless you were referred by the HMO, or there was a medical emergency.]

In subsequent rounds, respondents who had been previously identified as covered by Medicaid were asked whether the name of their insurance plan had changed since the previous interview. An affirmative response triggered the previous set of questions about managed care (name on list of Medicaid HMOs or signed up with an HMO).

In each round, the variable MCDHMO has five possible values:

1	The person was covered by a Medicaid HMO.
2	The person was covered by Medicaid but the plan was not an HMO.
3	The person was not covered by Medicaid.
-9	The person was covered by Medicaid but the plan type was not ascertained.
-1	The person was out-of-scope.

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If the respondent did not belong to a Medicaid HMO, a third question was used to determine whether the person was in a gatekeeper plan. The variable MCDMCxy was set to "yes" if the person provided an affirmative response to the following question:

1. Does {{Medicaid /{STATE NAME FOR MEDICAID}} require (READ NAME(S) BELOW) to sign up with a certain primary care doctor, group of doctors, or with a certain clinic which they must go to for all of their routine care?

Probe: Do not include emergency care or care from a specialist to which they were referred to.

In each round, the variable MCDMC has five possible values:

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Persons with private insurance were identified from their responses to questions in the health insurance section of the MEPS questionnaire. In some cases, persons were assigned private insurance as a result of comments collected during the interview, but data editing was minimal. As a consequence, most persons with private insurance were asked about the characteristics of their plan, and their responses were used to identify HMO and gatekeeper plans.

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If a person was identified as being without insurance as of January 1st in the MEPS Round 1 interview, a series of follow-up questions were asked to determine the duration of uninsurance prior to the start of the MEPS survey. If the person said he/she was covered by insurance in the 2 years prior to the MEPS Round 1 interview (PREVCOVR), the month, year (COVRMM, COVRYY), and type of coverage (Employer-sponsored (WASESTB), Medicare (WASMCARE), Medicaid (WASMCAID), CHAMPUS/CHAMPVA (WASCHAMP), VA/Military Care (WASVA), Other public (WASOTGOV, WASAFDC,WASSSI, WASSTAT1-3, WASOTHER) or Private coverage purchased through a group, association or insurance company (WASPRIV) was ascertained. For persons who were covered by health insurance on January 1st, it was ascertained if they were ever without health insurance in the previous year (NOINSBEF). The number of weeks/months without health insurance was also ascertained (NOINSTM, NOINUNIT). For persons who reported only non-comprehensive coverage as of January 1st, a question was asked to determine if they had been covered by more comprehensive coverage that paid for medical and doctors bills in the previous 2 years (MORCOVR). If they were, the most recent month and year of coverage was ascertained (INSENDMM, INSENDYY) as was the type of coverage (see the variable names above). Note that these variables are unedited and have been taken directly as they were recorded from the raw data. There may be inconsistencies with the health insurance variables released on public use files that indicate that an individual is uninsured in January.

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All individuals, regardless of their insurance status, were also asked in Round 1 if they had ever been denied insurance (DENYINSR) and if so, due to what conditions (DNYCANC, DNYHYPER, DNYDIAB, DNYCORON, DENYOTH). Individuals insured in January were asked whether there were any limitations or restrictions on their plans due to any physical or mental health condition (INSLIMIT) and if so, which conditions caused these limitations or restrictions (LMTASTHM, LMTBACK, LMTMIGRN, LMTCATAR, LIMITOT). Individuals under age 65 without any coverage in January were also asked if they had ever tried to purchase health insurance (INSLOOK). It should be noted that conditions collected in these questions were not recorded on the condition roster.

Note: The duration of uninsurance, limitation, denial and ever looked for insurance questions were only asked in Round 1. These variables are included on the file only for individuals in Panel 2 since Panel 2’s Round 1 occurred in 1997 but Panel 3’s Round 1 occurred in 1998. Round 1 data for Panel 3 members is contained on the 1998 Supplemental File (HC-043). The unedited health insurance variables are included on this supplemental file to facilitate longitudinal analysis. However, since they are not available for Panel 3, Round 3, they cannot be used to generate national estimates for the estimation year.
 

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Constructed and edited variables are provided that indicate health insurance coverage at any time in a given round’s reference period as well as at the MEPS interview dates and on December 31st, 1997. Note that for respondents who left the RU before the MEPS interview date or before December 31st , the variables measuring coverage at the interview date or on December 31st represent coverage at the date the person left the RU. In addition, since Round 5 only covers the time period from the Round 4 interview date up to December 31st , values for the December 31st variables are equivalent to those for Round 5 variables for Panel 1 members.

The health insurance variables are constructed for the sources of health insurance coverage collected during the MEPS interviews (Panel 1, Rounds 3 through 5 and Panel 2, Rounds 1 through 3). Note that the Medicare variables on this file as well as the private insurance variables that indicate the particular source of private coverage (rather than any private coverage) only measure coverage at the interview date and on December 31st. Users should also note that while the same general editing rules were followed for the month-by-month health insurance variables released on other MEPS public use files and those on this file, in a small number of cases the month-by-month variables experienced further edits performed after the variables on this file were completed. Since editing programs checking for consistencies between these sets of variables developed over time, there should be fewer discrepancies in data for calendar year 1998 and beyond than in data for the years 1996 and 1997.

In Rounds 2,3,4 and 5, insurance that was in effect at the previous round’s interview date was reviewed with the respondent. Most of the insurance variables have been logically edited to address issues that arose during such reviews in Rounds 2,3, 4, and 5. One edit to the private insurance variables corrects for a problem concerning covered benefits that occurred when respondents reported a change in any of their private health insurance plan names. Additional edits address issues of missing data on the time period of coverage for both public and private coverage that was either reviewed or initially reported in a given round. For CHAMPUS/CHAMPVA coverage (CHAMP31X, CHAMP42X, CHAMP53X, CHAMP97X, CHMAT31X, CHMAT42X, CHMAT53X, CHMAT97X), respondents who were age 65 and over had their reported CHAMPUS/CHAMPVA coverage overturned. Additional edits, described below, were performed on the Medicare and Medicaid variables to assign persons to coverage from these sources. Observations that contain edits assigning person to Medicare or Medicaid coverage can be identified by comparing the edited and unedited versions of the Medicare and Medicaid variables.

Public sources include Medicare, CHAMPUS/CHAMPVA, Medicaid and other public hospital/physician coverage. State-specific program participation (STAPR31, STAPR42, STAPR53, STAPR97, STPRAT31, STPRAT42, STPRAT53, STPRAT97) in non-comprehensive coverage was also identified but is not considered health insurance for the purpose of this survey.
 

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Medicare (MCARE31, MCARE42, MCARE53 and MCARE97) coverage was edited (MCARE31X, MCARE42X, MCARE53X and MCARE97X) for persons age 65 or over. Within this age group, individuals were assigned Medicare coverage if:

They answered yes to a follow-up question on whether or not they received Social Security benefits; or

They were covered by Medicaid, other public hospital/physician coverage or Medigap coverage: or

Their spouse was covered by Medicare.

They reported CHAMPUS/CHAMPVA coverage.
 

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Questions about other public hospital/physician coverage were asked in an attempt to identify Medicaid recipients who may not have recognized their coverage as Medicaid.  These questions were asked only if a respondent did not report Medicaid directly.  Respondents reporting other public hospital/physician coverage were asked follow-up questions to determine if their coverage was through a specific Medicaid HMO or if it included some other managed care characteristics.  Respondents who identified managed care from either path were asked if they paid anything for the coverage and/or if a government source paid for the coverage.  

The Medicaid variables (MCAID31, MCAID42, MCAID53, MCAID97) have been edited to include persons who paid nothing for their other public hospital/physician insurance when such coverage was through a Medicaid HMO or reported to include some other managed care characteristics (MCAID31X, MCAID42X, MCAID53X, MCAID97X, MCDAT31X, MCDAT42X, MCDAT53X, MCDAT97X). 

To assist users in further editing sources of insurance, this file contains variables constructed from the other public hospital/physician series that measure whether:

The respondent reported some type of managed care and paid something for the coverage, Other Public A Insurance (OTPUBA31, OTPUBA42, OTPUBA53, OTPUBA97, OTPAAT31, OTPAAT42, OTPAAT53, OTPAAT97 ); and

The respondent did not report any managed care, Other Public B insurance (OTPUBB31, OTPUBB42, OTPUBB53, OTPUBB97, OTPBAT31, OTPBAT42, OTPBAT53, OTPBAT97). 

The variables for Other Public A and B Insurance are provided only to assist in editing and should not be used to make separate insurance estimates for these types of insurance categories.

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The file also includes summary measures that indicate whether or not a sample person has any public insurance during a given round, at the interview date, or on December 31st (PUB31X, PUB42X, PUB53X, PUB97X, PUBAT31X, PUBAT42X PUBAT53X and PUBAT97X). Persons identified as covered by public insurance are those reporting coverage under CHAMPUS/CHAMPVA, Medicare, Medicaid, or other public hospital/physician programs. Persons covered only by state-specific programs that did not provide comprehensive coverage (STAPR31, STAPR42, STAPR53, STAPR97, STPRAT31, STPRAT42, STPRAT53, STPRAT97), for example, Maryland Kidney Disease Program, were not considered to have public coverage when constructing the variables PUB31X.....PUBAT97X.

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Variables identifying private insurance in general (PRIV31, PRIV42, PRIV53, PRIV97, PRIVAT31, PRIVAT42, PRIVAT53, PRIVAT97) and specific private insurance sources [such as employer/union group insurance (PRIEU31, PRIEU42, PRIEU53, PRIEU97); non-group (PRING31, PRING42, PRING53, PRING97); and other group (PRIOG31, PRIOG42, PRIOG53, PRIOG97)] were constructed. Variables indicating any private insurance coverage are available for the following time periods: at any time in a given round, at the interview date and on December 31st. The variables for the specific sources of private coverage are only available for coverage on the interview dates and on December 31st. Note that these variables indicate coverage within a source and do not distinguish between persons who are covered on one or more than one policy within a given source. In some cases, the policyholder was unable to characterize the source of insurance (PRIDK31, PRIDK42, PRIDK53, PRIDK97). Covered persons are also identified when the policyholder is living outside the RU (PROUT31, PROUT42, PROUT53, PROUT97). An individual was considered to have private health insurance coverage if, at a minimum, that coverage provided benefits for hospital and physician services (including Medigap coverage). Sources of insurance with missing information regarding the type of coverage were assumed to contain hospital/physician coverage. Persons without private hospital/physician insurance were not counted as privately insured.

Health insurance through a job or union (PRIEU31, PRIEU42, PRIEU53, PRIEU97) was initially asked about in the Employment Section of the interview and later confirmed in the Health Insurance Section. Respondents also had an opportunity to report employer and union group insurance for the first time in the Health Insurance Section, but this insurance was not linked to a specific job.

All insurance reported to be through a job classified as self-employed with firm size of 1 (PRIS31, PRIS42, PRIS53, PRIS97) was initially reported in the Employment Section and verified in the Health Insurance Section. Unlike the other employment-related variables, self-employed-firm size 1 health insurance could not be reported in the Health Insurance section for the first time. The variables PRIS31, PRIS42, PRIS53, PRIS97 have been constructed to allow users to determine if the insurance should be considered employment-related.

Private insurance that was not employment-related was reported in the Health Insurance section only.
 

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The file also includes summary measures that indicate whether or not a person has any insurance in a round, at an interview date or on December 31st (INS31X, INS42X, INS53X, INSAT31X, INSAT42X, INSAT53X, INSAT97X). Persons identified as insured are those reporting coverage under CHAMPUS/CHAMPVA, Medicare, Medicaid or other public hospital/physician or private hospital/physician insurance (including Medigap plans). A person is considered uninsured if not covered by one of these insurance sources.

Persons covered only by state-specific programs that provide non-comprehensive coverage (STAPR31, STAPR42, STAPR53, STAPR97, STPRAT31, STPRAT42, STPRAT53, STPRAT97), for example, Maryland Kidney Disease Program, and those without hospital/physician benefits (for example, private insurance for dental or vision care only, accidents or specific diseases) were not considered to be insured when constructing the variables INS31X, INS42X, INS53X, INSAT31X, INSAT42X, INSAT53X and INSAT97X.
 

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Round specific variables (DENTIN31/42/53) are provided that indicates the respondent was covered by a private health insurance plan that included at least some dental coverage for each round of 1997. It should be noted that the information was elicited from a pick-list, code all that apply, question that asked what type of health insurance person obtained through an establishment. The list included: hospital and physician benefits including coverage through an HMO, Medigap coverage, vision coverage, dental, and prescription drugs. It is possible that some dental coverage provided by hospital and physician plans was not independently enumerated in this question. Users should also note that persons with missing information on dental benefits for all reported private plans and those who reported that they did not have dental coverage for one or more plans but had missing information on other plans are coded as not having private dental coverage. Respondents who reported dental coverage from at least one reported private plan were coded as having private dental coverage.

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Round specific variables (PMEDIN31/42/53) are provided that indicate the respondent was covered by a private health insurance plan that included at least some prescription drug insurance coverage for each round of 1997. It should be noted that the information was elicited from a pick-list, code all that apply, question that asked what type of health insurance a person obtained through an establishment. The list included: hospital and physician benefits including coverage through an HMO, Medigap coverage, vision coverage, dental, and prescription drugs. It is possible some prescription drug coverage provided by hospital and physician plans was not independently enumerated in this question. Users should note that some insured persons have more than one private plan. In these cases, if the policyholder identified any plan as having prescription drug coverage, the prescription drug variable was set to “yes”. If a person had multiple plans and one or more were identified as not having prescription drug coverage and the other(s) had missing values for prescription drug coverage, the person level variable was set to missing. Those who reported that they did not have prescription drug coverage for all private plans are coded as not having private prescription drug coverage.  

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The disability days section of the core interview contains questions about time lost from work or school and days spent in bed because of a physical illness, injury, or mental or emotional problem. Data were collected on each individual in the household. These questions were repeated in each round of interviews; these files contains data from Rounds 3, 4, and 5 of the MEPS panel initiated in 1996 and Rounds 1, 2, and 3 of the MEPS panel initiated in 1997, respectively. The number at the end of the variable name (31, 42 or 53) identifies the Rounds in which the information was collected.

The reference period for these questions is the time period between the beginning of the panel or the previous interview date and the current interview date. In order to establish the length of a round, analysts are referred to the variables that indicate the beginning date and ending date of each Round (BEGREFD, BEGREFM, BEGREFY, ENDREFD, ENDREFM, ENDREFY). Analysts should be aware that Round 3 was conducted across both 1996 and 1997. Some data from Round 3 thus pertains to 1997. The number of disability days in Round 3 that occurred in each calendar year was not ascertained. If analysts want to create an indicator of disability days for a given calendar year, some adjustment must be made to the Round 3 data. Analysts who want to estimate disability days for a given calendar year will need to develop an algorithm for deciding what portion of reported disability days occurred in the year of interest and what portion occurred in the following year.

The variables DDNWRK31, DDNWRK42 and DDNWRK53 represent the number of times the respondent lost a half-day or more from work because of illness, injury or mental or emotional problems during Rounds 31, 42, and 53, respectively. A response of "no work days lost" was coded as zero; if the respondent did not work, these variables were coded -1 (inapplicable), and for some analyses these values may have to be recoded to zero. Respondents who were less than 16 years old were not asked about lost workdays, and these lost workdays variables are coded as -1 (inapplicable).

WKINBD31, WKINBD42 and WKINBD53 represent the number of work-loss days during each round in which the respondent spent at least half of the day in bed. These questions were asked only of persons aged 16 and over. Persons aged 15 or younger received a code of -1 (inapplicable). If a respondent answered the preceding work-loss question with "zero days" or "does not work", then the corresponding WKINBD question was coded as -1 (inapplicable).

DDNSCL31, DDNSCL42 and DDNSCL53 indicate the number of times that a respondent missed a half-day or more of school during Rounds 31, 42, or 53, respectively. These questions were asked of persons aged 3 to 22; respondents aged less than 3 or older than 22 were not asked these questions and are coded as -1 on these variables. In a small number of cases this was not implemented for the 1996 data. The analyst will need to implement this edit when doing longitudinal analyses). A code of -1 also indicates that the person does not attend school. The analyst should be aware that there was no attempt to reconcile school loss days with the time of year (e.g., summer vacation). In order to establish time of year, analysts are referred to the variables that indicate the beginning date and ending date of each Round (BEGREFD, BEGREFM, BEGREFY, ENDREFD, ENDREFM, ENDREFY).

SCLNBD31, SCLNBD42 and SCLNBD53 represent the number of school-loss days during each round in which the individual spent at least a half-day in bed. Respondents aged less than 3 or older than 22 did not receive these questions and are coded as -1 on these variables (in a small number of cases this was not done for the 1996 data, the analyst will need to make this edit when doing longitudinal analyses). If a respondent answered the preceding school-loss question with "zero days" or "does not attend school", then the corresponding SCLNBD question is coded as -1 (inapplicable).

DDBDYS31, DDBDYS42 and DDBDYS53 represent additional days, other than school or work loss days, in which the respondent spent at least half a day in bed, because of a physical illness or injury or a mental or emotional problem. These are the only indicators of disability days for persons who do not work or go to school. This question was not asked of children less than one year of age (coded -1).

A final set of variables indicate if an individual took a half-day or more off from work to care for the health problems of another individual in the family. OTHDYS31, OTHDYS42, and OTHDYS53 indicate if a person missed work because of someone else's illness, injury or health care needs, for example to take care of a sick child or relative. These variables each have three possible answers: yes -- missed work to care for another (coded 1); no ­ did not miss work to care for another (coded 2); or the person does not work (coded 2), based on responses to the DDNWRK variable for the same Round. Respondents younger than 16 were not asked these questions and are coded as -1 Again in a small number of cases this was not done for the 1996 data, the analyst will need to implement this edit when doing longitudinal analyses.

OTHNDD31, OTHNDD42 and OTHNDD53 indicate the number of days during each round in which work was lost because of another's health problem. Respondents younger than 16, those who do not work, and those who answer "no" to OTHDYS are skipped out of OTHNDD and receive codes of -1.

For respondents with positive weights, a minimal amount of editing was performed on these variables to preserve the skip patterns. Missing cases were not imputed.
 

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The variables ACCELIG2 through OTHRPRO2 contain data from the Access to Care section of the HC questionnaire, which was administered in Panel 2 Round 2 of the MEPS HC. The access to care supplement serves a number of purposes in the MEPS HC by gathering information on three main topic areas: whether each family member has a usual source of health care, the characteristics of usual source of health care providers for the family, and barriers the family has faced in obtaining needed health care. The variable ACCELIG2 indicates whether persons were eligible to receive the Access to Care questions. Note that the 1997 Access to Care data is limited to Panel 2 Round 2. For Panel 1 Round 4 Access to Care data was not collected, these records are set to -1 (n = 20,868). In subsequent years’ Access to Care data were collected from Rounds 2 and 4 within the data reference year. The 1997 Access to Care variables cannot be used to make full-year estimates, but can be useful in such analyses as trend analyses, or for enhancing subgroup analyses. These variables may be of particular interest because of the 1997 oversample of populations (such as poverty, children with activity limitations, adults with functional limitations, high medical expenditures cases, and the elderly) where access issues are particularly relevant.

Family members' usual source of health care. For each individual family member, MEPS HC ascertains whether there is a particular doctor's office, clinic, health center, or other place that the individual usually goes to if he/she is sick or needs advice about his/her health (HAVEUSC2). For those family members who do not have a usual source of health care, MEPS HC ascertains the reason(s) why (YNOUSC2 through OTHREA42). If any family members changed their usual source of health care during the 12 months prior to the interview, MEPS HC gathers information on the reason why this change was made (CHNGUSC2 through YNOMORE2).

Characteristics of usual source of health care providers for the family. For each unique usual source of care provider for a given family, MEPS HC asks for information on the following characteristics of the usual source of care provider:

• is the provider a medical doctor or some other type of medical provider (followed by questions which ask either the provider's medical specialty or the type of non-physician provider) (TYPEPER2), and is the provider hospital-based (TYPEPLC2 and LOCATIO2);

• is the provider the person or place family members would go to for new health problems, preventive health care, and referrals to other health professionals (MINORPR2 through REFFRLS2);

• does the provider have office hours nights and weekends, characteristics of the provider related to appointments and waiting time, ease of contacting a medical person at the provider's office by telephone (OFFHOUR2 through PHONEDI2);

• a number of quality-related characteristics of the provider, including whether the provider generally listens to family members, asks about prescription medications other doctors may give them, and family members' confidence in and satisfaction with the care received from the provider (PRLISTE2 through USCQUAL2).

Family barriers. Finally, the Access to Care supplement gathers information on barriers to health care for the family. This includes one question that asks if any family members have recently gone without needed health care because the family needed money to buy food, clothing, or pay for housing (NOCARE2). In addition, the respondent is asked to rate his/her satisfaction with the ability of family members to obtain health care if needed (HCNEEDS2). A series of two questions is asked to directly assess whether any family members experienced difficulty in obtaining any type of health care, delayed obtaining care, or did not receive health care they thought they needed due to any of the following reasons (OBTAINH2 through OTHRPRO2):

• Financial/Insurance Problems, including couldn't afford care; insurance company wouldn't approve, cover, or pay for care; pre-existing condition; insurance required a referral, but couldn't get one; doctor refused to accept family's insurance plan;

• Transportation Problems, including medical care was too far away; can't drive or don't have car/no public transportation available; too expensive to get there;

• Communication Problems, including hearing impairment or loss; different language;

• Physical Problems, including hard to get into building; hard to get around inside building; no appropriate equipment in office;

• Other Problems, including couldn't get time off work; didn't know where to go to get care; was refused services; couldn't get child care; didn't have time or took too long.
 

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Editing consisted primarily of logical editing for consistency with skip patterns. Other editing included the construction of new variables describing the USC provider, and recoding several "other specify" text items into existing or new categorical values, which are described below.

Not all variables or categories that appear in the Access to Care section are included on the file, as some small cell sizes have been suppressed to maintain respondent confidentiality. This affects the following questions:

AC03: Category 5 was combined with 91 OTHER REASON (YNOUSC2)

AC11: Category 7 was combined with 10 OTHER NON-MD PROVIDER (TYPEPER2).

AC23: Categories 2 and 4 were combined with 91 OTHER REASON (YNOMORE2)

AC25A: Categories 9, 11, 12, 13 and 17 were combined with 91 OTHER (MAINPRO2)

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The variables PROVTYX2, TYPEPLC2, TYPEPER2 and LOCATIO2 provide information on the type and location of the usual source of care provider. These variables were constructed as follows, using one or more questionnaire items which are not included on the file:

PROVTYX2 was constructed from items in the Provider Roster Section (available as a downloadable file on the MEPS Home Page), and has the following possible values:

1 FACILITY
2 PERSON
3 PERSON IN FACILITY PROVIDER

Question PV01, in the Provider Roster Section, asks whether the provider is a person or a facility. For providers designated as a person, the responses to item PV05 (which indicates if the provider is part of a group practice or HMO) and items PV03/ PV10 (which indicate the provider's address), were used to determine if the provider is a "person in facility" provider (i.e., a person for whom both person and facility characteristics are known, such as "Dr. X at Y Medical Associates").
TYPEPER2 was constructed from responses to items AC10, AC11, AC11OV, AC12 and AC12OV in the Access to Care Section and describes the type of medical provider for providers indicated as person or person in facility providers (records with PROVTYX2 = 1 (FACILITY) have a value of -1 for TYPEPER2). TYPEPER2 has the following possible values:

1 MD- GENERAL/FAMILY PRACTICE
2 MD- INTERNAL MEDICINE
3 MD - PEDIATRICS
4 MD - OB/GYN
5 MD-SURGERY
6 MD - OTHER
7 CHIROPRACTOR
8 NURSE/NURSE PRACTITIONER
9 PHYSICIAN'S ASSISTANT
10 OTHER NON-MD PROVIDER
11 UNKNOWN

Note that the value 6 MD-OTHER includes doctors of osteopathy, as well as a small number of medical doctors whose specialty is unknown.

TYPEPLC2 was constructed from responses to Access to Care items AC06 and AC07 and describes the type of place corresponding to the usual source of care provider with the following values:

1 HOSPITAL CLINIC OR OUTPATIENT DEPARTMENT
2 PRIVATE OFFICE IN HOSPITAL
3 HOSPITAL EMERGENCY ROOM
4 NON-HOSPITAL PLACE

TYPEPLC2 was only constructed for cases with provider type indicated as facility or person in facility provider (records with PROVTYX2=2 (PERSON) have a value of -1 for TYPEPLC2).

LOCATIO2 was constructed from the variables PROVTYX2 and TYPEPLC2, and describes the location of the provider as either office based or hospital based, and if hospital based, as either emergency room or non-emergency room. LOCATIO2 has the following values:

1 OFFICE
2 HOSPITAL, NOT EMERGENCY ROOM
3 HOSPITAL EMERGENCY ROOM

Note that all cases with PROVTYX2=2 (PERSON) have LOCATIO2 = 1 (OFFICE).

These 4 variables in combination describe the usual source of care provider. For example, a group practice or clinic with no particular person named is coded as:

PROVTYX2 = 1 FACILITY, LOCATIO2 = 1 OFFICE and TYPEPER2 = -1 INAPPLICABLE.

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For Access to Care items AC03, AC04, AC08, AC09, AC21 and AC23, the other specify text responses were reviewed and coded as an existing or new value for the related categorical variable (for AC03, AC08, AC21 and AC23), or coded as an existing or new "yes/no" variable (for items AC04 and AC09). The following are the new codes or variables which were created from these other specify text responses.

for item AC03 - this new value was constructed for the variable YNOUSC2:

10 OTHER INSURANCE RELATED REASON

for item AC04 - the new variable OTHINSR2 was constructed for insurance-related reasons

for item AC08 - these new values were constructed for the variable YGOTOUS2:

8 MILITARY/VA
10 INSURANCE RELATED REASON

for item AC09 - the new variable INSREAS2 was constructed for insurance-related reasons

for item AC21 - these new values were constructed for the variable YCHNGUS2:

8 COST-RELATED REASON
9 OTHER INSURANCE-RELATED REASON
11 NEW DOCTOR WAS REFERRED OR RECOMMENDED
12 OTHER COMPLAINTS ABOUT OLD DOCTOR

for item AC23 - these new values were constructed for the variable YNOMORE2:

8 COST-RELATED REASON
9 SELDOM OR NEVER SICK/NO NEED FOR DOCTOR
10 OTHER INSURANCE-RELATED REASON

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Eligibility for each series of questions is determined by summary variables coded as either “1" (eligible for series) or “0" (ineligible for series). These summary variables are based on age and responses to selected questions in the health status section of the household questionnaire. The nine sections of the LTC questionnaire and associated summary variables are shown below:

Based on the identifiers of eligibility, logical editing was performed on variables in the LTC supplemental questionnaire. Editing was fairly minor. It mainly consisted of editing responses to conform to questionnaire skip patterns and consistency with the eligibility variables.

Several caveats should be noted when using this file:

• Individuals who were not in the second round of 1997 (Round 4 of Panel 1 and Round 2 of Panel 2) are not represented in this file. For example, a person who was eligible for the LTC supplement but died before it was fielded would not be represented in these data. As a consequence, the data can only be generalized to individuals who were in the survey at the time that the LTC questionnaire was asked.

• A small number of individuals who only had social limitations, but not other limitations or impairments, did not receive the questions in the LTC supplement that they were supposed to receive. These individuals can be identified as having SOCONLY=1.

• Analysts interested in studying communication, work accommodations, community services, and use of assisted technology will notice that some of the individual variables have low usual source of health care levels (e.g., SERVSCTX). Use of these measures will require analysts to aggregate the individual items into summary variables.

• All medical conditions (three-digit ICD-9 codes) associated with long term care problems and limitations of persons in the LTC supplement have been added to the LTC file. The medical conditions were abstracted from 1996 and 1997 Medical Conditions files. More information on these conditions can be obtained by using the encrypted condition code IDs (CONDIX1-22) to link to the MEPS Medical Conditions files. (See Attachment 1: Sample SAS Program for Merging the LTC File with the Condition File.)

• There are two situations in which persons on the LTC file might have information in the Medical Conditions files even though their encrypted condition code IDs (CONDIX1-22) have a value of minus 1. The first situation applies to persons who did not reply to the LTC supplement, or who did reply but no conditions were linked to the Medical Conditions files as a result. The second situation applies to persons on the file who did reply to the LTC supplement and had one or more conditions linking to the Medical Conditions files. Persons in either of these situations may have conditions in the Medical Conditions file(s) that are unrelated to their LTC limitations.
 

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The variables ALTCAR97 through REFRMD97 contain data from the Alternative Care section of the HC questionnaire, which was administered in Panel 2 Round 3 of the MEPS HC. An initial screening question (ALTCAR97) asked if each person had received alternative or complementary care. Specifically, respondents were shown a card listing different types of alternative care and were asked if that person, during calendar year 1997, had for health reasons consulted someone who provided these types of treatments. If the response was "yes," the respondent was asked to specify which of the treatments on the list had been received. Multiple types of service used by one person were possible. Respondents could also specify that some other treatment, not explicitly included on the list, had been received. This file contains a variable indicating that a respondent used a type of alternative treatment other than that specified on the list; the file does not contain any further information regarding the nature of this "other" alternative treatment.

The list included the following types of alternative treatments:

acupuncture (ACUPNC97)
nutritional advice or lifestyle diets (NUTRIT97)
massage therapy (MASAGE97)
herbal remedies purchased (HERBAL97)
bio-feedback training (BIOFDB97)
training or practice of meditation, imagery, or relaxation techniques (MEDITA97)
homeopathic treatment (HOMEO97)
spiritual healing or prayer (SPIRTL97)
hypnosis (HYPNO97)
traditional medicine, such as Chinese, Ayurvedic, American Indian, etc. (TRADIT97)
other treatment (ALTOTH97)

If a person was reported not to have used any alternative treatment during 1997 (i.e., ALTCAR97 = 2, "no"), or if the respondent refused to answer ALTCAR97, or didn’t know the answer, or if data for this question were otherwise missing, then each variable representing a type of alternative treatment received a code of -1 ("inapplicable"). If the person had received some type of alternative care (i.e., ALTCAR97 =1, "yes"), then each variable representing a type of alternative treatment received a code of 1 ("yes") if specified or a code of 2 ("no") if not specified.

Those persons who had indicated receipt of alternative care were next asked to specify the type of alternative care practitioner used. Response options included the following:

massage therapist (MASTHE97)
acupuncturist (ACPTHE97)
physician (MDTRT97)
nurse (NURTRT97)
homeopathic or naturopathic doctor (HOMEMD97)
chiropractor (CHIRO97)
clergy, spiritualist, or channeler (CLERGY97)
herbalist (HERBTR97)
other (OTHALT97)

One person could specify multiple types of practitioners. If a person was reported not to have used any alternative treatment during 1997 (i.e., ALTCAR97 = 2, "no"), or if the respondent refused to answer ALTCAR97, or didn’t know the answer, or if data for this question were otherwise missing, then each variable representing a type of alternative practitioner received a code of -1 ("inapplicable"). If the person had received some type of alternative care (i.e., ALTCAR97 = 1, "yes"), then each variable representing a type of alternative practitioner received a code of 1 ("yes") if specified or a code of 2 ("no") if not specified.

Those persons who indicated receipt of alternative care were asked whether the use of complementary or alternative care was ever discussed with the person’s regular doctor (DSCALT97), whether the person was ever referred for alternative care by a physician or other medical provider (REFRMD97), and whether the person consulted the alternative physical or complementary care practitioner(s) for a specific physical or mental health problem (ALTCSP97). As with the other alternative care variables, responses to these questions received a code of -1 ("inapplicable") if a person was reported not to have used any alternative treatment during 1997 (i.e., ALTCAR97 = 2, "no"), or if the respondent refused to answer ALTCAR97, or didn’t know the answer, or if data for this question were otherwise missing.

For each person who used alternative care, respondents were asked approximately how many times in 1997 the person actually visited these types of practitioners (ALTCVS97). Respondents provided an estimated number of visits. Respondents who did not know the number of visits were asked to provide a range of visits (e.g., one time, 2-4 times, etc.); ALTCVE97 reflects their responses to this question. As with the other alternative care variables, responses to these questions received a code of -1 ("inapplicable") if a person was reported not to have used any alternative treatment during 1997 (i.e., ALTCAR97 = 2, "no"), or if the respondent refused to answer ALTCAR97, or didn’t know the answer, or if data for this question were otherwise missing.

For each person who indicated receipt of alternative care, respondents were asked to provide an estimate of the total amount spent by the person or family for alternative care in 1997 (ALTCRE97). For confidentiality reasons, when necessary, ALTCRE97 was top-coded at $20,000. Respondents who did not know the total amount spent were then asked to provide a range of the amount spent (e.g., $1 - $100, $101 - $500, etc.); the response to this question is reflected in the variable ALTCRX97. If the person was reported not to have received any alternative care during 1997 (i.e., ALTCAR97 = 2, "no"), or if the respondent refused to answer ALTCAR97, or did not know the answer, or if data for this question were otherwise missing, then these variables received a code of –1 ("inapplicable").

Those respondents who indicated receipt of alternative care were asked whether the person’s health insurance paid for any of the alternative care (INSALT97). Respondents who indicated that health insurance did pay for any of the person’s alternative care were asked to provide their best estimate of the percent paid by insurance (PERINS97). As with the other alternative care variables, responses to these questions received a code of -1 ("inapplicable") if a person was reported not to have used any alternative treatment during 1997 (i.e., ALTCAR97 = 2, "no"), or if the respondent refused to answer ALTCAR97, or didn’t know the answer, or if data for this question were otherwise missing.

For those persons who received alternative care, respondents were asked to provide an estimate of the total amount spent by the person or family on the products or remedies associated with the alternative care (PRALTX97). For confidentiality reasons, when necessary, PRALTX97 was top-coded at $3,000. Respondents who did not know the total amount spent on such products were asked to provide a range of the amount spent (i.e., $1 - $50, $51 - $100. etc.) This range is reflected in the variable PRALTE97. As with the other alternative care variables, responses to these questions received a code of -1 ("inapplicable") if a person was reported not to have used any alternative treatment during 1997 (i.e., ALTCAR97 = 2, "no"), or if the respondent refused to answer ALTCAR97, or didn’t know the answer, or if data for this question were otherwise missing.
 

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The variables DENTCK97 through MAMGRM97 contain data from the Preventive Care section of the HC questionnaire, which was administered in Panel 2 Round 3 of the MEPS HC. For each person, excluding decedents, a series of questions asked primarily about receipt of preventive care or screening examinations. Questions varied in the applicable age or gender subgroups to which they pertained. The list of variables in this series, along with their applicable subgroup, is as follows:

DENTCK97 frequency of dental check-ups
All ages and both genders

BLDPCK97 time since last having blood pressure taken by a doctor, nurse, or other health professional
Age > 17; both genders

CHOLCK97 time since last checking cholesterol level
Age > 17; both genders

PHYSCL97 time since last complete physical
Age > 17; both genders

FLUSHT97 time since last flu shot
Age > 17; both genders

WRDENT97 does person wear dentures
Age > 34; both genders

LOSTEE97 has person lost all adult teeth
Age > 34; both genders

PROSEX97 time since last prostate exam
Age > 17; male only

PAPSMR97 time since last pap smear test
Age > 17; female only

BRSTEX97 time since last breast exam
Age > 17; female only

MAMGRM97 time since last mammogram
Age > 39; female only

For each of the above variables, a code of -1 ("inapplicable") was assigned if the person was deceased, or if the person did not belong to the applicable age or gender subgroups.

Note: For Panel 1 Round 5 Alternative Care and Preventive data was not collected. These records set to -1 (n = 20,868). In subsequent years, Alternative/Preventive Care was asked in Rounds 3 and 5 within the reference year. The 1997 Alternative and Preventive Care variables cannot be used to make full-year estimates, but may be useful for trend analysis.
 

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A series of three questions (HE25A to HE25C) provides information on child care arrangements. These questions were only asked in Round 5 (Panel 1). These questions were asked only if the household contained children 15 years of age or younger. DAYCAR97 indicates whether any children in the household required child care arrangements, other than school attendance, because the child’s parents were working. If the response to DAYCAR97 was no (2), or refused (-7) or don’t know (-8), the other two questions in this set were not asked. If DAYCAR97 was yes (1), then WHOCAR97 was asked to determine whether the child was usually cared for by a relative or a non-relative. If the respondent answered relative (1) or refused (-7) or don’t know (-8) to WHOCAR97, then the third question was not asked. However, if the respondent answered non-relative (2), WHRCAR97 was asked to determine where the care was usually provided. Possible responses to WHRCAR97 were: child’s home (1); other private home (2); nursery, pre-school (3); organized (before/after) school activities (4); day care center, not at parent’s work place (5); day care center, at parent’s work place (6); parent watches child at work (7); some other arrangement (91); refused (-7); and don’t know (-8). (If multiple children in a household were under 16 years old, WHOCAR97 and WHRCAR97 were asked about the youngest child.)
To reflect skip patterns, WHOCAR97 and WHRCAR97 were coded "not applicable" (-1) if the response to DAYCAR97 was no (2), refused (-7), or don’t know (-8). Responses to WHRCAR97 were coded –1 if the response to WHOCAR97 was relative (1), refused (-7), or don’t know (-8). Responses to all three questions were coded –1 if there was no child under age 16 in the household.

Note: Child Care arrangement variables are only available for Panel 1. They cannot be used to make full-year estimates, but may be useful in longitudinal analysis of Panel 1 data.
 

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This file contains a variable describing an outpatient event reported by respondents in the Outpatient Department section of the MEPS Household questionnaire. The following variable, which was inadvertently omitted from the original 1997 Outpatient Department Visit file, is provided as unedited: see (HC-016F) for complete documentation.

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When a person reported having had a visit, it was reported whether the person actually saw the provider in person or talked to the provider on the telephone (SEETLKPV).

The Caregiver (CG) supplement was designed with two main goals. For all individuals in MEPS with certain limitations, information was collected on: 1) care provided by other household members; and 2) individuals (outside of the household) who could potentially provide assistance.

The CG supplement was administered in Round 4 (Panel 1) and Round 2 (Panel 2) Individuals were eligible for the CG supplement if they met one of the following conditions:

• had activities of daily living (ADL) limitations in the current round or a previous round;

• had instrumental activities of daily living (IADL) limitations in the current round or a previous round;

• had cognitive limitations in the current round or a previous round;

• was a child aged 4 or younger with activity limitations in the current round or a previous round;

• was a child with school attendance limitations in the current round or a previous round;
or

• had a home health event in the current round.

Individuals who met one of the conditions above were eligible for the CG supplement (CGELIG=1).

For individuals who were eligible for the CG supplement, a series of questions were asked about care provided by other household members (if there were other persons in the household), including the type of care, the length of time that care has been provided and the amount of extra time the household member provided to the person.

For each person eligible for the CG supplement, additional information was collected on the potential caregivers that the person could rely on for help (a potential caregiver may not actually provide care). For each of the potential caregivers, detailed information was collected on the characteristics of these individuals (including age, marital status, sex, education, number of children, number of children under age six, health status, distance from the MEPS person, employment status and occupation, wife’s employment status for married men, whether care was actually provided, the type of care provided, the frequency of care, and the length of a typical visit).

The set of potential caregivers for whom detailed information was collected was determined by the age of the MEPS person.

• For MEPS persons ages 50 and older who were eligible for the CG supplement, potential caregivers include the person’s children ages 18 or older.

• For MEPS persons ages 35-49 who were eligible for the CG supplement, potential caregivers include children ages 18 and older, brothers and sisters ages 18 and over, and parents.

• For MEPS persons under age 35 who were eligible for the CG supplement, potential caregivers included brothers and sisters ages 18 and older and parents.

Although detailed information was not collected on other potential caregivers, several additional questions were asked to determine whether there were other potential caregivers. For eligible persons ages 50 or older, additional information was collected on whether the person had living brothers, sisters and parents. For persons less than 50 years old, information was collected to determine whether the individual had living parents and living parents-in-law. Finally, for eligible persons ages 35 or younger, information was collected to determine whether the person had living grandparents.
 

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The following ID and indicator variables are provided on the file:

• DUID, PID and DUPERSID: These contain the dwelling unit, person number and person ID number, respectively, of the MEPS person represented on the file. There is a total of 34,162 persons (i.e., unique values of DUPERSID) represented on the file.

• CGVRIDX: This contains the caregiver record ID. There is one record on the file for each unique combination of MEPS person (DUPERSID) and potential caregiver (CGVRIDX).

• CGDUPERS: This contains the DUPERSID of the potential caregiver, if the potential caregiver was part of the MEPS household.

• CGCOUNT: This indicates the total number of potential caregivers on the file for the MEPS person (i.e., the person identified by DUPERSID).
  
   

The unit of analysis of the CG file is the MEPS person-potential caregiver. For example, a person ineligible for the CG supplement will have one record on the file (with CGCOUNT=0 and containing no potential caregiver information), while a person with three potential caregivers will have three records on the file (and each record will have CGCOUNT=3 and will contain information about a different potential caregiver). Note that on records with CGCOUNT=0, the variables CGVRIDX and CGDUPERS have a value of -1 (Inapplicable).
 

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The structure of the CG file allows analysts to link these data to other 1997 MEPS files. Additional information on the individuals who are eligible for the CG supplement can be obtained by linking the file by DUPERSID (e.g., if an analyst were interested in the health conditions of the CG supplement-eligible person, they could link to HC-018).

For persons identified as potential caregivers who were also part of the MEPS, additional information can be obtained on these individuals using the variable CGDUPERS, which is the DUPERSID of the potential caregiver.
 

Other Information

• The CG supplement was only administered for eligible persons who were present in Round 4 (Panel 1) and Round 2 (Panel 2). Individuals who were deceased or no longer part of MEPS prior to the interview are not represented in this file.

• For individuals less than 50 years old who lived with parents (PARELSEX=95), parents were added as potential caregivers in the file, if they were not active caregivers. No other household members, however, were added as potential caregivers if they did not provide care. To link other household members to the file (if an analyst wants to consider other household members as potential caregivers) requires the analyst to link to the other household members using the dwelling unit identifier (the variable DUID).

• Information on potential caregivers who were part of the MEPS household (CGDUPERS>0) were merged into the CG file to complement the data collected for other potential caregivers through the CG supplement so that similar information was available for all caregivers. One exception was occupation since occupation was coded differently in the original CG supplement and within MEPS. Analysts interested in this variable will need to develop a common coding scheme for potential caregivers who are part of MEPS and those potential caregivers who were added as part of the caregiver supplement.

• A small number of cases with CGELIG=0 had valid caregiver ID information, indicating that these individuals responded to the CG supplement without meeting the conditions described above for eligibility. Analysts will need to make a decision about the appropriate way to treat these cases for their research.

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File 1:

SURVEY ADMINISTRATION VARIABLES

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