TABLE OF  CONTENTS

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 Contents
2.5.1 Long Term Care (LTC) Variables (PANELRN - NUM_COND)
D. Variable-Source Crosswalk
Attachment 1

A. Data Use Agreement

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:

1. No one is to use the data in this data set in any way except for statistical reporting and analysis; and

2.  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

3. No one will attempt to link this data set with individually identifiable records from any data sets other than the Medical Expenditure Panel Survey or the National Health Interview Survey.

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

The Medical Expenditure Panel Survey (MEPS) provides 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) and the National Center for Health Statistics (NCHS).

 MEPS is a family of three surveys.  The Household Component (HC) is the core survey and forms the basis for the Medical Provider Component (MPC) and part of the Insurance Component (IC). 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 and the National Medical Expenditure Survey (NMES-2) in 1987.  Since 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 advance these goals, MEPS includes linkage with the National Health Interview Survey (NHIS) - a survey conducted by NCHS from which the sample for the MEPS HC is drawn - and enhanced 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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The MEPS HC, a nationally representative survey of the U.S. civilian non-institutionalized population, collects medical expenditure data at both the person and household levels. The HC collects detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment.

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

The sampling frame for the MEPS HC is drawn from respondents to NHIS.  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 subsampled 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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3.0 Insurance Component

The MEPS IC collects data on health insurance plans obtained through private and public-sector employers.  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 three 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.

To provide an integrated picture of health insurance, data collected from the first sampling frame (employers and insurance providers identified by MEPS HC respondents) are linked back to data provided by those respondents.  Data from the two Census Bureau sampling frames are used to produce annual national and state estimates of the supply and cost of private health insurance available to American workers and to evaluate policy issues pertaining to health insurance.  National estimates of employer contributions to group insurance from the MEPS IC are used in the computation of Gross Domestic Product (GDP) by the Bureau of Economic Analysis.

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 follow-up for nonrespondents.

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4.0 Survey Management

MEPS data are collected under the authority of the Public Health Service Act. They are edited and published in accordance with the confidentiality provisions of this act and the Privacy Act. NCHS provides consultation and technical assistance.

As soon as data collection and editing are completed, the MEPS survey data are released to the public in staged releases of summary reports, microdata files and compendiums of tables.  Data are released through MEPSnet, an online interactive tool developed to give users the ability to statistically analyze MEPS data in real time.  Summary reports and compendiums of tables are released as printed documents and electronic files. Microdata files are released on electronic files.

Selected printed documents 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 you are requesting.

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

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C. Technical and Programming Information

1.0 General Information

This documentation describes a series of MEPS variables that were obtained for calendar year 1998. This data release is intended to supplement the MEPS variables previously released for 1998. In order to use these variables, researchers will need to link them to the 1998 Consolidated Full-Year Use and Expenditure File (HC-028) which contains all previously released 1998 person level data including demographic and socio-economic information. Please refer to the HC-028 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 file, and programming information. It contains the following sections:

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

A codebook of all the variables included in this 1998 Long Term Care Supplemental File is provided in a separate file (H49CB.PDF).

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.

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2.0 Data File Information

This 1998 long term care supplemental variable public use data set consists of one person-level file.  Unweighted frequencies are provided for each variable on the files. In conjunction with the weight variable (WTDPER98) provided on MEPS HC-028: 1998 Full Year Consolidated Data File, data for these persons can be used to make estimates for the civilian non-institutionalized U. S. population for 1998. The records on this data release can be linked to all other 1998 MEPS-HC public use data files by using the sample person identifier (DUPERSID). Panel 2 cases (Panel 98=2) can be linked back to the 1997 MEPS-HC public use data files. A longitudinal weight to facilitate Panel 2, 1997-98 analysis can be found on HC-035.

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2.1 Codebook Structure

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

• Long Term Care variables

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2.2 Reserved Codes

The following reserved code values are used:

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2.3 Codebook Format

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

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2.4 Variable Naming

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 2 and Round 1, 2, or 3 of Panel 3. Unless otherwise noted, variables that end in 98 represent status as of December 31, 1998.

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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2.5 File Contents

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

The MEPS LTC supplemental questionnaire is used to collect detailed information on individuals who have activity or functional limitations, hearing or vision impairments, and special equipment requirements.  It includes persons in the second round of the 1998 survey (Round 4 of Panel 2 and Round 2 of Panel 3) who were flagged for one or more sections of the LTC supplement based on their responses to screener questions in the health status section of the household survey questionnaire.  The health status flags could have been set in Round 3 or 4 for Panel 2, and in Round 1 or 2 for Panel 3. 

The LTC supplement consists of nine series of questions about functional limitations and the use of special equipment.  Each series of questions and the associated question numbers in the LTC supplement are shown below for persons who were eligible for some or all questions in a specific series:

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 1998 (Round 4 of Panel 2 and Round 2 of Panel 3) 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 1997 and 1998 Medical Conditions files.  More information on these conditions can be obtained by using the encrypted condition code IDs (CONDIX1-17) to link to the MEPS Medical Conditions files.  (See Attachment A: SAS Job for linking the LTC file with the Conditions file Example.)  

• 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 (CONDIX1-17) 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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D Variable-Source Crosswalk

LONG TERM CARE (LTC) VARIABLES

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Sample SAS Codes for Merging the LTC file with the Condition file Example - 1998

/* Sort the person-condition level file CONDIDS by CONDIDX */
PROC SORT DATA=CONDIDS;
  BY CONDIDX;
RUN; 

/* Sort the condition file COND by CONDIDX */
PROC SORT DATA=COND (KEEP=CONDIDX CCCODEX) OUT=CONDS;
  BY CONDIDX;
RUN;

/* Merge the CCCODEX codes from the condition file to the person-condition level LTC file */
DATA CONDITION (DROP=CONDIDX);
  MERGE CONDIDS (IN=A) CONDS;
  BY CONDIDX;
  IF A;
RUN;

/* Convert the person-condition level LTC file containing the CCCODEX codes of persons with valid condition IDs back to a person level file and merge it back to the original person level LTC file */
PROC SORT DATA=CONDITION;
  BY DUPERSID;
RUN; 

DATA CONVET (KEEP=DUPERSID CCCODEX1-CCCODEX17);
  SET CONDITION;
  BY DUPERSID;
  ARRAY CCCODEXS(17) $3 CCCODEX1-CCCODEX17;
  RETAIN CCCODEX1-CCCODEX17;
  IF FIRST.DUPERSID THEN
  DO;
    J = 0;
    DO I = 1 TO 17;
      CCCODEXS(I) = ' ';
    END;
  END;
  J + 1;
  CCCODEXS(J) = CCCODEX;
  IF LAST.DUPERSID;
RUN;

PROC SORT DATA=INOUT.LTC17X OUT=LTC17X;
  BY DUPERSID;
RUN;

DATA INOUT.LTC18X;
  MERGE LTC17X (IN=A) CONVET;
  BY DUPERSID;
IF A;
RUN;

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