STATISTICAL BRIEF #549:
Healthcare Use and Expenditures for COVID-19, U.S. Civilian Noninstitutionalized Population, 2020

Introduction

Findings

Overall (figure 1 and table 1)

Table 1. Healthcare use and expenditures among people with any COVID-19 treatment, by event type, 2020

^* An ambulatory visit is an office-based medical visit or hospital outpatient department visit
^** ER visits resulting in hospital admission are included in estimates for the corresponding inpatient stay.

Note that while overall treated prevalence for COVID-19 includes people with home health visits and prescribed medicine purchases, we do not report estimates for these event types for the following reasons:

• The number of people with home health visits for COVID-19 was too small to produce reliable estimates for these events.
• MEPS collects information only on retail prescribed medicines and does not collect information on drugs administered during a hospital stay or medical visit. In 2020, there were limited options available for treating COVID-19 with prescribed medicines, and most medicines used to treat COVID-19 were administered in a healthcare setting. Because MEPS excludes medicines administered in a healthcare setting, estimates for prescribed medicine treatment of COVID-19 are not separately presented in this Brief.

Age groups (figure 2 and tables 2a,b)

Table 2a. Treated prevalence for COVID-19, by age group, 2020

Table 2b. Healthcare use and expenditures among people with any COVID-19 treatment, by age group, 2020

* Relative standard error is greater than 30%, indicating higher uncertainty around the accuracy of this estimate.

Insurance coverage (figure 3 and tables 3a,b)

Table 3a. Treated prevalence for COVID-19, by insurance coverage status and age, 2020

* Persons age 65+ who reported no Medicare are excluded from the insurance coverage by age categories due to small sample size.

Table 3b. Healthcare use and expenditures among people with any COVID-19 treatment, by insurance coverage status and age, 2020

* Relative standard error is greater than 30%, indicating higher uncertainty around the accuracy of this estimate.
** Persons age 65+ who reported no Medicare are excluded from the insurance coverage by age categories due to small sample size. In addition, the number of people with treatment for COVID-19 who were uninsured or ages 65+ with Medicare and other public insurance was too small to present reliable estimates for these groups.

Income (figure 4 and tables 4a,b)

Table 4a. Treated prevalence for COVID-19, by income level, 2020

Table 4b. Healthcare use and expenditures among people with any COVID-19 treatment, by income level, 2020

* Relative standard error is greater than 30%, indicating higher uncertainty around the accuracy of this estimate.

Race/ethnicity (figure 5 and tables 5a,b)

Table 5a. Treated prevalence for COVID-19, by race/ethnicity, 2020

Table 5b. Healthcare use and expenditures among people with any COVID-19 treatment, by race/ethnicity, 2020

* Relative standard error is greater than 30%, indicating higher uncertainty around the accuracy of this estimate.
** The numbers of Asian, non-Hispanic and other non-Hispanic or multiple races with treatment for COVID-19 were too small to present reliable estimates for these groups.

Region (figure 6 and tables 6a,b)

Table 6a. Treated prevalence for COVID-19, by region, 2020

Table 6b. Healthcare use and expenditures among people with any COVID-19 treatment, by region, 2020

* Relative standard error is greater than 30%, indicating higher uncertainty around the accuracy of this estimate.

Urbanicity (figure 7 and tables 7a,b)

Table 7a. Treated prevalence for COVID-19, by urbanicity, 2020

Table 7b. Healthcare use and expenditures among people with any COVID-19 treatment, by urbanicity, 2020

Data Source

The estimates reported in this Brief are based on data from the following MEPS data files:

• 2020 Full-Year Consolidated Public Use File (HC-224)
• 2020 Medical Conditions Public Use File (HC-222)
• 2020 Office-Based Medical Provider Visits Public Use File (HC-220G)
• 2020 Outpatient Visits Public Use File (HC-220F)
• 2020 Hospital Inpatient Stays Public Use File (HC-220D)
• 2020 Emergency Room Visits Public Use File (HC-220E)
• 2020 Prescribed Medicines Public Use File (HC-220A)
• 2020 Home Health Public Use File (HC-220H)
• 2020 Condition-Event Link (CLNK) Public Use File (HC-220I File 1)
• 2020 MEPS internal data file with MSA variables

Definitions

Age

Age is defined as age at the end of the year 2020 (or on last date of MEPS eligibility if person was out of scope at the end of the year).

COVID-19

A person in the MEPS sample is defined as having treatment for COVID-19 if the household respondent reports one or more healthcare events (i.e., office-based, hospital outpatient or ER visits, hospital inpatient stays, prescribed medicine purchases, or home healthcare) where the respondent reported that COVID-19 led to or was discovered during the event. COVID-19 conditions can be identified on the MEPS Medical Conditions Public Use Files with an International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code starting with "U07" (ICD10CDX = "U07").

Event type

• Ambulatory: Includes office-based visits (visits to medical providers seen in office settings) and hospital outpatient visits, including both in-person and telehealth visits. In the fall of 2020, a module was added to the MEPS instrument to explicitly collect telehealth information. Prior to this addition, interviewers had been trained to collect data on telehealth visits; however, it is unclear to what extent these visits may have been underreported, particularly in the round of data collection occurring during the spring of 2020. Expenses for outpatient visits include payments for services covered under the basic facility charge and those for separately billed physician services.
• ER visit: Includes treat-and-release ER visits. Treat-and-release ER visits include payments for services covered under the hospital facility charge as well as those for separately billed physician services. Expenses for ER visits resulting in hospital admission are included in the corresponding hospital inpatient stay.
• Hospital inpatient: Includes room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, payments for separately billed physician inpatient services, and emergency room expenses incurred immediately prior to inpatient stays.

Expenditures

Total expenditures are defined as the sum of payments from all sources to hospitals, physicians, other healthcare providers, and pharmacies for services reported by respondents in the Medical Expenditure Panel Survey Household Component (MEPS-HC).

Income

Three income groups are defined based on the percentage of the poverty line for total family income, adjusted for family size and composition. We use three categories:

• Poor or near-poor: People in families with income up to 125 percent of the poverty line.
• Low income: People in families with income over 125 percent through 200 percent of the poverty line.
• Middle or high income: People in families with income over 200 percent of the poverty line.

Insurance coverage

• Any private health insurance: Individuals who, at any time during the year, had insurance that provides coverage for hospital and physician care (other than Medicare, Medicaid/Children's Health Insurance Program [CHIP], or other public hospital/physician coverage) were classified as having private insurance. Coverage by TRICARE (Armed Forces-related coverage) was also included as private health insurance. Insurance that provides coverage for a single service only, such as dental or vision coverage, was not included.
• Public coverage only: Individuals were considered to have public coverage only if they met both of the following criteria: 1) they were not covered by private insurance at any time during the year, and 2) they were covered by any of the following public programs at any point during the year: Medicare, Medicaid/CHIP, or other public hospital/physician coverage.
• Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, Medicare, TRICARE, Medicaid/CHIP, or other public hospital/physician programs at any time during the entire year or period of eligibility for the survey.

Insurance coverage by age

• < 65, Any private: People who were under age 65 and reported any private insurance coverage during the year (see "Any private health insurance" above).
• < 65, Public only: People who were under age 65 and reported only public coverage during the year (see "Public coverage only" above).
• < 65, Uninsured: People who were under age 65 and uninsured the entire year (see "Uninsured" above).
• 65+, Medicare only: People ages 65 or older and covered only by Medicare during the year.
• 65+, Medicare and private: People ages 65 or older covered by Medicare as well as private insurance during the year.
• 65+, Medicare and other public only: People ages 65 and older covered by Medicare as well as another public insurance (e.g., Medicaid) who were not covered by private insurance.
• 65+, no Medicare: People ages 65 and older who were not covered by Medicare at any time during the year. This group includes people who were uninsured as well as those who were not covered by Medicare but were covered by private insurance, Medicaid, TRICARE/Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), Veteran's Administration, or other public coverage during the year. The sample size of this group was too small to support making a separate estimate in this Brief.

Race/ethnicity

MEPS respondents were asked if each family member was Hispanic or Latino and about each member's race. Based on this information, categories of race and Hispanic origin were constructed as follows:

• Hispanic
• White, non-Hispanic (no other races reported)
• Black, non-Hispanic (no other races reported)
• Asian, non-Hispanic (no other races reported)
• Other/multiple races, non-Hispanic

Region

Each sample person was classified as living in one of the following four regions as defined by the U.S. Bureau of the Census:

• Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont
• Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin
• South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia
• West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming

Urbanicity

About MEPS

References

1. Centers for Disease Control and Prevention. COVID data tracker. Accessed March 14, 2023. https://covid.cdc.gov/covid-data-tracker
2. Johns Hopkins University Center for Systems Science and Engineering. GitHub repository. Accessed March 24, 2023. https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data
3. Karmakar M, Lantz PM, Tipirneni R. Association of social and demographic factors with COVID-19 incidence and death rates in the US. JAMA Network Open. 2021;4(1):e2036462. doi:10.1001/jamanetworkopen.2020.36462
4. Lopez L, Hart LH, Katz MH. Racial and ethnic health disparities related to COVID-19. JAMA. 2021;325(8):719-720. doi:10.1001/jama.2020.26443
5. Zuvekas SH, Kashihara D. The impacts of the COVID-19 pandemic on the Medical Expenditure Panel Survey. Am J Public Health. 2021;111(12):2157-2166.

The following methodology reports contain information on the survey and sample designs for the MEPS-HC and MEPS-Medical Provider Component (MEPS-MPC). Data collected in these two components are jointly used to derive MEPS healthcare expenditure data.

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS Methodology Report #1. AHCPR Pub. No. 97-0026. July 1997. Agency for Health Care Policy and Research (AHCPR), Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr1/mr1.pdf

Ezzati-Rice, T. M., Rohde, F., and Greenblatt, J. Sample Design of the Medical Expenditure Panel Survey Household Component, 1998-2007. Methodology Report #22. March 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr22/mr22.pdf

Machlin, S. R., Chowdhury, S. R., Ezzati-Rice, T., DiGaetano, R., Goksel, H., Wun, L.-M., Yu, W., and Kashihara, D. Estimation Procedures for the Medical Expenditure Panel Survey Household Component. Methodology Report #24. September 2010. Agency for Healthcare Research and Quality, Rockville, MD. https://www.meps.ahrq.gov/data_files/publications/mr24/mr24.shtml

Stagnitti, M. N., Beauregard, K., and Solis, A. Design, Methods, and Field Results of the Medical Expenditure Panel Survey Medical Provider Component (MEPS MPC)—2006 Calendar Year Data. Methodology Report #23. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr23/mr23.pdf

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