MEPS HC-005:
1997 P1R3/P2R1
Population Characteristics
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406
Table Of Contents
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Insurance Component
4.0 Nursing Home Component
5.0 Survey Management
C. Technical and Programming Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Naming
2.5 File Contents
2.5.1 Survey Administration Variables
2.5.2 Demographic Variables
2.5.3 Health Status Variables
2.5.4 Employment Variables
2.5.5 Health Insurance Variables
3.0 Survey Sample Information
3.1 Sample Design and Response Rates
3.1.1 Panel 1
3.1.2 Panel 2
3.1.3 Combined Panel Response
3.2 Sample Weights
3.2.1 Person Level Weight
3.2.2 Family Level Weight
3.2.2.1 Definition of MEPS Families
3.2.2.2 Assignment of Weights
3.2.2.3 Instructions to Create Family Estimates
3.2.3 Relationship Between Person and Family Level Weights
3.3 Variance Estimation
D. Codebook
(link to separate file)
E. Variable-Source Crosswalk
F. Catalog of Medical Expenditure Panel Survey Products
G. Appendices
1. Household Survey Sample Design Report
2. Household Survey Design and Methods Report
A. Data Use Agreement
Individual identifiers have been removed from the micro-data contained in the files on this
CD-ROM. Nevertheless, under sections 308 (d) and 903 (c) of the Public Health Service Act
(42 U.S.C. 242m and 42 U.S.C. 299 a-1), data collected by the Agency for Health Care Policy
and Research (AHCPR) and /or the National Center for Health Statistics (NCHS) may not be
used for any purpose other than for the purpose for which it was 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 AHCPR will be advised of this incident, (c) the information that
would identify any individual or establishment will be safeguarded or destroyed, as
requested by AHCPR, and (d) no one else will be informed of the discovered
identity.
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 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
18 U.S.C. 1001 and is punishable by a fine of up to $10,000 or up to 5 years in prison.
The Agency for Health Care Policy and Research requests that users cite AHCPR 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
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.
The Medical Expenditure Panel Survey (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 also includes a
nationally representative survey of nursing homes and their residents. MEPS is cosponsored
by the Agency for Health Care Policy and Research (AHCPR) and the National Center for
Health Statistics (NCHS).
MEPS comprises four component surveys: the Household Component (HC), the Medical
Provider Component (MPC), the Insurance Component (IC), and the Nursing Home
Component (NHC). The HC is the core survey, and it forms the basis for the MPC sample
and part of the IC sample. The separate NHC sample supplements the other MEPS
components. Together these surveys yield comprehensive data that provide national estimates
of the level and distribution of health care use and expenditures, support health services
research, and can be used to assess health care policy implications.
MEPS is the third in a series of national probability surveys conducted by AHCPR 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 1987. Beginning in 1996, MEPS continues this
series with design enhancements and efficiencies that provide a more current data resource to
capture the changing dynamics of the health care delivery and insurance system.
The design efficiencies incorporated into MEPS are in accordance with the Department of
Health and Human Services (DHHS) Survey Integration Plan of June 1995, which focused on
consolidating DHHS surveys, achieving cost efficiencies, reducing respondent burden, and
enhancing analytical capacities. To accommodate these goals, new MEPS design features
include linkage with the National Health Interview Survey (NHIS), from which the sampling
frame for the MEPS HC is drawn, and continuous longitudinal data collection for core survey
components. The MEPS HC augments NHIS by selecting a sample of NHIS respondents,
collecting additional data on their health care expenditures, and linking these data with
additional information collected from the respondents' medical providers, employers, and
insurance providers.
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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 2 ½-year period. Using
computer-assisted personal interviewing (CAPI) technology, data on medical expenditures and
use for 2 calendar years are collected from each household. This series of data collection
rounds is launched each subsequent year on a new sample of households to provide
overlapping panels of survey data and, when combined with other ongoing panels, will
provide continuous and current estimates of health care expenditures.
The sampling frame for the MEPS HC is drawn from respondents to NHIS, conducted by
NCHS. NHIS provides a nationally representative sample of the U.S. civilian non-institutionalized population, with oversampling of Hispanics and blacks.
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2.0 Medical Provider Component
The MEPS MPC supplements and validates information on medical care events reported in
the MEPS HC by contacting medical providers and pharmacies identified by household
respondents. The MPC sample includes all hospitals, hospital physicians, home health
agencies, and pharmacies reported in the HC. Also included in the MPC are all office-based
physicians:
- Providing care for HC respondents receiving Medicaid.
- Associated with a 75-percent sample of HC households receiving care through an
HMO (health maintenance organization) or managed care plan.
- Associated with a 25-percent sample of the remaining HC households.
Data are collected on medical and financial characteristics of medical and pharmacy events
reported by HC respondents, including:
- Diagnoses coded according to ICD-9-CM (9th Revision, International Classification of
Diseases) and DSM-IV (Fourth Edition, Diagnostic and Statistical Manual of Mental
Disorders).
- Physician procedure codes classified by CPT-4 (Common Procedure Terminology,
Version 4).
- Inpatient stay codes classified by DRGs (diagnosis-related groups).
- Prescriptions coded by national drug code (NDC), medication names, strength, and
quantity dispensed.
- Charges, payments, and the reasons for any difference between charges and payments.
The MPC is conducted through telephone interviews and mailed survey materials.
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3.0 Insurance Component
The MEPS IC collects data on health insurance plans obtained through employers, unions, and
other sources of private health insurance. Data obtained in the IC include the number and
types of private insurance plans offered, benefits associated with these plans, premiums,
contributions by employers and employees, eligibility requirements, and employer
characteristics.
Establishments participating in the MEPS IC are selected through four sampling frames:
- A list of employers or other insurance providers identified by MEPS HC respondents
who report having private health insurance at the Round 1 interview.
- A Bureau of the Census list frame of private sector business establishments.
- The Census of Governments from Bureau of the Census.
- An Internal Revenue Service list of the self-employed.
To provide an integrated picture of health insurance, data collected from the first sampling
frame (employers and insurance providers) are linked back to data provided by the MEPS HC
respondents. Data from the other three sampling frames are collected to provide annual
national and State estimates of the supply of private health insurance available to American
workers and to evaluate policy issues pertaining to health insurance.
The MEPS IC is an annual 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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4.0 Nursing Home Component
The 1996 MEPS NHC was a survey of nursing homes and persons residing in or admitted to
nursing homes at any time during calendar year 1996. The NHC gathered information on the
demographic characteristics, residence history, health and functional status, use of services,
use of prescription medications, and health care expenditures of nursing home residents.
Nursing home administrators and designated staff also provided information on facility size,
ownership, certification status, services provided, revenues and expenses, and other facility
characteristics. Data on the income, assets, family relationships, and care-giving services for
sampled nursing home residents were obtained from next-of-kin or other knowledgeable
persons in the community.
The 1996 MEPS NHC sample was selected using a two-stage stratified probability design. In
the first stage, facilities were selected; in the second stage, facility residents were sampled,
selecting both persons in residence on January 1, 1996, and those admitted during the period
January 1 through December 31.
The sample frame for facilities was derived from the National Health Provider Inventory,
which is updated periodically by NCHS. The MEPS NHC data were collected in person in
three rounds of data collection over a 1 ½-year period using the CAPI system. Community
data were collected by telephone using computer-assisted telephone interviewing (CATI)
technology. At the end of three rounds of data collection, the sample consists of
approximately 815 responding facilities, 3,100 residents in the facility on January 1, and 2,200
eligible residents admitted during 1996.
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5.0 Survey Management
MEPS data are collected under the authority of the Public Health Service Act. They are edited
and published in accordance with the confidentiality provisions of this act and the Privacy Act.
NCHS provides consultation and technical assistance.
As soon as data collection and editing are completed, the MEPS survey data are released to the
public in staged releases of summary reports and microdata files. Summary reports are
released as printed documents and electronic files. Microdata files are released on CD-ROM
and/or as electronic files. A catalog of all MEPS products released to date is provided in
Section F of this document.
Printed documents and CD-ROMs are available through the AHCPR Publications
Clearinghouse. Write or call:
AHCPR 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 AHCPR number of the document or CD-ROM you are requesting.
Selected electronic files are available from the Internet on the AHCPR home page: http://www.meps.ahcpr.gov/
Additional information on MEPS is available from the MEPS project manager or the MEPS
public use data manager at the Center for Cost and Financing Studies, Agency for Health Care
Policy and Research.
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C. Technical and Programming Information
1.0 General Information
This documentation describes the second point in time data file to be released from Medical
Panel Expenditure Survey Household Component (MEPS HC). The data are being released
both as an ASCII file (with related SAS programming statements) and in SAS transport
format. This public use file provides information on data collected on a nationally
representative sample of the civilian non-institutionalized population of the United States
during the first part of 1997. The data consists of 1997 data obtained in Round 3 of Panel 1
and Round 1 of Panel 2 of the MEPS Household Component and contains variables pertaining
to survey administration, demographics, employment, health status, and health insurance.
These data are being released prior to final data cleaning and editing in order to provide the
research and policy community prompt access to MEPS data. Analysts should consider this
data as preliminary as they have not been subject to the same level of quality control
procedures which are usually performed on products of this type. Please refer to the MEPS
web page (www.meps.ahrq.gov) for information on any post production updates.
The following documentation offers a brief overview of the types and levels of data provided,
the content and structure of the files and the codebook, and programming information. It
contains the following sections:
- Data file information
- Survey sample information
- Programming information
- Codebook
- Variable /Questionnaire Crosswalk
Detailed information on sample design and data collection methods can be found in
Appendices 1 and 2, Sample Design of the 1996 Medical Expenditure Panel Survey
Household Component and Design and Methods of the Medical Panel Expenditure Survey
Household Component. A copy of the MEPS survey questionnaire is also included (see
README2.TXT file).
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2.0 Data File Information
This public use dataset contains variable and frequency distributions for a total of 37,381
persons (22,385 from Panel 1 Round 3 and 14,996 from Panel 2 Round 1). This count
includes all household survey respondents who resided in eligible responding households. Of
these persons, 35,916 were assigned a positive person level weight (21,411 from Panel 1
Round 3 and 14,505 from Panel 2 Round 1). For each variable both weighted and unweighted
frequencies are provided. In conjunction with the weight variable (WGTSP13) provided on
this file, data for these persons can be used to make estimates for the civilian
noninstitutionalized U.S. population as of the first half of 1997.
The records on this file can be linked to all MEPS public use data sets containing the same
sample by the sample person identifier (DUPERSID). Some analysts may with to use the data
contained on this file in concert with previously released 1996 data to conduct longitudinal
analysis. Some modifications will be made to the stratification (VARST13) and primary
sampling unit (PSU13) variables on future MEPS data releases to facilitate this type of trend
analysis. It is recommended that analysts wait until these revised variables are available to
conduct such analysis.
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2.1 Codebook Structure
The codebook and data file sequence lists variables in the following order:
Unique person identifiers
Demographic variables
Employment variables
Health Status variables
Health Insurance variables
Weight and variance estimation variables
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2.2 Reserved Codes
The following reserved code values are used:
VALUE DEFINITION
-1 INAPPLICABLE Question was not asked due to skip pattern
-7 REFUSED Question was asked and respondent refused to answer
question.
-8 DK Question was asked and respondent did not know answer
-9 NOT ASCERTAINED Interviewer did not record the data
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2.3 Codebook Format
This codebook describes an ASCII data set and provides the following programing identifiers
for each variable:
| IDENTIFIER |
DESCRIPTION |
| Name |
Variable name (maximum of 8 characters) |
| Description |
Variable descriptor (maximum 40 characters) |
| Format |
Number of bytes |
| Type |
Type of data: numeric (indicated by NUM) or character (indicated
by CHAR) |
| Start |
Beginning column position of variable in record |
| End |
Ending column position of variable in record |
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2.4 Variable Naming
In general, variable names reflect the content of the variable, with an 8 character limitation.
All of the variables on this file end in "13" to denote they are combination Panel 2 Round 1
Panel 1 Round 3 variables. For edited variables the 13 is followed by an X, and are so noted
in the variable label. 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 "E. Variable-Source Crosswalk." Sources for each variable are
indicated in one of four ways: (1) variables which are derived from CAPI or assigned in
sampling are so indicated; (2) variables derived from complex algorithms associated with re-enumeration are labeled "RE Section"; (3) variables which come from one or more specific
questions have those numbers listed in the "Source" column; (4) variables constructed from
multiple questions using complex algorithms are labeled "Constructed" in the "SOURCE"
column.
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2.5 File Contents
2.5.1 Survey Administration Variables
The survey administration variables contain information related to conducting the interview,
household and family composition, and person-level and RU-level status codes. Data for the
survey administration variables were derived from the sampling process, the CAPI programs,
or were computed based on information provided by the respondent in the reenumeration
section of the questionnaire. Most Survey Administration variables on this file are asked
during every round of the MEPS interview. Variables in this delivery describe data for Panel
1, Round 3 and Panel 2, Round 1 in 1997.
The variable PANEL13 indicates from which panel the data are derived. A value of 1
indicates Panel 1 data and a value of 2 indicates Panel 2 data.
Note that Round 3 of Panel 1 covers both the end of 1996 and the beginning of 1997. (When
possible, the variables were constructed to represent data from the 1997 portion of Round 3.)
Dwelling Units, Reporting Units, and Families
The definitions of Dwelling Units (DUs) and Group Quarters in the MEPS Household Survey
are generally consistent with the definitions employed for the National Health Interview
Survey. The dwelling unit ID (DUID) is a five-digit random ID number assigned after the case
was sampled for MEPS. The person number (PID) uniquely identifies all persons within the
dwelling unit. The variable DUPERSID, a combination of the variables DUID and PID, thus
uniquely identifies each sampled person in MEPS.
A Reporting Unit (RU) is a person or group of persons in the sampled dwelling unit who are
related by blood, marriage, adoption, foster care or other family association. Each RU is to be
interviewed as a single entity for MEPS. Thus, the RU serves chiefly as a family-based
"survey operations" unit rather than an analytic unit. Members of each RU within the DU are
identified by the variable RULETR13. Regardless of the legal status of their association, two
persons living together as a "family" unit were treated as a single reporting unit if they chose
to be so identified. Examples of different types of reporting units are:
1. A married daughter and her husband living with her parents in the same
dwelling unit constitute a single reporting unit.
2. A husband and wife and their unmarried daughter, age 18, who is living away
from home while at college constitute two reporting units.
3. Three unrelated persons living in the same dwelling unit would each constitute
a distinct reporting unit, three reporting units in all.
Unmarried college students less than 24 years of age who usually live in the sampled
household, but were living away from home and going to school at the time of the MEPS
interview, were treated as a Reporting Unit separate from that of their parents for the purpose
of data collection. The variable RUSIZE13 indicates the number of persons in each RU,
treating each student as a single RU separate from their parents. Thus, students are not
included in the RUSIZE count of their parents' RU. However, for many analytic objectives,
the student reporting units would be combined with their parents' reporting unit, treating the
combined entity as a single family. Family identifier and size variables are described below
and include students with their parents' reporting unit.
The variable FAMID13 identifies a family (i.e., persons living together related to one another
by blood, marriage, adoption, foster care, or self-identified as a single unit plus related
students who are living away at post-secondary school) for each round. These family
identifier variables use a letter and a DU identifier to indicate a person's family affiliation. In
order to identify a person's family affiliation, users must create a unique set of FAMID13
variables by concatenating the DU identifier (DUID) and the FAMID13 variable.
The variable FAMSIZ13 indicates the number of persons associated with a single family unit
after students are linked to their associated parent RUs for analytical purposes. Family-level
analyses should use the FAMSIZ13 variables. In five cases, students were deleted from the
file because attempts to contact them were unsuccessful, and no data were collected for them.
However, these persons are accounted for in the FAMSIZ13 variable.
The family size (FAMSIZ13) and the reporting unit (RU) size (RUSIZE13) counts may not be
consistent with the count of records on the file. There are 282 reporting units where the RU
size variable (RUSIZE13) is not equal to the number of people in that RU actually included on
the file. This occurs because people who did not respond for their entire period of eligibility
were not included on the file. In addition, for 209 of these reporting units, the reference person
is not included on the file for this same reason.
The variable RURSLT13 indicates the RU response status for Round 3 for the Panel 1 sample
and Round 1 for the Panel 2 sample. The values include the following:
60 Complete with RU member
61 Complete with proxy--all RU members deceased on or after 1/1/97
62 Complete with proxy--all RU members institutionalized or deceased on or after
1/1/97
63 Complete with proxy, other
There are several other variables that characterize the reporting unit. The variable RUCLAS13
indicates the RU classification. RUs are classified for fielding purposes as 1 "Standard", 2
"New RU", or 3 "Student RU". Standard RUs are the original RUs from NHIS. All primary
RUs are classified as standard RUs. A new RU is one which has been created when members
of the household leave the primary RU and are followed according to the rules of the survey.
A student RU is one in which an unmarried college student under 24 years of age is
considered a usual member of the household but was living away from home while going to
school and was treated as a Reporting Unit (RU) separate from that of their parents for the
purpose of data collection.
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Reference Period Dates
The reference period is the period of time for which data were collected in each round for each
person. The reference period dates were determined during the interview for each person by
the CAPI program.
The round-specific beginning reference period dates are included for each person. These
variables include BEGRFM13, BEGRFD13, and BEGRFY13. The reference period for Panel
2, Round 1 for most persons identified at NHIS began on January 1, 1997 and ended on the
date of the Round 1 interview. Persons who joined the RU after 1/1/1997 have their
beginning reference date for the round as the day they joined the RU.
For Panel 1, Round 3 the reference period for most persons began on the date of the previous
round's interview and ended on the date of the current round's interview. Persons who joined
after the previous round's interview had their beginning reference date for the round set as the
day they joined the RU. Persons who were present only for the 1996 portion of Round 3 are
not included in this delivery.
The ending reference period dates are included for each person. These variables include
ENDRFM13, ENDRFD13, and ENDRFY13. In general, the date of the interview is the
reference period end date for most persons. Note that the end date of the reference period is
prior to the date of the interview if the person was deceased during the round, left the country,
was institutionalized prior to that round's interview, or joined the military during the round
and was not living with someone else who was eligible. If a person left the RU and that
person were key and inscope, these persons were followed in the new RU to which they
moved and their reference period dates pertain to the new RU.
Reference Person Identifiers
The variable RNDREF13 identifies the reference person for the RU. In general, the reference
person is defined as the household member 16 years of age or older who owns or rents the
home. If more than one person meets this description, the household respondent identifies one
from among them. If the respondent was unable to identify a person fitting this definition, the
questionnaire asked for the head of household and this person was then considered the
reference person for that RU. This information was collected in the reenumeration section of
the CAPI questionnaire.
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Respondent Identifiers
The respondent is the person who answered the interview questions for the reporting unit
(RU). The round specific variables RDRESP13 identifies the respondent. Only one
respondent is identified for each RU. In instances where the interview was completed in more
than one session, only the first respondent is indicated.
There are two types of respondents. The respondent can be either an RU member or a non-RU
member proxy. The variable PROXY13 identifies the type of respondent.
Person Status
A number of variables describe the various components reflecting each person's status for
each round of data collection. These variables provide information about a person's inscope
status, keyness status, eligibility status, and disposition status. These variables include:
INSCOP13, KEYNESS, and PSTAT13. These variables are set based on sampling
information and responses provided in the reenumeration section of the CAPI questionnaire.
Through the reenumeration section of the CAPI questionnaire, each member of a reporting
unit was classified as "key" or "non-key", "in-scope" or "out-of-scope", and "eligible" or
"ineligible" for MEPS data collection. To be included in the set of persons used in the
derivation of MEPS person level estimates, a person had to be a member of the civilian non-institutionalized population for at least one day during 1997. Because a person's eligibility for
the survey might have changed since the NHIS interview, a reenumeration of household
membership was conducted at the start of each round's interview. Only persons who were "in-scope" sometime during 1997, "key", and responded for the full period in which they were
inscope were assigned person level weights and thus are to be used in the derivation of person
level national estimates from the MEPS.
In-Scope
A person is considered as in-scope during a round if he or she is a member of the U.S. civilian,
non-institutionalized population at some time during that round. The variable INSCOP13
indicates a person's inscope status, specifically indicating whether a person was ever inscope
during the 1997 portion of the round.
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Keyness
The term "keyness" is related to an individual's chance of being included in MEPS for
purposes of making estimates about the U. S. civilian non-institutionalized population. A
person is key if that person is linked for sampling purposes to the set of NHIS sampled
households designated for inclusion in MEPS. Specifically, a key person either was a member
of an NHIS household at the time of the NHIS interview, or was a family member who began
living with a member of such a household after being out-of-scope prior to joining that
member (examples of the latter situation include newborns and persons returning from
military service, an institution, or living outside the United States.).
A non-key person is one whose chance of selection for the NHIS (and MEPS) was associated
with a household eligible but not sampled for the NHIS, and who later became a member of a
MEPS reporting unit. MEPS data, (e.g., utilization and income) were collected for the period
of time a non-key person was part of the sampled unit to provide information for family level
analyses. However, non-key persons who leave a sample household unaccompanied by a key,
inscope member were not followed for subsequent interviews. Non-key individuals do not
receive person level sample weights and thus do not contribute to person level national
estimates. They may receive family level weights if they are a member of a responding
family.
The variable KEYNESS indicates a person's keyness status. This variable is not round-specific. Instead, it is set at the time the person enters MEPS, and the person's keyness status
never changes. Once a person is determined to be key, that person will always be key.
It should be pointed out that a person may be key even though not part of the civilian, non-institutionalized portion of the U.S. population. For example, a person in the military may
have been living with his or her civilian spouse and children in a household sampled for the
NHIS. The person in the military would be considered a key person for MEPS. However,
such a person would not be eligible to receive a person-level sample weight if he or she was
never inscope during 1997. He or she may receive a family weight if a member of a
responding family.
Eligibility
The issue of a person's eligibility for MEPS is a data collection issue. Data are to be collected
only for persons considered eligible for MEPS.
All key, in-scope persons of a sampled RU are eligible for data collection. The only non-key
persons eligible for data collection are those who happen to be living in an RU with at least
one key, inscope person. Their eligibility continues only for the time that they are living with
at least one such person. The only out-of-scope persons eligible for data collection are those
persons serving full-time on active duty in the military who were living with key in-scope
persons, and again only for the time they are living with such a person.
A person may be classified as eligible for an entire round or for some part of a round. For
persons who are eligible for only part of a round, data are collected for that person only for the
period of time for which that person was classified as eligible.
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Person Disposition Status
The variable PSTAT13 indicates a person's response and eligibility status. The PSTAT13
indicates the reasons for either continuing data collection for a person or terminating data
collection for each person in the MEPS. Using this variable, one could identify persons who
moved during the reference period, died, were born, institutionalized or who were in the
military.
The following codes specify the value labels for the PSTAT13 variables. Note that some
values for PSTAT13 are round-specific, as indicated in the labels.
11 Person in original RU, not full time active military duty
12 Person in original RU, full time active military duty, out-of-scope for whole
reference period.
13 Full time student living away from home, but associated with sampled RU
14 The person is full time active military duty during round and is in-scope for
part of the reference period and is in the RU at the end of the reference period
22 The person leaves a health care institution and rejoins the community - round 3
only
23 The person leaves a health care institution, goes into community and then dies -
round 3 only
31 Person from original RU, dies during reference period
32 Entered health care institution during reference period
33 Entered non-healthcare institution during reference period
34 Moved from original RU, outside US (not as student)
35 Moved from original RU, to a military facility while on full time active military
duty
41 Moved from the original RU, to new RU within US (new RUs include RUs
originally classified as "Student RU" but which converted to "New RU")
42 The person joins RU and is not full time military during round or joins RU and
is in the military the entire round
44 The person leaves an RU and joins an existing RU and is not both in the
military and coded as inscope during the round
51 Newborn in reference period
Geographic Variables
The variable REGION13 indicates the Census region for the RU. MSA13 indicates whether
or not the RU is found in a metropolitan statistical area. These variables indicate the
geographic location of the reporting unit. The region variable is coded according to the Census
regions, and the MSA13 variable reflects the June 30, 1997 definition of metropolitan
statistical areas.
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2.5.2 Demographic Variables
These variables provide information about the demographic characteristics of each person. As
noted below, some variables have edited and imputed values. Most demographic variables on
this file are asked during each round of the MEPS interview. These variables describe data for
Panel 1, Round 3 and Panel 2, Round 1, as well as a number of characteristics which are not
round specific.
Sex
Data on the sex of each RU member (SEX), as determined during the NHIS interview, was
verified and, if necessary, corrected during each MEPS interview. The data for new RU
members (persons who were not members of the RU at the time of the NHIS interview) was
also obtained during each MEPS Round. When sex of the RU member was not available from
the NHIS interview and was not ascertained during one of the subsequent MEPS interviews, it
was assigned in the following way. The person's first name was used to assign sex, if obvious.
If the person's first name provided no indication of gender, then family relationships were
reviewed. If neither of these approaches made it possible to determine the individual's sex, sex
was randomly assigned.
Age
Date of birth and age for each RU member were asked or verified during each MEPS
interview (DOBMM, DOBYY, AGE13X). If date of birth was available, age was calculated
based on the difference between date of birth and date of interview (or the date of death, if the
person died prior to the interview date). Inconsistencies between the calculated age and the
age reported during the CAPI interview were reviewed and resolved. For purposes of
confidentiality, the variable AGE13X was top coded at 90 years, and DOBYY bottom coded
at 1906. When date of birth was not provided but age was (from either the MEPS or the NHIS
data), the month and year of birth were assigned randomly from among the possible valid
options. For any cases still not accounted for, age was imputed using (1) the mean age
difference between MEPS participants with certain family relationships (where available) or
(2) the mean age value for MEPS participants. For example, a mother's age is imputed as her
child's age plus the mean age difference between MEPS mothers and their children, or a
wife's age is imputed as the husband's age plus the mean age difference between MEPS wives
and husbands.
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Race, Race/Ethnicity, Hispanic Ethnicity, and Hispanic Ethnicity Group
Race (RACEX) and Hispanic ethnicity (HISPANX) were asked for each RU member during
the MEPS interview. If this information was not obtained in Round 1, the questions were
asked in subsequent Rounds. When race and/or ethnicity was not reported in the interview,
values for these variables were obtained based on the following priority order. When
available, they were obtained from the originally collected NHIS data. If not ascertained, the
race, and/or ethnicity were assigned based on relationship to other members of the DU using a
priority ordering that gave precedence to blood relatives in the immediate family. The variable
RACETHNX indicating both race and ethnicity (e.g., with categories such as "Hispanic" and
"black but not Hispanic") reflects the imputations done for RACEX and HISPANX. The
specific Hispanic ethnicity group is given in the unedited variable HISPCAT.
Student Status and Educational Attainment
The variables FTSTD13X indicates whether the person was a full-time student at the
interview date. This variable has valid values for all persons between the ages of 17 - 23
inclusive. Completed years of education are indicated in the variable EDUCYR13.
Information was obtained from questions RE 103-105. Children who are 5 years of age or
older and who never attended school were coded as 0; children under the age of 5 years were
coded as -1 "Inapplicable" regardless of whether or not they attended school.
The variables indicating highest degree (HIDEG13) was obtained from two questions: high
school diploma (RE 104) and highest degree (RE 105). Persons under 16 years of age were
coded as 8 "inapplicable". In cases where the response to the highest degree question was "no
degree" and highest grade was 13 through 17, the variable was coded as 3 "high school
diploma". If highest grade completed for those with a "no degree" response was "refused" or
"don't know", the variable was coded as 1 "no degree". The user should note that the
EDUCYR13 and HIDEG13 variables are unedited variables and minimal data cleaning was
performed on these variables. Therefore, discrepancies in data may remain for these two sets
of variables. Decisions as to how to handle these discrepancies are left to the analyst.
Marital Status and Spouse ID
Current marital status was collected and/or updated during each Round of the MEPS
interview. This information was obtained in RE13 and RE97 and is reported as MARRY13X.
Persons under the age of 16 were coded as 6 "under 16 - inapplicable." In instances where
there were discrepancies between the marital status of two individuals within a family, other
person-level variables were reviewed to determine the edited marital status for each
individual. For example, in Panel 1, Round 3, when one spouse was reported as married and
the other spouse reported as widowed, the data were reviewed to determine if one partner
should be coded as 8 "widowed in Round".
Four edits were performed to ensure minimal consistency across rounds for the Panel 1,
Round 3 data. First, a person could not be coded as "Never Married" after previously being
coded as any other marital status (e.g. "Widowed"). Second, a person could not be coded as
"Under 16 - Inapplicable" after being previously coded as any other marital status. Third, a
person could not be coded as "Married in Round" after being coded as "Married" in the Round
immediately preceding. Fourth, a person could not be coded as an "in Round" code (e.g.,
"widowed in Round") in two subsequent Rounds.
The person identifier for each individual's spouse is reported in SPOUID13. These are the
PIDs (within each family) of the person identified as the spouse during the round. If no spouse
was identified in the household, the variable was coded as 995 "no spouse in household".
Those with unknown marital status are coded as 996. Persons under the age of 16 are coded
as 997 "Less than 16 years old".
The SPOUIN13 variable indicates whether a person's spouse was present in the RU during the
round. If the person had no spouse in the household, the value was coded as 2. For persons
under the age of 16 the value was coded as 3. The SPOUID13 and SPOUIN13 variables were
obtained from RE76 and RE77, where the respondent was asked to identify how each pair of
persons in the household were related. Analysts should note that this information was
collected in a set of questions separate from the questions that asked about marital status.
While editing was performed to ensure that SPOUID13 and SPOUIN13 are consistent within
each Round, there was no consistency check between these variables and marital status in a
given Round. Apparent discrepancies between marital status and spouse information may be
due to any of the following causes: 1) Ambiguity as to when during a Round a change in
marital status occurred. This is a result of relationship information being asked for all persons
living in the household at any time during the Round, while marital status is asked as of the
interview date (e.g., If one spouse died during the reference period, the surviving spouse's
marital status would be "widowed in Round", but SPOUIN13 and SPOUID13 for the same
round would indicate that a spouse was present); 2) Valid discrepancies in the case of persons
who are married but not living with their spouse, or separating but still living together; or 3)
Discrepancies which cannot be explained for either of the previous reasons.
Military Service and Service Era
Information on active duty military status was collected during each Round of the MEPS
interview. Persons currently on full-time active duty status are identified in the variable
ACTDTY13 Those under 16 years of age were coded as 3 "under 16- inapplicable" and those
over the age of 59 were coded as 4 "over 59-inapplicable".
Relationship to the Reference Person within Reporting Units
For each reporting unit (RU), the person who owns or rents the dwelling unit is usually
defined as the reference person. For student RUs, the student is defined as the reference
person. (For additional information on reference persons, see the documentation on survey
administration variables.) The variables RFREL13X indicates the relationship of each
individual to the reference person of the reporting unit (RU) in a given round. For the
reference person, this variable has the value "self"; for all other persons in the RU,
relationship to the reference person is indicated by codes representing "husband/spouse",
"wife/spouse", "son", "daughter", "female partner", "male partner", etc. A code of 91,
meaning "other related", was used to indicate rarely observed relationship descriptions such as
"mother of partner". If the relationship of an individual to the reference person was not
ascertained during the Round-specific interview, relationships between other RU members
were used, where possible, to assign a relationship to the reference person. If MEPS data were
not sufficient to identify the relationship of an individual to the reference person, relationship
variables from the NHIS data were used to assign a relationship. In the event that a meaningful
value could not be determined or data were missing, the relationship variable was assigned a
missing value code.
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2.5.3 Health Status Variables
Health Status variables involved the construction of person-level variables based on
information collected in the Condition Enumeration and Health Status sections of the
questionnaire. The majority of Health Status questions were initially asked at the family level
to ascertain if anyone in the household had a particular problem or limitation. These were
followed up with questions to determine which household member had each problem or
limitation. Logical edits were performed in constructing the person-level variables to assure
that family-level and person-level values were consistent. Particular attention was given to
cases where missing values were reported at the family level to ensure that appropriate
information was carried to the person level. Inapplicable cases occurred when a question was
never asked because of a skip patterns in the survey (e.g., individuals who were 13 years of
age or older were not asked some follow-up verification questions). Inapplicable cases are
coded as -1. In addition, for all variables, deceased persons were coded as inapplicable and
received a code of -1.
Perceived Health Status and Mental Health Status
Perceived health status (RTHLTH13) and mental health status (MNHLTH13) were collected
in the Condition Enumeration section. These questions (CE 01 and CE 02) asked the
respondent to rate each person in the family according to the following categories: excellent,
very good, good, fair, and poor. No editing was done to these variables. The corresponding
dichotomous variables RTPROX13 and MNPROX13 each indicate whether the ratings of
physical and mental health, respectively, were provided by oneself or by someone else.
IADL and ADL Help/Supervision
The Instrumental Activities of Daily Living (IADL) Help or Supervision variable
(IADLHP13) was constructed from a series of three questions. The initial question (HE01)
determined if anyone in the family received help or supervision with IADLs such as using the
telephone, paying bills, taking medications, preparing light meals, doing laundry, or going
shopping. If the response was "yes", a follow-up question (HE02) was asked to determine
which household member received this help or supervision. For persons under age 13, a final
verification question (HE03) was asked to confirm that the IADL help or supervision was the
result of an impairment or physical or mental health problem. If the response to the final
verification question was "no", IADLHP13 was coded as "no" for persons under the age of 13.
If no one in the family was identified as receiving help or supervision with IADLs, all
members of the family were coded as receiving no IADL help or supervision. In cases where
the response to the family-level question was "don't know", "refused", or otherwise missing,
all persons were coded according to the family-level response. In cases where the response to
the family-level question (HE01) was "yes" but no specific individuals were identified in the
follow-up question as having IADL difficulties, all persons were coded as "don't know (= -8)".
The Activities of Daily Living (ADL) Help or Supervision variable (ADLHLP13) was
constructed in the same manner as IADLHP13, but using questions HE04-HE06. Coding
conventions for missing data were the same as for IADLHP13.
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Functional Limitations
A series of questions pertained to functional limitations, defined as difficulty in performing
certain specific physical actions. WLKLIM13 was the filter question. It was derived from a
question (HE09) that was asked at the family level: Does anyone in the family have
difficulties walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or
stooping, or standing for long periods of time? If the answer was no then all family members
were coded as "no" (2) on WLKLIM13. If the answer was "yes", then the specific persons
who had any of these difficulties were identified and coded as "yes" (1) on WLKLIM13, and
remaining family members were coded as "no". If the response to the family-level question
was "don't know" (-8), "refused" (-7), "missing" (-9), or "inapplicable" (-1), then the
corresponding missing value code was applied to each family members value for WLKLIM13.
If the answer to HE09 was "yes", but no specific individual was named as experiencing such
difficulties, then each family member was assigned -8 for WLKLIM13. Deceased respondents
were assigned a -1 code ("inapplicable") for WLKLIM13.
If any family member was coded "yes" to WLKLIM13, a subsequent series of questions was
administered. The series of questions for which WLKLIM13 served as a filter was as follows:
LFTDIF13 - difficulty lifting 10 pounds
STPDIF13 - difficulty walking up 10 steps
WLKDIF13 - difficulty walking 3 blocks
MILDIF13 - difficulty walking a mile
STNDIF13 - difficulty standing 20 minutes
BENDIF13 - difficulty bending or stooping
RCHDIF13 - difficulty reaching over head
FNGRDF13 - difficulty using fingers to grasp
The series of questions was asked separately for each person who was coded "yes" to
WLKLIM13. The series of questions was not asked for other individual family members for
whom WLKLIM13 was "no". In addition, this series was not asked about family members
who were less than 13 years of age, regardless of their status on WLKLIM13. Finally, these
questions were not asked about deceased family members. In such cases (i.e., WLKLIM13 =
2, or age < 13, or PSTATUS = 31), each question in the series was coded as "inapplicable" (-1). Finally, if responses to WLKLIM13 were "refused" (-7), "don't know" (-8), "not
ascertained" (-9), or otherwise inapplicable (-1), then each question in this series was coded as
"inapplicable" (-1).
Analysts should note that, for WLKLIM13, there was no minimum age criterion that was used
to determine a skip pattern, whereas, for the subsequent series of questions, persons less than
13 years old were skipped and coded as inapplicable. Therefore, it is possible for someone
aged 12 or less to have a code of 1 yes on WLKLIM13, and also to have codes of inapplicable
on the subsequent series of questions.
Use of Assistive Technology and Social/Recreational Limitations
The variables indicating use of assistive technology (AIDHLP13, from question HE07) and
social/recreational limitations (SOCLIM13, from question HE22) were collected initially at
the family level. If there was a "yes" response to the family-level question, a second question
identified which specific individual(s) the "yes" response pertained to. Each individual
identified as having the difficulty was coded "yes" on the appropriate variable; all remaining
family members were coded "no". If the family-level response was "don't know", "refused",
or otherwise missing, all persons were coded with the family-level response. In cases where
the family-level response was "yes" but no specific individual was identified as having
difficulty, all family members were coded as "don't know".
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Work, Housework, and School Limitations
The variable indicating any limitation in work, housework, or school (ACTLIM13) was
constructed using questions HE19-HE20. Specifically, information was collected initially at
the family level. If there was a "yes" response to the family-level question (HE19), a second
question (HE20) identified which specific individual(s) the "yes" response pertained to. Each
individual identified as having a limitation was coded "yes" on ACTLIM13; all remaining
family members were coded "no". If the family-level response was "don't know", "refused",
or otherwise missing, all persons were coded with the family-level response. In cases where
the family-level response was "yes" but no specific individual was identified as having
difficulty, all family members were coded as "don't know" (-8). Persons less than five years
old were coded as "inapplicable" (-1) on ACTLIM13.
If ACTLIM13 was "yes" and the person was 5 years of age or older, a follow-up question
(HE20A) was asked to identify the specific limitation or limitations for each person. These
included working at a job (WRKLIM13), doing housework (HSELIM13), or going to school
(SCHLIM13). Respondents could answer "yes" to each activity; one person could thus report
limitation in multiple activities. WRKLIM13, HSELIM13, and SCHLIM13 have values of
"yes" or "no" only if ACTLIM13 was "yes"; each variable was coded as "inapplicable" (-1) if
ACTLIM13 was "no", "refused", or otherwise missing. When ACTLIM13 was "don't know",
these variables were all coded as "don't know". If a person was under 5 years old or was
deceased, WRKLIM13, HSELIM13, and SCHLIM13 were each coded as "inapplicable" (-1).
A second question (UNABLE13) asked if the person was completely unable to work at a job,
do housework, or go to school. This question was asked only of the same set of respondents
who provided data on WRKLIM13, HSELIM13, and SCHLIM13. Therefore, those
respondents who were coded no on ACTLIM13, or were under 5 years of age, or were
deceased, were coded as "inapplicable" (-1) on UNABLE13. UNABLE13 was asked once for
whichever set of WRKLIM13, HSELIM13, and SCHLIM13 the respondent had limitations; if
a respondent was limited in more than one of these three activities, UNABLE13 did not specify if the respondent was completely unable to perform all of them, or only some of them.
Cognitive Limitations
The variable (COGLIM13) was collected at the family level as a three-part question (HE24-01
to HE24-03) indicating if any of the adults in the family (1) experience confusion or memory
loss, (2) have problems making decisions, or (3) require supervision for their own safety. If a
"yes" response was obtained to any item, the persons affected were identified in HE25 and
COGLIM13 was coded as "yes". Remaining family members not identified were coded as
"no" for COGLIM13.
If responses to HE24-01 though HE24-03 were all "no", or if two of three were "no" and the
remaining was "don't know", "refused", or otherwise missing, all family members were coded
as "no". If responses to the three questions were combinations of "don't know", "refused",
and missing, all persons were coded as "don't know". If the response to any of the three
questions was "yes" but no individual was identified in HE25, all persons were coded as
"don't know".
COGLIM13 reflects whether any of the three component questions is "yes". Respondents
with one, two, or three specific cognitive limitations cannot be distinguished. In addition,
because the question asked specifically about "adult" family members, all persons less than 18
years of age are coded as "inapplicable" (-1) on this question.
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2.5.4 Employment Variables
Employment questions were asked of all persons 16 years and older at the time of the
interview. Employment variables consist of person-level indicators such as employment
status and job-related variables such as hourly wage. All job-specific variables refer to a
person's current main job. The current main job, defined by the respondent, indicates the main
source of employment.
Employment variables included on the Panel 1 Round 3/Panel 2 Round 1 1997 release are:
EMPST13, HRWAG13X, HRWGRD13, HRWAY13, HOUR13, HELD13X, OFFER13X,
NUMEMP13 and SELFCM13. Most employment variables pertain to status as of the date of
the interview.
With the exception of health insurance held or offered from a current main job, no attempt has
been made to logically edit any employment variables. When missing, values were imputed
for certain persons' hourly wage; however, there was no editing performed on any values
reported by the respondent.
Employment Status (EMPST13)
Employment status was asked for all persons aged 16 or older. Responses to the employment
status question were: "currently employed" if the person had a job at the interview date, "has a
job to return to" if the person did not work during the reference period but had a job to return
to as of the interview date, "employed during the reference period" if the person had no job at
the interview date but did work during 1997, and "not employed with no job to return to" if
the person did not have a job at the interview date, did not work during the reference period,
and did not have a job to return to. These responses are mutually exclusive. A current main
job was defined for persons reporting that they were currently employed and who identified a
current main job, and for persons who reported and identified a job to return to. Therefore,
job-specific information such as hourly wage exists for persons not presently working at the
interview date but who have a job to return to.
Hourly wage (HRWAG13X, HRWGRD13, and HRWAY13)
Hourly wage was asked of all persons who reported a current main job that was not self-employment (SELFCM13). The hourly wage on this file (HRWAG13X) should be considered
along with its accompanying variables HRWGRD13 and HRWAY13. HRWGRD13 is a flag
that indicates the round in which the reported hourly wage was collected. This flag is always
set to "1" for people who are a part of Panel 2 because the reported hourly wage is always
from Round 1 as only Round 1 information is reported on this file. People who are a part of
Panel 1 can have a current main job from a previous round and HRWGRD13 indicates the
round in which the wage information was collected. For round 3 current main jobs that
continue as the current main job from round 1, HRWGRD13 is "1". For round 3 current main
jobs that continue as the current main job from round 2 (but not round 1), HRWGRD13 is "2".
For round 3 current main jobs that are identified as current main for the first time in round 3,
HRWGRD13 is "3".
For persons who did not indicate a wage amount but who did indicate a range into which the
hourly wage falls, the reported hourly wage (HRWAG13X) is the median within that range.
The medians were calculated using actual wages reported from the same round by persons of
the same gender reporting hourly wages within each age range category. One exception is the
medians for the lower than minimum wage range. These medians did not consider gender in
order to provide a large enough base on which to calculate the medians.
HRWAY13 indicates how the corresponding HRWAG13X was constructed. Hourly wage was
derived, as applicable, from a large number of source variables. In the simplest case, hourly
wage was reported directly by the respondent. For other persons, construction of the hourly
wage was based upon their salary, the time period on which the salary was based, and the
number of hours worked per time period. If the number of hours worked per time period was
not available, a value of 40 hours per week was assumed, as identified in the HRWAY13
variable.
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Health Insurance (HELD13X and OFFER13X)
There are two employment-related health insurance measures included in this release: health
insurance held from a current main job (HELD13X) and health insurance offered from a
current main job (OFFER13X). The held and offer variables were logically edited using
health insurance information not available for public release.
HELD13X is "yes" if the person has a current main job where the person is not self-employed
with firm size = 1, reports insurance from the employer or union at that job, and this coverage
provides hospital/physician benefits or Medigap benefits. HELD13X is also "yes" if the
person's current main job is with the armed forces. HELD13X is "no" if the person does not
hold a current main job with the armed forces, is not self-employed at the current main job,
and either reported that health insurance is not provided through that job or reported insurance
but then disavowed it. To disavow insurance is to initially report it but then to deny that it is
provided later in the interview or to confirm it but to indicate that it does not include
hospital/physician benefits or Medigap benefits.
OFFER13X is "yes" if HELD13X is "yes" or if person has a current main job where person is
not self-employed with firm size = 1 and insurance was offered through the employer or union
at that job. OFFER13X is "no" if HELD13X is "no" and if the person has a current main job
where person is not self-employed with firm size = 1 and insurance was not offered by the
employer or union at that job.
As indicated above, information collected in the health insurance section of the interview was
considered in the construction of HELD13X and OFFER13X. For example, several persons
indicated in the employment section of the interview that they held health insurance through a
current main job and then denied this coverage later in the health insurance section. Such
people were coded as "no" for HELD13X. Due to questionnaire skip patterns, the value for
HELD13X was considered in constructing the OFFER13X variable. For example, if a person
responded that health insurance was held from a current main job, they were skipped past the
question relating to whether health insurance was offered at that job. If the person later
disavowed this insurance in the health insurance section of the questionnaire, we would not be
able to ascertain whether they were offered a policy. These individuals are coded as -9 for
OFFER13X.
Finally, persons under age 16 as well as persons aged 16 and older who did not hold a current
main job or who were self-employed with no employees were coded as inapplicable for the
health insurance-related employment variables.
Hours (HOUR13)
For people who are a part of Panel 1, have a current main job that continues from Round 2 or
Round 1, and are salaried, HOUR13 is the number of hours on which the salary is based.
HOUR13 is the number of hours worked per week for persons who are a part of Panel 2, or
who are a part of Panel 1 and have a new current main job in Round 3, or who are a part of
Panel 1 and have a continuing current main job in Round 3 but are not salaried.
Number of Employees (NUMEMP13)
Due to confidentiality concerns, the variable indicating the number of employees at the
establishment (NUMEMP13) has been top coded at 500 or more employees. NUMEMP13
indicates the number of employees at the location of the person's current main job. For
persons who reported a categorical size, we report a median estimated size from within the
reported range.
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2.5.5 Health Insurance Variables
Constructed and edited variables are provided for general categories of health insurance
coverage collected during the MEPS Panel 2/Round 1 and Panel 1/Round 3 interviews. These
variables include CHNOW13X (CHAMPUS/CHAMPVA coverage), MCARE13 (unedited
Medicare coverage), MCARE13X (edited Medicare coverage), OTPUB13X (other public
coverage including Medicaid and other government hospital/physician coverage), PRIV13
(private health insurance coverage), and INSRD13X (any health insurance coverage). With
the exception of PRIV13, the insurance variables for the Panel 2/Round 1 observations have
been edited. For the Panel 2/Round 1 sample, minimal editing was performed on the Other
Public Coverage and Medicare variables to assign persons to coverage from these sources.
For CHAMPUS/CHAMPVA coverage, respondents who were classified as active duty
military or who were over age 65 had their reported CHAMPUS/CHAMPVA coverage
overturned. As mentioned above, private insurance coverage was unedited and unimputed for
Panel 2/Round 1. For Panel 1/Round 3, most of the insurance variables have been logically
edited to address issues that arose during Rounds 2 and 3 when reviewing insurance reported
in earlier rounds. One edit corrects for possible respondent confusion with respect to a
question about covered benefits asked of respondents who reported a change in their private
health insurance plan name. Additional edits were performed to address issues of missing
data on the time period of coverage. Note that the Medicare and CHAMPUS/CHAMPVA
variables indicate coverage at the time of the Panel 2/Round 1 or Panel 1/Round 3 interview
dates. The private coverage and other public insurance variables indicate coverage at any time
during Panel 2/Round 1 or Panel 1/Round 3.
Medicare
Medicare (MCARE13) coverage was edited (MCARE13X) 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 age 65 or older and covered by Medicare; or
They reported CHAMPUS/CHAMPVA coverage.
Other Public Coverage
Unlike the Panel 1/Round 1 public use tape, the other public coverage variable on this tape
refers to coverage both by Medicaid and to other public hospital/physician coverage. The
MEPS questionnaire asks respondents about Medicaid coverage and then asks a follow-up
question on other public hospital/physician coverage 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 having Medicaid coverage. The variable
OTPUB13X is set to yes if a respondent indicated coverage from either source. Note that a
small number of persons reporting AFDC or SSI coverage (a limited number of questions was
included in the MEPS health insurance section for this purpose) were assigned other public
coverage for both Panel 1 and Panel 2 observations.
Private Insurance
This public use tape includes a variable indicating whether a household respondent was
covered by private insurance at any time during the first half of 1997 ( PRIV13). Private
insurance could have been obtained from an employer, union or have been purchased directly
either as part of a group or as non-group coverage. Private health insurance coverage was also
reported where the respondent could not identify the source of the coverage or the coverage
was obtained through a policyholder outside the household. 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.
Any Insurance in Round 1
The file also includes a summary measure that indicates whether or not a sample person has
any insurance during the first half of 1997 (INSRD13X). 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.
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3.0 Survey Sample Information
3.1 Sample Design and Response Rates
The MEPS is designed to produce estimates at the national and regional level over time for the
civilian non-institutionalized population of the United States and some subpopulations of
interest. Data are collected for each MEPS panel to cover a two-year period, with the first two
MEPS panels spanning 1996-97 and 1997-98, respectively. As described previously, this file
consists of the subset of data from the first two MEPS panels covering approximately the first
half of calendar year 1997. More specifically, data from the 1997 portion of the third round of
data collection for the MEPS Panel 1 sample are pooled with data from the first round of data
collection for the MEPS Panel 2 sample (illustrated below).
301 Moved Permanently
301 Moved Permanently
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3.1.1 Panel 1
The MEPS Panel 1 initially consisted of a sample of 10,639 households in 1996, a nationally
representative subsample of the households responding to the 1995 National Health Interview
Survey (NHIS). The 1995 NHIS sampled households with Hispanic members and households
with Black members at approximately 2.0 and 1.5 times the rate of other households,
respectively. These oversampling rates are also reflected in the MEPS sample of households.
The overall MEPS Panel 1 response rate at the end of round 3 (which collects data for the first
part of 1997) was 70.2 percent. This overall rate reflects response to the 1995 NHIS interview
and the MEPS interviews for rounds 1-3.
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3.1.2 Panel 2
The MEPS Panel 2 initially consisted of a sample of 6,281 households in 1997, a nationally
representative subsample of the households responding to the 1996 NHIS. As for Panel 1 (see
section 3.1.1 above), the Panel 2 sample reflects the oversampling of Hispanic and Black
households in the NHIS. However, the sample design for Panel 2 differed from that for Panel
1 because the following policy relevant groups (classified based on 1996 NHIS data) were also
oversampled to produce more reliable estimates for these groups:
1. adults (age 18 and over) with functional impairments (one or
more ADLs identified);
2. children with limitations in activity;
3. individuals aged 18-64 predicted to incur high medical
expenditures in 1997;
4. individuals predicted to reside in low-income households
(below 200% of poverty); and
5. adults (age 18 and over) with other health limitations (one or
more IADLs identified).
More specifically, a hierarchical sampling scheme was employed to select the MEPS sample.
Among the NHIS households that were candidates for the MEPS sample, all those having at
least one member in any of the first three groups were selected. Among the remaining
households, those that contained at least one member associated with groups four or five were
subsampled at a rate of .6. Finally, households that were not in any of the five groups were
subsampled at a rate of .3.
The overall MEPS Panel 2 response rate at the end of round 1 (when data were collected for
the first part of 1997) was 77.9 percent. This overall rate reflects response to both the 1996
NHIS interview and the MEPS round 1 interview.
3.1.3 Combined Panel Response
Each panel was given approximately equal weight in the development of sampling weights to
produce national estimates (see section 3.2 below). Therefore, a pooled response rate for the
survey respondents in this data set can be obtained by taking an average of the panel specific
response rates. This pooled response rate for the combined panels is 74.1 percent.
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3.2 Sample Weights
The sample weights provided in this file can be used to produce estimates for the U.S. civilian,
non-institutionalized population and subgroups of this population based on the sample data.
Two weights are provided: a person level weight and a family level weight.
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3.2.1 Person Level Weight
The person level weight variable (WGTSP13) was constructed as a composite of separate
panel specific weights. A positive person level weight was assigned to all key members of the
U.S. civilian non-institutionalized population for whom MEPS data were collected,
representing the corresponding U.S. population in early 1997. This weight reflects the original
household probability of selection for the NHIS, ratio-adjustment to NHIS national population
estimates at the household level, adjustment for non-participation in MEPS, and
poststratification to figures obtained from March 1997 Current Population Survey (CPS) data
at the person level. The person level poststratification reflected population distributions
across census region, MSA status, race/ethnicity (Hispanic, black/non-Hispanic, other), sex,
and age.
Overall, the weighted population estimate based on WGTSP13 for the civilian
noninstitutionalized population is 265,926,692. Estimates can be made for this population
based on the 35,916 sample persons in the file with positive weights (WGTSP13>0).
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3.2.2 Family Level Weight
3.2.2.1 Definition of MEPS Families
A family unit is defined in MEPS as two or more persons living together in the same
household during the reference period (in this data set, from January 1, 1997 to the date of
interview) who are related by blood, marriage, or adoption (including foster children). In
addition, unrelated persons who identify themselves as a family (e.g. domestic partners) are
also defined as a MEPS family unit. Persons who died during the first half of 1997 and those
who left the civilian non-institutionalized population part way through the reference period
due to institutionalization, emigration, or enrollment in the military were considered to be
family members. Relatives identified as usual residents of the household who were not there
at the time of the interview, such as college students living away from their parents' home
during the school year, were considered as members of the family that identified them.
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3.2.2.2 Assignment of Weights
If all key in-scope members of a family responded to MEPS for their entire period of
eligibility in 1997 for Round 1/Panel 2, or for Round 3/Panel 1, and the family had a key
reference person, then that family received a family level weight (WGTRU13>0). Reporting
units consisting of an individual respondent who was both key and in-scope also received a
family level weight. These individual person units can be included or excluded from family
level analyses at the analyst's discretion.
Family level weights were poststratified to figures obtained from the March 1997 CPS. The
family level poststratification reflected population distributions across family type (reference
person married, spouse present; male reference person, no spouse present; female reference
person, no spouse present), size of family, age of reference person, location of family (census
region and MSA status), and race/ethnicity of the family's reference person. The weighted
estimate of the number of units (families plus individual person units) with family level
weights containing at least one member of the U.S. civilian non-institutionalized population is
112,106,153, based on 14,147 responding units with WGTRU13>0.
It should be noted that CPS and MEPS definitions of family units are slightly different. In
particular, CPS does not include foster children in families or consider unmarried persons who
live together as family units. Adjustments were made in the poststratification process to help
compensate for some of these differences.
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3.2.2.3 Instructions to Create Family Estimates
To make estimates at the family level, it is necessary to prepare a family level file containing
one record per family. Each MEPS family unit is uniquely identified by the combination of
the variables DUID and FAMID13. Only persons with positive nonzero family weight values
(WGTRU13>0) are candidates for inclusion in family estimates. Following is a summary of
steps that can be used for family level estimation.
1. Concatenate the variables DUID and FAMID13 into a new
variable (e.g. DUFAM13).
2. To create a family level file, sort by DUFAM13 and then subset
to one record per DUFAM13 by retaining only the reference
person record (RNDREF13=1) for each value of DUFAM13. If
the analyst chooses to eliminate single person units from family
analyses, it is also necessary to exclude records where
FAMSIZ13=1. If aggregate measures for families' are needed
for analytic purposes (e.g. means or totals), then those measures
need to be computed using person-level information within
families and attached to the family record. For other types of
variables, analysts frequently use characteristics of the reference
person to represent family characteristics.
3. Apply the weight WGTRU13 to the analytic variable(s) of
interest to obtain national family estimates.
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3.2.3 Relationship Between Person and Family Level Weights
Some persons with positive person level weights do not have family level weights because at
least one member of their family was a non-participant in MEPS. In addition, some persons
with positive family level weights do not have person level weights because they were either
non-key or a member of the military during the first half of 1997. Analysts should only
include persons with positive person level weights for person level analyses and persons with
positive family level weights for family level analyses.
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3.3 Variance Estimation
To obtain estimates of variability (such as the standard error of sample estimates or
corresponding confidence intervals) for estimates based on MEPS survey data, one needs to
take into account the complex sample design of MEPS for both person and family level
analyses. Various approaches can be used to develop such estimates of variance including a
Taylor series method for variance estimation or various replication methodologies. Replicate
weights have not been developed for the MEPS data. We will describe the variables needed to
implement a Taylor series estimation approach.
Using a Taylor Series approach, variance estimation strata and the variance estimation PSUs
within these strata must be specified. The variables VARST13 and PSU13 on this MEPS data
file (updated versions of corresponding variables provided in previously released MEPS
public use files) serve to identify the sampling strata and primary sampling units required by
the variance estimation programs. Specifying a "with replacement" design in a computer
software package such as SUDAAN should provide estimated standard errors appropriate for
assessing the variability of MEPS survey estimates. It should be noted that the number of
degrees of freedom associated with estimates of variability indicated by such a package may
not appropriately reflect the number available. For MEPS sample estimates for characteristics
generally distributed throughout the country (and thus the sample PSUs), one can generally
expect to have at least 100 degrees of freedom associated with the corresponding estimates of
variance.
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D. Codebook
(link to separate file)
E. Variable-Source Crosswalk
SURVEY ADMINISTRATION VARIABLES
| VARIABLE |
LABEL |
SOURCE |
| DUID |
DU ID (Encrypted) |
Assigned in Sampling |
| PID |
Person Number (PN) |
Assigned in Sampling or by
CAPI |
| DUPERSID |
Sample Person ID (DU+PN) For Public Use |
Assigned in Sampling |
| PANEL13 |
Panel Number |
Assigned by CAPI |
| FAMID13 |
Family Identifier (Student Merged In) |
CAPI Derived |
| RULETR13 |
RU Letter |
CAPI Derived |
| RUSIZE13 |
RU Size |
CAPI Derived |
| RUCLAS13 |
RU Fielded As: Standard, New, Student |
CAPI Derived |
| FAMSIZ13 |
RU Size Including Students |
CAPI Derived |
| REGION13 |
Census Region |
Assigned in Sampling |
| MSA13 |
MSA |
Assigned in Sampling |
| RNDREF13 |
Reference Person |
RE 42-45 |
| RDRESP13 |
1st Respondent Indicator |
RE 6, 8 |
| PROXY13 |
Was Respondent A Proxy |
RE 2 |
| BEGRFD13 |
Reference Period Begin Date: Day |
CAPI Derived |
| BEGRFM13 |
Reference Period Begin Date: Month |
CAPI Derived |
| BEGRFY13 |
Reference Period Begin Date: Year |
CAPI Derived |
| ENDRFD13 |
Reference Period End Date: Day |
CAPI Derived |
| ENDRFM13 |
Reference Period End Date: Month |
CAPI Derived |
| ENDRFY13 |
Reference Period End Date: Year |
CAPI Derived |
| KEYNESS |
Person Key Status |
RE Section |
| INSCOP13 |
Inscope |
RE Section |
| PSTAT13 |
Person Disposition Status |
RE Section |
| RURSLT13 |
RU Result |
Assigned by CAPI |
| RUENDD13 |
Date of Intv (Date Started: Day) |
Assigned by CAPI |
| RUENDM13 |
Date of Intv (Date Started: Month) |
Assigned by CAPI |
| RUENDY13 |
Date of Intv (Date Started: Year) |
Assigned by CAPI |
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DEMOGRAPHIC VARIABLES
| VARIABLE |
LABEL |
SOURCE |
| AGE13X |
Age - (Edited/Imputed) |
RE 12, 57-66 |
| DOBMM |
Date of Birth: Month |
RE 12, 57-66 |
| DOBYY |
Date of Birth: Year |
RE 12, 57-66 |
| SEX |
Sex |
RE 12, 57, 61 |
| RACEX |
Race - (Edited/Imputed) |
RE 101, 102 |
| RACETHNX |
Race/Ethnicity - (Edited/Imputed) |
RE 98-102 |
| HISPANX |
Hispanic Ethnicity - (Edited/Imputed) |
RE 98-100 |
| HISPCAT |
Specific Hispanic Ethnicity Group |
RE 98-100 |
| MARRY13X |
Marital Status - (Edited/Imputed) |
RE 13, 97 |
| SPOUID13 |
Spouse ID |
RE 13, 97 |
| SPOUIN13 |
Marital Status W/ Spouse Present |
RE 13, 97 |
| EDUCYR13 |
Completed Years of Education |
RE 103-105 |
| HIDEG13 |
Highest Degree |
RE 103-105 |
| FTSTD13X |
Student Status Ages 17-23 (Edit/Imputed) |
RE 11A, 106-108 |
| ACTDTY13 |
Military Full-Time Active Duty |
RE14, 96 |
| RFREL13X |
Relation To Ref Pers (Edited/Imputed) |
RE 76-77 |
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HEALTH STATUS VARIABLES
| VARIABLE |
LABEL |
SOURCE |
| RTHLTH13 |
Perceived Health Status |
CE 1 |
| RTPROX13 |
Self/Proxy Rating of Health |
CE 1 |
| MNHLTH13 |
Perceived Mental Health Status |
CE 2 |
| MNPROX13 |
Self/Proxy Rating of Mental Health |
CE 2 |
| IADLHP13 |
IADL Screener |
HE 2,3 |
| ADLHLP13 |
ADL Screener |
HE 5,6 |
| AIDHLP13 |
Uses Assistive Devices |
HE 7,8 |
| WLKLIM13 |
Limitation in Physical Functioning |
HE 9,10 |
| LFTDIF13 |
Difficulty Lifting 10 Pounds |
HE 11 |
| STPDIF13 |
Difficulty Walking Up 10 Steps |
HE 12 |
| WLKDIF13 |
Difficulty Walking 3 Blocks |
HE 13 |
| MILDIF13 |
Difficulty Walking a Mile |
HE 14 |
| STNDIF13 |
Difficulty Standing 20 Minutes |
HE 15 |
| BENDIF13 |
Difficulty Bending/Stooping |
HE 16 |
| RCHDIF13 |
Difficulty Reaching Over Head |
HE 17 |
| FNGRDF13 |
Difficulty Using Fingers to Grasp |
HE 18 |
| ACTLIM13 |
Limitation Work/Housework/School |
HE 19,20 |
| WRKLIM13 |
Work Limitation |
HE 19,20 |
| HSELIM13 |
Housework Limitation |
HE 19,20 |
| SCHLIM13 |
School Limitation |
HE 19,20 |
| UNABLE13 |
Completely Unable To Do Activity |
HE 21 |
| SOCLIM13 |
Social Limitation |
HE 22 |
| COGLIM13 |
Cognitive Limitation |
HE 24,25 |
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EMPLOYMENT VARIABLES
| VARIABLE |
LABEL |
SOURCE |
| EMPST13 |
Employment Status |
EM 1-3; RJ 1, 6 |
| HRWAG13X |
Hourly Wage at Current Main Job |
EW section
EM 104, 111 |
| HRWGRD13 |
Hourly Wage Round Flag |
Constructed. |
| HRWAY13 |
Calculation Methods for Hourly Wage |
EM 1-3, 51,
65,104, 111;
EW section |
| HOUR13 |
Hours Worked Per Week at CM Job |
EM 1-3, 51, 65,
104-105, 111;
EW 17; RJ 1 |
| HELD13X |
Health Insurance Held From CMJ |
EM, HX, RJ and
HP sections |
| OFFER13X |
Health Insurance Offered at CMJ |
EM, HX, RJ and
HP sections |
| NUMEMP13 |
Number of Employees at Location of CMJ |
EM 91-92, 124;
RJ 8 |
| SELFCM13 |
Self-Employed at Current Main Job |
EM 1-3, 5, 11,
18, 27, 40, 53;
RJ 1, 6 |
Return To Table Of Contents
HEALTH INSURANCE VARIABLES
| VARIABLE |
LABEL |
SOURCE |
| CHNOW13X |
PID Cov By CHAMPUS/VA at Int Date - Edited |
HX 12, 13; PR
19 - 22; HQ
section;
AGE13X; RE 14,
96A |
| MCARE13 |
PID Cov By MEDICARE |
HX 5 - 7 |
| MCARE13X |
PID Cov By MEDICARE - Edited |
HX 5 - 7, 10 -
15; PRIV13 and
(HX 48 or (OE
10, 24, 37)); PR
7-10, 19-26 |
| OTPUB13X |
PID Cov By Other Public Ins - Edited |
HX 10, 11, 14,
15, 18, 19; HQ
section; PR 7-10,
23-26, 39-42 |
| PRIV13 |
PID Cov By Private Ins |
HX 2 - 4, 21 - 24,
48; HP, OE, HQ,
EM and RJ
sections |
| INSRD13X |
PID Is Insured - Edited |
CHNOW13X,
MCARE13X,
OTPUB13X,
PRIV13 |
Return To Table Of Contents
WEIGHTS
| VARIABLE |
LABEL |
SOURCE |
| WGTSP13 |
Person Weight |
Constructed |
| WGTRU13 |
Family Weight |
Constructed |
| VARST13 |
Variance Estimation Stratum |
Constructed |
| PSU13 |
Variance Estimation PSU |
Constructed |
Return To Table Of Contents
F. Catalog of Medical Expenditure Panel Survey Products
Catalog of Medical Expenditure Panel Survey Products
as of March 22, 1999
All of the products listed below are available free of charge by calling the Agency for Health Care
Policy and Research Publications Clearinghouse at 1-800-358-9295. Note that HC refers to the
Household Component of MEPS, and NHC refers to the Nursing Home Component; descriptions of
the MEPS components can be found in all of the Methodology Reports and Research Findings listed
below.
Data Products
MEPS-HC Round 1-4 Questionnaires. Diskette. AHCPR Pub. No. 97-DP02.
MEPS HC-001: 1996 Panel Round 1 Population Characteristics, March 1997. Data available on
CD-ROM. AHCPR Pub. No. 97-DP20. Also downloadable.
MEPS-NHC Round 1 Questionnaire. Diskette. AHCPR Pub. No. 97-DP03.
MEPS NHC-001: Round 1 Sampled Facility and Person Characteristics, March 1997. Data available
on CD-ROM. AHCPR Pub. No. 97-DP21. Also downloadable.
MEPS HC-002: 1996 Panel Round 1 Parent Identifiers and HMO Data / Round 2 Health Status and
Access to Care Data, October 1997. Diskette. AHCPR Pub. No. 98-DP01. Also downloadable.
MEPS HC-003: 1996 Panel Population Characteristics and Utilization Data for 1996, September
1998. Data available on CD-ROM. AHCPR Pub. No. 98-DP12. Also downloadable.
MEPS HC-004: 1996 Panel Employment Data and Family-Level Weight for 1996, January 1999.
Data available on diskette. AHCPR Pub. No. 99-DP02. Also downloadable.
Print Products
Methodology Reports
Cohen J. Design and methods of the Medical Expenditure Panel Survey Household Component.
Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report No.
1. AHCPR Pub. No. 97-0026.
Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household Component.
Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report No.
2. AHCPR Pub. No. 97-0027.
Potter, DEB. Design and methods of the 1996 Medical Expenditure Panel Survey Nursing Home
Component. Rockville (MD): Agency for Health Care Policy and Research; 1998. MEPS
Methodology Report No. 3. AHCPR Pub. No. 98-0041.
Bethel J, Broene P, Sommers JP. Sample Design of the 1996 Medical Expenditure Panel Survey
Nursing Home Component. Rockville (MD): Agency for Health Care Policy and Research; 1998. MEPS Methodology Report No. 4. AHCPR Pub. No. 98-0042.
Research Findings
Vistnes JP, Monheit AC. Health insurance status of the civilian noninstitutionalized population: 1996.
Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 1. AHCPR Pub. No. 97-0030.
Monheit AC, Vistnes JP. Health insurance status of workers and their families: 1996. Rockville
(MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 2. AHCPR
Pub. No. 97-0065.
Weinick RM, Zuvekas SH, Drilea SK. Access to health care--sources and barriers, 1996. Rockville
(MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 3. AHCPR
Pub. No. 98-0001.
Rhoades J, Potter DEB, Krauss N. Nursing homes--structure and selected characteristics, 1996.
Rockville (MD): Agency for Health Care Policy and Research; 1998. MEPS Research Findings No. 4 AHCPR Pub. No. 98-0006.
Krauss NA, Altman BM. Characteristics of nursing home residents - 1996.Rockville (MD): Agency
for Health Care Policy and Research; 1998. MEPS Research Findings No. 5. AHCPR Pub. No.
99-0006.
Freiman M, Brown E. Special care units in nursing homes - selected characteristics, 1996. Rockville
(MD): Agency for Health Care Policy and Research; 1999. MEPS Research Findings No. 6. AHCPR
Pub. No. 99-0017.
Highlights
Beauregard KM, Drilea SK, Vistnes JP. The uninsured in America--1996. Rockville (MD): Agency
for Health Care Policy and Research; 1997. MEPS Highlights No. 1. AHCPR Pub. No. 97-0025.
Krauss NA, Freiman MP, Rhoades JA, et al. Nursing home update--1996. Rockville (MD): Agency
for Health Care Policy and Research; 1997. MEPS Highlights No. 2. AHCPR Pub. No. 97-0036.
Agency for Health Care Policy and Research. Access to health care in America--1996. Rockville
(MD); 1997. MEPS Highlights No. 3. AHCPR Pub. No. 98-0002.
Agency for Health Care Policy and Research. Health Insurance Coverage in America--1996.
Rockville (MD); 1998. MEPS Highlights No. 4. AHCPR Pub. No. 98-0031.
Agency for Health Care Policy and Research. Job-Based Health Insurance 1987 and 1996. Rockville
(MD); 1998. MEPS Highlights No. 5. AHCPR Pub. No. 98-0032.
Vistnes JP, Monheit AC. Health Insurance Profile: Race/Ethnicity and Sex--1996. Rockville (MD):
Agency for Health Care Policy and Research; 1998. MEPS Highlights No. 6. AHCPR Pub. No.
98-0052.
Agency for Health Care Policy and Research. Uninsured Workers--Demographic Characteristics,
1996. Rockville (MD); 1998. MEPS Highlights No. 7. AHCPR Pub. No. 99-0007.
Agency for Health Care Policy and Research. Uninsured Workers--Job Characteristics, 1996.
Rockville (MD); 1998. MEPS Highlights No. 8. AHCPR Pub. No. 99-0008.
Chartbooks
Weigers ME, Weinick RM, Cohen JW. Children's health, 1996: health insurance, access to care, and
health status. Rockville (MD): Agency for Health Care Policy and Research; 1998. MEPS Chartbook
No. 1. AHCPR Pub. No. 98-0008.
Kass B, Weinick R, and Monheit A. Racial and Ethnic Differences in Health, 1996. Rockville (MD):
Agency for Health Care Policy and Research; 1998. MEPS Chartbook No. 2. Pub No. 99-0001.
Journal Articles
(available only through the AHCPR Publications Clearinghouse)
Cohen JW, Monheit AC, Beauregard KM, et al. The Medical Expenditure Panel Survey: a national
health information resource Inquiry 1996;33:373-389. AHCPR Pub. No. 97-R043.
Cooper PF, Schone BS. More offers, fewer takers for employment-based health insurance:
1987-1996. Health Affairs November/December 1997; 16,6:142-149.
Weinick RM, Drilea SK. Usual Sources of Health Care and Barriers to Care, 1996. Statistical Bulletin Jan-Mar 1998; 79(1): 11-17.
Weinick RM, Weigers ME, Cohen, JW. Children's Health Insurance, Access to Care, and Health
Status: New Findings. Health Affairs March/April 1998; 17(2): 127-136.
Return To Table Of Contents
G. Appendices
Appendix 1
Household Survey Sample Design Report
Sample Design of the 1996 Medical Expenditure Panel Survey
Household Component
March 1997
Steven B. Cohen
Agency for Health Care Policy and Research
Center for Cost and Financing Studies
2101 E. Jefferson St., Suite 501
Rockville, Maryland 20852
(301) 594-1406
1.0 Introduction
The Household Component of the 1996 Medical Expenditure Panel Survey (MEPS) was
designed to produce national and regional estimates of the health care utilization, expenditures,
sources of payment, and insurance coverage of the U.S. civilian noninstitutionalized population. The
MEPS includes surveys of medical providers, employers, and other health insurance providers to
supplement the data provided by household respondents. The design of the MEPS permits both
person-based and family-level estimates. The scope and depth of this data collection effort reflects
the needs of government agencies, legislative bodies, and health professionals for the comprehensive
national estimates needed in the formulation and analysis of national health policies.
The MEPS collects data on the specific health services that Americans use, how frequently
they use them, the cost of these services and how they are paid, as well as data on the cost, scope, and
breadth of private health insurance held by and available to the U.S. population. The MEPS is
unparalleled for the degree of detail in its data, as well as its ability to link health service medical
expenditures and health insurance data to the demographic, employment, economic, health status,
utilization of health services, and other characteristics of survey respondents. Moreover, the MEPS is
the only national survey that provides a foundation for estimating the impact of changes in sources of
payment and insurance coverage on different economic groups or special populations of interest, such
as the poor, elderly families, veterans, the uninsured, and racial and ethnic minorities.
In this paper, the sample design of the MEPS, initially referred to as the National Medical
Expenditure Survey (NMES-3), is described. The 1996 MEPS used the 1995 National Health
Interview Survey (NHIS) as the sample frame for the survey. The redesigned MEPS reflects the first
stage of implementation of the Department of Health and Human Services (DHHS) Survey
Integration Plan, which provides directives targeted to improve the analytic capacity of programs, fill
major data gaps, and establish a framework in which DHHS data activities are streamlined and
rationalized. Through this effort, specifically through a linkage to the NHIS, the MEPS has achieved
a number of significant design improvements and analytic enhancements.
Attention is given to the resultant design efficiencies and enhancements in analytical capacity
that have been and will be realized through the MEPS sample design integration with the NHIS. The
report includes a summary of sample size specifications and precision targets for national population
estimates and health care expenditure estimates for policy-relevant population subgroups. A
discussion is also provided regarding the modification of the MEPS from a periodic annual survey to
an ongoing continuous data collection effort with each expenditure panel of households followed for
two years.
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2.0 Redesign of the Medical Expenditure Survey as a Component of the DHHS
Survey Integration Plan
As part of the Reinventing Government Part II (REGO II) activities, the DHHS targeted the
improvement of the analytical capacity of DHHS programs, the filling of major data gaps, and the
establishment of a survey consolidation framework in which DHHS data activities are streamlined
and rationalized. A Survey Consolidation Working Group was charged with developing a consensus
plan for meeting these objectives (Hunter, Arnett, Mathiowetz, et al., 1995; Arnett, Hunter, and
Cohen, et al., 1996). A major concentration of the Survey Integration Plan was the redesign of the
health care expenditure and insurance studies conducted by the DHHS which include the National
Medical Expenditure Survey (NMES), the Medicare Current Beneficiary Survey (MCBS), the
National Employer Health Insurance Survey (NEHIS), and the NHIS. The proposed integrated survey
design was specified to achieve significant cost efficiencies by eliminating duplicative efforts and
reducing overall respondent burden. Furthermore, by virtue of integrating the design features of the
component surveys, their respective analytical capacities are enhanced. A number of survey design
enhancements were also proposed to improve upon current survey design capabilities. These included
considering an ongoing longitudinal survey effort and allowing for a future capacity to derive state-specific health care estimates. Consideration was also given to the inclusion of a periodic institutional
component in the survey to provide national use and expenditure estimates for the population residing
in nursing homes (Hunter, Arnett, Mathiowetz, et al., 1995).
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2.1 Design Enhancements and Efficiencies to be Achieved Through Survey
Integration
One of the attractions of the DHHS Survey Integration Plan was the enhanced analytical
capacity that would be achieved by the distinct surveys that would be linked through design
integration. This could be realized by sample size expansions that would occur through survey
mergers such as the planned integration between the MEPS and the MCBS and the consolidation of
employer surveys conducted by the DHHS. Also, use of the NHIS as a sample frame for the MEPS
would increase the analytical content of the resultant linked surveys. Through design integration of
the respective surveys sponsored by the DHHS, inefficiencies associated with duplicative survey
efforts would be significantly reduced. Another goal was to achieve reductions in survey design costs
by the implementation of a uniform framework for DHHS-sponsored surveys with overlapping
analytical focus with respect to questionnaire content, data editing, imputation, estimation, database
structure, and development of analytic files. Additional efficiencies in survey operations are
anticipated in future years as a consequence of conducting an annual medical expenditure survey
rather than one every decade.
By moving to this integrated, annual household data collection effort, the DHHS expands and
enhances its analytic capabilities as described below:
Retains the design of the core NHIS household interview. This core will provide cross-sectional population statistics on health status and health care utilization with sufficient
sample size to allow for analyses based on detailed breakdowns of age, race, sex, income, and
other sociodemographic characteristics. The core will also allow the use of data on a broad
range of topics currently provided by the NHIS.
Retains the analytical capacity to obtain both annual and quarterly population estimates of
health care utilization and the prevalence of health conditions, for the nation and for policy-relevant population subgroups.
Provides the ability to model individual (and family-level) health status, access to care and
use, expenditure, and insurance behavior over the year and examine the distribution of these
measures across individuals. The longitudinal feature of the MEPS to collect data over
multiple years further enhances the capacity to model behavior over time.
Provides the ability to relate data from a detailed sample (e.g., MEPS) to a larger sample (e.g.,
NHIS) to enhance the utility of the MEPS for national health account estimation and
microsimulation modeling, including disaggregation by age group or geographic area.
Provides the potential to expand to state-level estimates for marginal costs using the enhanced
358 PSU sample design of the NHIS.
The longitudinal (over several years) aspect of the MEPS integrated data collection effort
provides the following:
- An increase in statistical power to examine change or make comparisons over time;
- The capacity to examine changes over time as well as changes in the relationship
among measures of health status, access to care, health care use, expenditures, health
insurance coverage, employment, functional limitations and disabilities, and
demographic characteristics.
Return To Table Of Contents
2.2 MEPS Household Component
The original NMES-3 sample design called for an independent screening interview to identify
a nationally representative sample and facilitate oversampling of policy-relevant population
subgroups. Data collection and training costs associated with this independent screening interview
were projected to exceed $8 million. As part of the DHHS Survey Integration Plan, the separate
screening interview to identify the expenditure survey sample was eliminated. As an alternative, the
NHIS was specified as the sampling frame for the medical expenditure survey, MEPS. The NHIS is
an ongoing annual household survey of approximately 42,000 households (109,000 individuals)
conducted by the National Center for Health Statistics (NCHS) to obtain national estimates for the
U.S. civilian noninstitutionalized population on health care utilization, health conditions, health
status, insurance coverage, and access. In addition to the cost savings achieved by the substitution of
the NHIS as the MEPS sample frame, the design modification will result in an enhancement in
analytical capacity of the resultant survey data. Use of the 1995 NHIS data in concert with the data
collected for the 1996 MEPS provides an additional capacity for longitudinal analyses not available in
the original (NMES-3) design. Furthermore, the greater number and dispersion of the sample PSUs
that comprise the MEPS national sample should result in improvements in precision over the original
design specifications.
To fill major data gaps identified by the DHHS, the MEPS is specified as a continuous survey
with sample peaks at five year intervals. The initial sample of 10,597 NHIS dwelling units selected
for the 1996 MEPS is reduced from the original 1996 plan to also permit estimates for calendar year
1997. An overlapping panel design will be adopted for the MEPS, where the 1996 panel will be
followed for data collection through 1997. A new nationally representative sample of 6,300 dwelling
units will be selected from the 1996 NHIS to supplement the 1996 MEPS panel in order to meet the
original precision specifications for the specified policy-relevant population subgroups for calendar
year 1997, with the exception of the elderly. These policy-relevant population subgroups consist of:
Adults (18+) with functional impairments.
Children with limitations of activity.
Individuals predicted to incur high medical expenditures.
Individuals predicted to have incomes less than 200% of the poverty level.
(Cohen, 1996).
A preliminary contact with the NHIS responding households selected for the MEPS study was made
prior to the start of the MEPS, to announce the survey and introduce record-keeping activities. The
revised study design of the MEPS includes several components: the Household Component (HC)
consisting of an overlapping panel design in which any given sample panel is interviewed a total of
six times over three consecutive years to yield annual data for two calendar years; the Medical
Provider Component (MPC) with a sample of medical providers that treated HC persons; and the
Insurance Component (IC) with a sample of employers and other sources of health insurance of HC
persons. The survey is co-sponsored by the Agency for Health Care Policy and Research (AHCPR)
and the NCHS. Westat and the National Opinion Research Center (NORC) are the data collection
organizations for the 1996 MEPS Household Component.
Return To Table Of Contents
2.3 MEPS Household Component Sample Design
The 1996 MEPS Household Component sample was selected from households that responded
to the 1995 NHIS. The NHIS has been designed to permit nationally representative subsamples to be
selected by restricting the sample to one of four distinct panels. Any combination of one to four
panels will provide a nationally representative sample of households. Furthermore, each NHIS panel
subsample for a given quarter of a calendar year is nationally representative. The 1996 MEPS
household sample linked to the 1995 NHIS was selected from two of the four 1995 NHIS panels and
encompassed half of the households in the NHIS sample during the second and third quarters of 1995.
The complete 1995 NHIS sample (panels 1-4) consists of 358 Primary Sampling Units (PSUs,
e.g., counties or groups of contiguous counties) with a targeted sample of approximately 42,000
responding households. The sample PSUs selected for the NHIS were stratified by geographic
(Census region and state), metropolitan status, and sociodemographic measures (Judkins, Marker, and
Waksberg, 1994). Within sample PSUs, a sample of blocks (segments) were selected after being
stratified by measures of minority population density which allowed for an oversample of areas with
high population concentrations of blacks and Hispanics. A nationally representative sample of
approximately 71,000 addresses within sampled blocks was selected and targeted for further
screening to facilitate an oversample of blacks and Hispanics as part of the 1995 NHIS interview.
The 1995 NHIS subsample selected for the 1996 MEPS consists of 195 PSUs. In the two
targeted quarters of 1995 these PSUs include approximately 1,675 sample segments (second stage
sampling units) and 10,597 responding NHIS households. This NHIS sample reflects an oversample
of households with Hispanics and blacks at the following approximate ratios of representation relative
to the remaining households (Hispanics 2.0:1, blacks 1.5:1). This 1996 MEPS sample will constitute a
panel that will be surveyed to collect annual data for two consecutive years.
A new 1997 MEPS panel sample will be selected as a nationally representative subsample
from households that respond to the 1996 NHIS. More specifically, the 1997 MEPS sample linked to
the 1996 NHIS will be selected from two of the four NHIS panels and will reflect additional
disproportionate sampling in order to satisfy the precision requirements specified for the 1997 MEPS
household survey, which generally coincide with the original plan for the 1996 survey (Cohen, 1996).
As in 1995, the complete 1996 NHIS sample will consist of 358 PSUs with a targeted sample of
approximately 42,000 responding households. The nationally representative 1996 NHIS subsample
reserved for the 1997 MEPS prior to additional subsampling will be obtained from the same 195
PSUs selected for the 1996 MEPS household sample and include approximately 21,000 responding
NHIS households as eligible for sample selection. Once again, this NHIS sample reflects an
oversample of Hispanics and blacks at the following approximate ratios of representation relative to
the remaining households (Hispanics 2.0:1, Blacks 1.5:1). A nationally representative subsample of
approximately 6,300 NHIS responding households (6,480 reporting units) will be selected for the new
1997 MEPS panel. This sample will consist of an oversample of the following policy-relevant
subgroups:
Adults (18+) with functional impairments.
Children with limitations of activity.
Individuals predicted to incur high medical expenditures.
Individuals predicted to have incomes less than 200% of the poverty level.
An oversample of non-functionally impaired elderly individuals was not planned for the 1997 survey,
given the availability of the 1997 MCBS and the planned future consolidation of the MCBS and the
MEPS. The MCBS is an annual person-based survey to obtain the same types of estimates derivable
from the MEPS household survey on the health care utilization, expenditures, sources of payment,
and health insurance coverage for Medicare beneficiaries. The new 1997 MEPS panel will be fielded
to collect annual data for two consecutive years.
As part of the redesign, the 1997 MEPS Household Component sample will consist of the new
nationally representative 1997 MEPS panel in combination with the second year of the 1996 MEPS
sample. Overall, the 1997 MEPS household sample will consist of approximately 13,700 reporting
units (total adjusted for MEPS Round 1 "split-offs," though not reflecting new split-offs in Rounds 2
and 3) completing the full series of MEPS interviews to obtain calendar year use and expenditure data
for calendar year 1997. Sample selection procedures for the 1997 MEPS sample will be implemented
in-house by AHCPR staff, based on data keyed from the 1996 NHIS interviews.
In 1998, a new MEPS sample of approximately 5,200 households (5,350 reporting units) will
be selected as a nationally representative subsample of households that responded to the 1997 NHIS.
In addition, the entire 1997 panel of 5,397 reporting units will be continued to obtain calendar year
1998 data on health care use and expenditures (with a targeted round-specific response rate of 97
percent). Consequently, the MEPS sample for 1998 will consist of approximately 9,500 reporting
units (adjusted for split-offs in Round 1) completing three core rounds of data collection to obtain
calendar year data (4,457 households from the new sample, 5,078 from the 1997 MEPS sample). In
1998, the 1996 MEPS panel will be retired.
For years 1998-2001, the survey will scale back to an overall sample of approximately 9,500
reporting units completing three core rounds of data collection to obtain calendar year data on health
care utilization and expenditures, with approximately 5,000 continuing from the previous year for
each of the years. In 2002, the survey would begin the five year cycle again with an increase to 13,700
reporting units (adjusted only for Round 1 split-offs) completing three core rounds of data collection
to obtain calendar year data on health care utilization and expenditures. Coupled with data from the
MCBS, this would provide the DHHS with the analytic capabilities first proposed for the 1996
NMES-3 with respect to sample size.
Return To Table Of Contents
2.4 Dwelling Units, Reporting Units, and Other Definitions
The definitions for Dwelling Units and Group Quarters in the MEPS Household Component
are generally consistent with the definitions employed for the NHIS. A Reporting Unit is a person or
group of persons in the sampled dwelling unit that are related by blood, marriage, adoption or other
family associations, who are to be interviewed at the same time in MEPS. Examples of discrete
reporting units are:
(1) a married daughter and her husband living with her parents in the same dwelling are
considered one reporting unit.
(2) a husband and wife and their unmarried daughter, age 18, who is living away from
home at college constitute one family, but two reporting units.
(3) three unrelated persons living in the same dwelling unit would be three reporting units.
College students under 24 years of age who usually live in the sampled household, but are currently
living away from home and going to school, will be treated as separate reporting units for the purpose
of data collection.
The 1996 MEPS sample consisted of households (dwelling units) that responded to the 1995
NHIS in the two panels reserved for the MEPS, with the basic analysis unit defined as the person.
Analysis is planned with both the individual and the family as units. Through the reenumeration
section of the Round 1 questionnaire, the status of each individual sampled at the time of the NHIS
interview is classified as "key" or "non-key," "in-scope" or "out-of-scope," and "eligible" or
"ineligible" for MEPS data collection. For an individual to be in-scope and eligible for person-level
estimates derived from the MEPS household survey, the person needs to be a member of the civilian
noninstitutionalized population for some period of time in the calendar year of analytical interest.
Because a person's eligibility for the survey may have changed since the NHIS interview, sampling
reenumeration takes place in each subsequent reinterview for persons in all households selected into
the core survey. The keyness, in-scope, and eligibility indicators, together, define the target sample to
be used for person-level national estimates. Only persons who are key, in-scope, and eligible for data
collection will be considered in the derivation of person-level national estimates from the MEPS.
Key Persons: Key survey participants are defined as all civilian non-institutionalized
individuals who resided in households that responded to the nationally representative NHIS
subsample reserved for the MEPS (e.g. approximately 10,600 households from the 1995 NHIS), with
the exception of college students interviewed at dormitories. Members of the armed forces that are on
full time active duty and reside in responding NHIS households which include other family members
who are civilian non-institutionalized individuals are also to be defined as key persons, but will be
considered out of scope for person-level estimates derived for the survey.
All other individuals who join the NHIS reporting units that define the 1996 MEPS household
sample (in Round 1 or later MEPS rounds) and did not have an opportunity for selection during the
time of the NHIS interview will also be considered key persons. These include newborn babies,
individuals who were in an institution or outside the country moving to the United States, and military
personnel previously residing on military bases who join MEPS reporting units to live in the
community.
College students under 24 years of age interviewed at dormitories in the 1995 NHIS will be
considered ineligible for the 1996 MEPS sample and not included in that sample. Furthermore, any
unmarried college students under 24 years of age that responded to the 1995 NHIS interview while
living away at school (not in a dormitory) will be excluded from the sample if it is determined in the
MEPS Round 1 interview that the person is unmarried, under 24 years of age, and a student with
parents living elsewhere who resides at his/her current housing only during the school year. If, on the
other hand, the person's status at the time of the MEPS Round 1 interview is no longer that of an
unmarried student under 24 years of age living away from home, then the person will be retained in
the 1996 MEPS sample as a key person.
Alternatively, at the time of the MEPS Round 1 interview with NHIS sample respondents, a
determination will be made if there are any related college students under 24 years of age who usually
live in the sampled household, but are currently living away from home and going to school. These
college students are considered key persons and will be identified and interviewed at their college
address, but linked to the sampled household for family analyses. Some of these college students
living away from home at the time of the Round 1 interview will have been identified as living in
sampled household at the time of the 1995 NHIS interview. The remainder will be identified at the
time of the MEPS Round 1 interview with the NHIS sampled households.
Non-key Persons: Persons who were not living in the original sampled dwelling unit at the
time of the 1995 NHIS interview and who had a non-zero probability of selection for that survey will
be considered non-key. If such persons happen to be living in sampled households (in Round 1 or
later rounds), MEPS data (e.g., utilization and income) will be collected for the period of time they
are part of the sampled unit to permit family analyses. Non-key persons who leave any sampled
household will not be recontacted for subsequent interviews. Non-key individuals are not part of the
target sample used to obtain person-level national estimates.
In situations where key persons from the NHIS sampled household selected for MEPS move
out (in Round 1 or later rounds) and join or create another family, data on all members of this new
household who are related by blood, marriage, adoption or foster care to the persons from the NHIS
sampled household will be obtained from the point in time that the NHIS sampled person joined that
new household. Similarly, data will be collected (in Round 1 and later rounds) on all related persons
who join NHIS sampled households selected into the MEPS.
Persons in NHIS sampled households selected in the MEPS who subsequently enter an
institution and leave the civilian, noninstitutionalized population of the United States will require data
collection during their stay in institutions that are nursing homes. Alternatively, persons in NHIS
sampled households selected in the MEPS who subsequently enter institutions that are not nursing
homes and leave the civilian, noninstitutionalized population of the United States do not require any
data collected in these institutions that are not nursing homes (this also applies for military service or
moving out of the U.S.), but their whereabouts must be monitored during the field period. Upon their
return to the U.S. civilian noninstitutional population, these persons shall once again be subject to HC
data collection.
MEPS Data Collection Eligibility: In order for a MEPS reporting unit to be eligible for data
collection, the unit must include at least one individual who is key and in-scope for some period of
time during the reference period for a given round of data collection. If this condition holds, the
persons who are key and in-scope and all other individuals who are members of the reporting unit
(living together and related by blood, marriage, adoption or other family associations) are eligible for
data collection in a given round of the MEPS.
Return To Table Of Contents
2.5 Sample Size Targets and Precision Requirements
The 1996 MEPS sample size targets require approximately 9,000 reporting units yielding the
complete series of core interviews (i.e., Rounds 1-3) to obtain use and expenditure data for calendar
year 1996. The expected yield at each of the stages of data collection for each new MEPS sample
linked to the NHIS is: (1) a NHIS response rate of 94 percent at the household level; (2) a response
rate of 85 percent (83 percent achieved for the 1996 MEPS) among reporting units at Round 1
(conditioned on a completed NHIS interview); a round-specific response rate of 95 percent among
reporting units at Rounds 2; a round-specific response rate of 97.5 percent among reporting units at
Round 3; a round-specific response rate of 97 percent among reporting units at Rounds 4 and 5; and a
round-specific response rate among reporting units of 98 percent at Round 6 (See Table 1).
Consequently, the targeted response rate for obtaining calendar year 1996 data on health care
utilization and expenditures from the 1996 MEPS sample is 77 percent, conditioned on response to
the NHIS (interviews for Rounds 1-3), or 72 percent overall.
The response rate target for the core MEPS household survey for obtaining calendar year 1997
data on health care utilization and expenditures from the new 1997 MEPS sample is 79 percent
conditioned on response to the NHIS (interviews for Rounds 1-3), or 74 percent overall (See Table 1).
Furthermore, the minimum acceptable response rate target for the core MEPS household survey
within a PSU is 65 percent for calendar year 1997 data from the new MEPS panel, conditioned on
NHIS response (interviews for Rounds 1-3), and is 60 percent for calendar years 1996 and 1997 for
the 1996 MEPS panel (interviews for Rounds 1-5, conditioned on response to the NHIS).
It should be noted that the 1995 NHIS response rate achieved for the households eligible for
the MEPS was 94 percent. Of 10,639 responding NHIS dwelling units eligible for the MEPS, 99.6
percent were identified with the necessary information to facilitate MEPS data collection. Of the
11,424 eligible reporting units targeted for interviews in Round One, 9,488 responded to the first core
MEPS interview (83.1 percent). Overall, the joint NHIS - Round One response rate for the 1996
MEPS household survey was 77.7 percent (.939 x .996 x .831).
Table 1. Expected number of responding reporting units and associated response rate for each round
of data collection of the 1996 and the 1997 MEPS Household Component.
| |
1995 NHIS
Linked
Sample |
Calendar Year
1996 |
Calendar Year
1997 |
Calendar Year
1998 |
| 1996 MEPS Panel |
|
Round
1A |
Round
2A |
Round
3A |
Round
4A |
Round
5A |
Round
6A |
| Responding Reporting Units
(by Round)
(Response rate by Round) |
111,424
210,800
(94%) |
19,488
(83%) |
39,018
(95%) |
38,792
(97.5%) |
38,528
(97%) |
38,272
(97%) |
38,106
(98%) |
| |
|
|
|
|
| |
1996 NHIS
Linked
Sample |
|
Calendar Year
1997 |
Calendar Year
1998 |
| 1997 MEPS Panel |
|
|
|
Round
1B |
Round
2B |
Round
3B |
Round
4B |
| Responding Reporting Units
(by Round)
(Response rate by Round) |
16,857
26,480
(94%) |
|
|
15,828
(85%) |
35,536
(95%) |
35,397
(97.5%) |
35,235
(97%) |
1 Includes Round 1 "splits-offs" (family member(s) that move apart from the originally sampled household) in Round 1 of the 1996
and 1997 MEPS panels.
2 Original sample of Reporting Units.
3 Does not include new split-offs after Round 1 in counts.
The estimates of response rates in Table 1 are for the original sample of NHIS responding reporting units, with the inclusion of split-offs in Round 1. The rates specified in the table are also expected to apply to split-offs in subsequent rounds, i.e., households that
will be created in the course of the survey field period as a result of key persons moving away from originally sampled NHIS
households.
Source: Agency for Health Care and Policy Research. 1996 Medical Expenditure Panel Survey--Household Component.
The sample size specifications have been set to meet precision requirements developed for the
MEPS. Given the major changes in the design of the survey that were required as a consequence of
the DHHS Survey Integration Plan, the sample size constraints placed on the MEPS as a consequence
of restricting the sample to the 195 PSU NHIS subsample, and use of the first quarter of the 1995
NHIS sample for inclusion in a Disability Survey sponsored by the Assistant Secretary of Planning
and Evaluation, DHHS, the precision requirements for the first year of the MEPS were relaxed
relative to the original design specifications of the NMES-3 (Cohen, 1996; DiGaetano, 1994).
For the 1996 MEPS sample, the relative standard error for a population estimate of 20 percent
for the overall population at the family level was specified to be no more than 2.7 percent; and the
relative standard error for a population estimate of 20 percent for the overall population at the person
level was specified to be no more than 1.7 percent. For example, if it was determined that the national
population estimate of the percentage of the population ever uninsured in 1996 was 20 percent, the
standard error of the estimate should not exceed 0.34 percent. That would translate to a 95 percent
confidence interval of (19.33%, 20.67%) for the insurance coverage estimate that characterized the
nation at the person level. Preliminary design work suggested that a 1996 MEPS sample selected from
a nationally representative 1995 NHIS subsample characterized by 195 PSUs, 1,675 segments, and
approximately 9,000 responding households at the end of Round 3, with disproportionate sampling
rates that ranged from 1.0 to 0.5, should yield average design effects for MEPS survey estimates of
annual use and expenditure measures in the 1.5-1.6 range.
The 1996 MEPS sample linked to the NHIS was designed to produce unbiased estimates for
the four Census regions. This NHIS linked sample reflects an oversample of Hispanics and blacks at
the following ratios of representation relative to the remaining households (Hispanics 2.0:1, blacks
1.5:1). The overall expected sample yield after three rounds of data collection at the person level is
approximately 22,000 overall, with 3,400 black/non-Hispanic individuals and 4,200 Hispanic
individuals. The average design effect target for survey estimates for the 1996 MEPS is 1.6. The
sample design should satisfy the following precision requirements for mean estimates of the following
measures of health care utilization and expenditures at the person level: (total health expenditures;
utilization and expenditure estimates for inpatient hospital stays; physician visits; dental visits and
prescribed medicines).
| Demographic group |
Persons at the end
of Round 3 standard error |
Average relative |
| 1. Black/Non-Hispanics |
3,400 |
.065 |
| 2. Hispanics |
4,200 |
.055 |
| 3. Overall Population |
22,000 |
.025 |
Return To Table Of Contents
2.6 Procedures for Data Collection
For a description of the preliminary contact with households responding to the NHIS and
subsampled as part of a MEPS panel, see "Design and Methods of the Medical Expenditure Panel
Survey, Household Component" by Joel Cohen.
HC Main Rounds 1-5
Five interviews will be conducted with each NHIS panel selected for the MEPS at three- to
four-month intervals over an approximately 24-month field period. The first three of these rounds
(Rounds 1A-3A) define the 1996 MEPS Household Component, and will collect the main body of
annual utilization and expenditure data for calendar year 1996. Rounds 3A-5A of the 1996 MEPS
panel will be combined with Rounds 1B-3B of the 1997 MEPS panel to yield the sample base for the
1997 MEPS Household Component and the source of annual estimates for that calendar year. All
interviews will be conducted in person through a Computer-assisted Personal Interview (CAPI) as the
principal data collection mode. Round 1 will ask about the period since January 1 of the MEPS year
to the date of that interview; Round 2 will ask about the time since the Round 1 interview through the
date of the Round 2 interview; and Round 3 will collect data since the date of the Round 2 interview
through the date of the Round 3 interview in 1997.
Questionnaires for these field rounds will parallel those used in 1987 NMES with some
modifications implemented for the 1992 Feasibility Study and with further changes indicated by the
latter experience and the FAMES (NMES-3) pretest. The instruments contain items that are asked
once in the life of the study, items that are asked repeatedly in each round, and items that are updated
in later rounds. Questions asked only once include basic sociodemographic characteristics. Core
questions asked repeatedly include health status, health insurance coverage, employment status, days
of restricted activity due to health problems, medical utilization, hospital admissions, and purchase of
medicines. For each health encounter identified, data will be obtained on the nature of health
conditions, the characteristics of the provider, the services provided, the associated charges, and
sources and amounts of payment.
Permission forms for medical providers and for sources of employment and private health
insurance coverage will be collected in the field. Under this design, anyone who reports being
employed but not covered by private health insurance will be asked to sign a permission form that
will allow contact with the employer. A sample of medical providers identified by MEPS
respondents will be contacted in the survey of medical providers, MPC, to verify and supplement
information provided by the family respondent in the household interview; employers and other
health insurance providers will be contacted in the survey of health insurance providers, IC, to verify
analogous insurance information and to collect other information on insurance characteristics that
household respondents would not typically know.
As a consequence of a successful test in the Feasibility Study, copies of policies providing
private insurance coverage to sampled persons will be collected from household respondents. These
requests will be initiated in Round 1 and will be followed up in Round 2 for eligible individuals who
have not provided copies of their policies at the time of the first request. Sampled persons will be
asked to provide the policies directly or to obtain them from their health insurance providers. A
description of the type of documents to be collected, a list of the policies identified by the respondent,
and request forms to be given to providers will be given to interviewing staff to assist in this effort.
HC Main Round 6
Round 6 is concerned with obtaining valuable ancillary information before a MEPS
panel is retired. For the 1997 MEPS, it will take place after April 15, 1998 and ask for tax filing
information details. Comparable information will be collected for the 1996 panel in Round 4 after
April 15, 1997. Administration of the majority of Round 6 interviews will be by telephone from the
interviewers' homes; in-person interviews will be conducted for those respondents without access to a
suitable telephone or for those for whom telephone administration is not feasible, e.g., respondents
with hearing or comprehension problems.
Return To Table Of Contents
3.0 Summary
The benefits of the redesigned MEPS include significant cost savings, enhanced analytical
capacities, increased opportunities for longitudinal analyses, reduction of major data gaps, and major
improvements in providing timely data access to the research community at large. The MEPS will
provide information to help understand how the dramatic growth of managed care, changes in private
health insurance, and other dynamics of today's market-driven health care delivery system have
affected, and are likely to affect, the kinds, amounts, and costs of health care that Americans use. The
survey will also provide necessary data for projecting who benefits from and who bears the cost of
changes to existing health policy and the creation of new policies.
The MEPS data will serve as the primary source to inform research efforts which examine
how health care use and expenditures vary among different sectors of the population, such as the
elderly, veterans, children, disabled persons, minorities, the poor, and the uninsured; and how the
health insurance of households varies by demographic characteristics, employment status and
characteristics, geographic locale, and other factors. The MEPS data will provide answers to
questions about private health insurance costs and coverage, such as how employers' costs vary by
region, and help evaluate the growing impact of managed care and of enrollment in different types of
managed care plans.
The first MEPS data will be available on public use data tapes starting as early as spring 1997.
MEPS data also will be used in a series of studies to be published by AHCPR, and by Agency and
other researchers publishing in the scientific literature. As a consequence of the shift to a continuous
ongoing annual survey, additional efficiencies in survey data collection, data editing and imputation
tasks will be realized, as well as further improvements in the timely release of MEPS data products to
the research community.
Return To Table Of Contents
4.0 References
Arnett RA, Hunter E, Cohen S, Madans J, Feldman J. The Department of Health and Human
Services' Survey Integration Plan. Proceedings of the American Statistical Association, section on
Government Statistics; 1996 Aug; Chicago (IL).
Cohen SB. The redesign of the Medical Expenditure Panel Survey: A component of the DHHS
Survey Integration Plan. Proceedings of the COPAFS Seminar on Statistical Methodology in the
Public Service; 1996 Nov; Bethesda (MD).
DiGaetano R. Sample design of the Household Component of the National Medical Expenditure
Survey (NMES-3). Draft report. Rockville (MD): Westat, Inc.; 1994.
Hunter E, Arnett R, Mathiowetz N, Cohen S, Madans J, Feldman J. HHS Survey Integration Plan:
Background materials, 1995.
Judkins D, Marker D, Waksberg J. National Health Interview Survey: Research for the 1995
redesign. Draft report prepared for the National Center for Health Statistics. Westat, Inc.; 1994.
Return To Table Of Contents
Appendix 2
Household Survey Design and Methods Report
Design and Methods of The Medical Expenditure Panel Survey
Household Component
March 1997
Joel Cohen
Agency for Health Care Policy and Research
Center for Cost and Financing Studies
2101 E. Jefferson Street, Suite 501
Rockville, Maryland 20852
(301) 594-1406
The Medical Expenditure Panel Survey (MEPS), is the third in a series of nationally
representative surveys of medical care use and expenditures sponsored by the Agency for Health Care
Policy and Research (formerly the National Center for Health Services Research). The first of these
surveys, called the National Medical Care Expenditure Survey (NMCES) was conducted in 1977, and
the second, called the National Medical Expenditure Survey (NMES), in 1987. The 1996 MEPS,
which is co-sponsored by the National Center for Health Statistics (NCHS), will update the 1987 data
to reflect the dramatic changes that have occurred in the U.S. health care system over the last decade.
Major changes have taken place in the health care delivery system of the nation since the last
NMES survey was conducted almost ten years ago. The most notable is the rapid expansion of
managed care arrangements such as HMOs, PPOs, and other provider networks that seek to minimize
the increases in health care costs, as well as the appearance of new hybrid forms of health insurance
coverage. Changes such as these have affected both the private and public sectors. The new MEPS is
needed to provide information about the current state of the health care system in the U.S., and the
changes that have taken place since the last national survey of medical expenditures was conducted in
1987. The information collected by the MEPS will also provide valuable baseline data for use in
evaluating future changes in the system.
The revised MEPS study design enhances
the capabilities to study change over time and the effects of new
health policies. These are important objectives in view of the various
health reform
initiatives that are being implemented by states and the Federal government.
The revised design allows for the production of annual estimates
for two calendar years, and also permits the tracking of
changes in employment, income, health status, and medical care use
and expenditures over the two consecutive years during which households
in the 1996 panel will be interviewed. In addition, the
National Health Interview Survey (NHIS) baseline data are available
for persons in the 1996 and 1997 MEPS panels, thereby adding another
data point for comparisons of change over time.
The MEPS extends the NMES series of studies on medical expenditures and health insurance,
and provides for the first time, data suitable for detailed analysis of trends and changes in these areas.
The survey is a unique resource for a number of reasons, including:
(1) Scope. MEPS provides information on a broad spectrum of the population, as the survey
sample base represents the civilian noninstitutionalized population and, in a separate
component survey, the population institutionalized in nursing homes. The MEPS also
provides information on all types of health care services, expenditures, and sources of
payment for both individuals and families.
(2) Population Basis. The fact that MEPS is a survey of persons allows population groups
that are or may become of special policy concern to be identified and analyzed. This is
especially important for analyzing the effect of particular eligibility requirements on the
enrollment and budgets of public programs and on those who are not eligible for such
programs.
(3) Cost-effectiveness. MEPS will collect data needed by groups that might otherwise sponsor
separate or overlapping surveys, or do without crucial information needed for important
decisions. Experience has demonstrated that broad-based data on use, expenses, and financing
of health care collected from a nationally representative sample can meet the data needs of a
wide variety of users in a cost-effective manner.
The original sample design of the NMES household surveys has been revised for the MEPS.
Instead of defining the MEPS sample through an initial screening round, the sample in the new design
is selected as a nationally representative subsample from households that participated in the NHIS.
The 1996 MEPS sample (based on the 1995 NHIS) will be carried forward into 1997 and combined
with a new subsample of households responding to the 1996 NHIS. These two panel samples (the
1996 MEPS sample and the new MEPS selections from the 1996 NHIS) will jointly define the sample
base for the 1997 MEPS Household Component. Exhibit 1 is a diagram of the study design for the
1996 and 1997 MEPS Household Components. Exhibit 2 summarizes various features of the study
design for the Household Component.
In 1996, the MEPS sample linked to the
1995 NHIS was selected from a nationally representative NHIS subsample
that included 195 PSU's and approximately 1,700 segments, yielding
approximately 10,500 responding NHIS households that MEPS recontacted.
This NHIS subsample
reflects an oversample of Hispanics and blacks. Other groups with
high public policy relevance in the areas of health care use and
financing are targeted for oversample as part of the MEPS 1997 panel
to
improve the precision of the estimates for those groups.
Households selected for participation in the 1996 or the 1997 MEPS household surveys are
interviewed in person five times (Rounds 1-5), and a last time during a brief telephone interview
(Round 6). The rounds of data collection are spaced approximately 4 months apart. The interviews
take place with a family respondent who reports for him/herself and for other family members.
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Preliminary Contact. Mail and telephone contacts take place prior to the first MEPS
interview (Round 1) with the NHIS participating households selected for each MEPS panel. The
purpose of the Preliminary Contact is to enlist the household respondent into the MEPS study and
plan for the delivery of study record-keeping materials prior to the start of the study observation
period on January 1st of the survey year. An advance letter announcing the MEPS survey is mailed in
December to the family respondent at the address where the NHIS interview was conducted. That
letter is followed up with an interviewer telephone call to confirm the arrival of the letter, verify the
identity of the household, identify the MEPS family respondent (if different from the NHIS
respondent), and announce the future mailing of a study calendar and record file. These materials are
sent accompanied by $5 to compensate respondents for the time and effort devoted to keeping records
in preparation for the Round 1 interview. A second telephone call confirms the arrival of these
materials and arranges for the most convenient time to conduct the Round 1 interview.
Households without telephones or those that can not be reached using the telephone number from
NHIS, are contacted by mail and asked to return a postcard identifying a telephone number where the
study can contact them (e.g., number at work, neighbor's house, etc.).
Core rounds. Data collection
for the MEPS Household Component takes place using the Computer-assisted
Personal Interview (CAPI) system. The study instrumentation is organized
as a
core instrument that is administered in each of the first 5 rounds
of data collection, with periodic supplements added in selected rounds
to deal with specific topics in greater depth. Dependent
interviewing methods, in which respondents are asked to confirm or
revise data provided in earlier interviews will be used to update
information in several of the core questionnaires, such as
employment and health insurance, after the initial interview.
Core Instrument: The core instrument
will collect data about all persons in sampled households. The core
instrument includes questionnaires on: demographics, health status
and
conditions, utilization, charges and payments, prescribed and over-the-counter
medicines purchased, employment, and health insurance.
Periodic Supplements: Supplements
scheduled for inclusion in the survey include questionnaires on:
access to care and satisfaction, income and assets, long-term care,
and
alternative care.
Self-Administered Questionnaire (SAQ): All adults in sample households are asked to
complete an SAQ in Round 2. This questionnaire collects information about health behaviors
and opinions that would be difficult if not impossible to collect on a proxy basis from the
family respondent. Similar information is collected for children as part of the regular
interview with the household survey respondent, usually the mother.
Medical Provider Permission Forms: Requests for signed permission forms take place in
Round 1 of the survey, much earlier than in past NMES studies, in order to expedite the
timetable for the later Medical Provider Component (MPC) of the survey, which collects data
about specific medical events directly from providers. Because results from a previous
methodological study suggested that early requests for signed permission forms involving
office-based physicians have a modest negative effect on survey cooperation rates in later
rounds, the requests for signed permission forms in Round 1 will be limited to events taking
place in hospitals. In Round 2 and subsequent rounds, requests for signed permission forms
will apply to all types of MPS-eligible medical providers (hospitals, physicians, and home
health agencies), including those associated with utilization reported in Round 1.
Health Insurance Permission Forms: Signed permission forms are needed to contact sources
of employment and private health insurance coverage in the Insurance Component of the
survey, which collects data directly from individuals' sources of health insurance (typically
their employers). These requests will be initiated in Round 2, and apply to the insurance
sources associated with plans held at the time of the Round 1 interview.
Health Insurance Policy Booklet Requests: Following procedures tested successfully in a
previous methodological study, MEPS interviewers will attempt to secure, directly from
respondents, health insurance booklets or other summary materials that describe the
characteristics of private plans held by family members at the time of the Round 1 interview.
The requests for policy information will include all sources of private insurance coverage, not
just employment-related coverage. Respondents are reimbursed $15 for the time and effort
involved in procuring policy booklets.
Provider Directories: To expedite the identification of medical providers and assist with the
preparation of an unduplicated list of medical providers for the fielding of MPS, interviewers
use a computerized database (directory) of health providers that has been loaded into the CAPI
laptop. Search software also loaded into the laptops enables interviewers to query the
database of providers in the course of the MEPS interview. If a match is found in the database
for the provider nominated by the household respondent, the matched directory record is
associated with the household member. Directory records include the following information
for each provider: a unique provider ID; the provider's name, address and telephone number;
and the provider's specialty (for individual office-based physicians).
At the most basic level, the objective
of the MEPS Household Component is the collection of data that can
be used to produce annual estimates for a variety of measures related
to the characteristics
of individuals, their health insurance coverage, and their health care
use, expenditures, and sources of payment for care. The data can
also be used to support behavioral analyses that inform researchers
and policymakers about how the characterstics of individuals and families,
including their health
insurance, affect medical care use and spending.
Data obtained in this study will be used to produce, for example, the following national
estimates for calendar years 1996 and 1997:
annual estimates of health care use and expenditures for persons and families.
annual estimates of sources of payment for health care expenses, including amounts paid by
public programs, such as Medicare and Medicaid, and by private insurance, as well as out-of-pocket payments.
annual estimates of health care use, expenditures and sources of payment for persons and
families by type of service, including: inpatient hospital stays, ambulatory care, home health
care, dental care, and purchases of prescribed and over-the-counter medicines.
the number and characteristics of the population eligible for each of the public programs,
including the use of services and expenditures of the population eligible for benefits under
Medicare, Medicaid, CHAMPUS/VA and the Veterans Administration.
the number, characteristics, use of services, expenditures and benefits of persons and families
with individual or group coverage, commercial and nonprofit coverage, and coverage through
HMOs or other managed care arrangements.
In addition to national estimates, data collected in this longitudinal study will be used to study
the determinants of the use of services and expenditures, and the effects of individual characteristics
and policy changes on medical care use and expenses. These behavioral analyses will include studies
of:
social and demographic factors such as employment and income.
methods of financing health care and health insurance.
the health habits, life styles and behavioral patterns of individuals and families.
the health needs of specific subpopulation groups of current or potential policy interest, such
as the elderly and members of racial or ethnic minorities.
Finally, data collected in this survey in conjunction with data from the 1977 NMCES and the
1987 NMES will be used to study trends in the nature and distribution of national health expenditures,
sources of care, and amounts and types of services consumed by the U.S. noninstitutionalized
population.
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