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MEPS HC-026I: Appendix to MEPS 1998 Event Files
HC-026A - HC-026H
December 2001
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 Survey Management
C. Technical and Programming
Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Format
2.2 Variable Naming and Source
2.3 Contents of File 1:
Condition-Event Link File (CLNK)
2.4 Contents of File 2:
Prescribed Medicines-Event Link File (RXLK)
2.5 1998 Condition-Event
Frequency Table
2.6 1998 Utilization and
Expenditures Summary Table
3.0 Merging/Linking MEPS Data
Files3.1 Example A: Using the RXLK
and CLNK Files with the Medical
Conditions File (HC-027), the
Prescribed Medicines and Office-Based Medical Provider Visits Event
Files (HC-026A and HC-026G)
3.2 Example B: Using the CLNK
File with the Medical Conditions File (HC-027) and the Prescribed
Medicines
Event File (HC-026A)
3.3 Example C: Using the CLNK
File with the Medical Conditions File (HC-027) and Office-Based
Medical Provider Visits Event File (HC-026G)
3.4 Example D: Using the RXLK
File with the Other Medical Expenses Event File (HC-026C)
3.5 Limitations/Caveats of the
CLNK File
3.6 Limitations/Caveats of the
RXLK File
Attachment 1: Clinical Classification Code to ICD-9-CM Code Crosswalk (link to separate file)
Attachment 2: Sample SAS Jobs for Linking Examples (link to separate file)
A. Data Use Agreement
Individual identifiers have been removed
from the microdata 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 Healthcare Research and
Quality (AHRQ) and/or the National Center for Health Statistics (NCHS) may not
be used for any purpose other than for the purpose for which they were supplied;
any effort to determine the identity of any reported cases, is prohibited by
law.
Therefore in accordance with the above
referenced Federal statute, it is understood that:
-
No one is to use the data in this
data set in any way except for statistical reporting and analysis.
-
If the identity of any person or
establishment should be discovered inadvertently, then (a) no use will be
made of this knowledge, (b) the Director, Office of Management, AHRQ will
be advised of this incident, (c) the information that would identify any
individual or establishment will be safeguarded or destroyed, as requested
by AHRQ, and (d) no one else will be informed of the discovered identity.
-
No one will attempt to link this
data set with individually identifiable records from any data sets other
than the Medical Expenditure Panel Survey or the National Health Interview
Survey.
By using these data you signify your
agreement to comply with the above-stated statutorily based requirements, with
the knowledge that deliberately making a false statement in any matter within
the jurisdiction of any department or agency of the Federal Government violates
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 Healthcare Research and
Quality requests that users cite AHRQ and the Medical Expenditure Panel Survey
as the data source in any publications or research based upon these data.
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B. Background
This documentation describes one in a
series of public use files from the Medical Expenditure Panel Survey (MEPS). The
survey provides a new and extensive data set on the use of health services and
health care in the United States.
MEPS is conducted to provide nationally
representative estimates of health care use, expenditures, sources of payment,
and insurance coverage for the U.S. civilian noninstitutionalized population.
MEPS is cosponsored by the Agency for Healthcare Research and Quality (AHRQ)
(formerly the Agency for Health Care Policy and Research (AHCPR)) and the
National Center for Health Statistics (NCHS).
MEPS comprises three component surveys:
the Household Component (HC), the Medical Provider Component (MPC) and the
Insurance Component (IC). The HC is the core survey, and it forms the basis for
the MPC sample and part of the IC sample. Together these surveys yield
comprehensive data that provide national estimates of the level and distribution
of health care use and expenditures, support health services research, and can
be used to assess health care policy implications.
MEPS is the third in a series of national
probability surveys conducted by AHRQ on the financing and use of medical care
in the United States. The National Medical Care Expenditure Survey (NMCES, also
known as NMES-1) was conducted in 1977. The National Medical Expenditure Survey
(NMES-2) was conducted 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 noninstitutionalized population, collects medical
expenditure data at both the person and household levels. The HC collects
detailed data on demographic characteristics, health conditions, health status,
use of medical care services, charges and payments, access to care, satisfaction
with care, health insurance coverage, income, and employment.
The HC uses an overlapping panel design in
which data are collected through a preliminary contact followed by a series of
five rounds of interviews over a 2½-year period. Using computer-assisted
personal interviewing (CAPI) technology, data on medical expenditures and use
for two calendar years are collected from each household. This series of data
collection rounds is launched each 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 noninstitutionalized 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 who:
-
were identified by the household
respondent as providing care for HC respondents receiving Medicaid.
-
were selected through a 75-percent
sample of HC households receiving care through an HMO (health maintenance
organization) or managed care plan.
-
were selected through 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 name, 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. In some instances, providers sent
medical and billing records which were abstracted into the survey instruments.
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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 survey. Data are
collected from the selected organizations through a prescreening telephone
interview, a mailed questionnaire, and a telephone follow-up for nonrespondents.
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4.0 Survey
Management
MEPS data are collected under the
authority of the Public Health Service Act. They are edited and published in
accordance with the confidentiality provisions of this act and the Privacy Act.
NCHS provides consultation and technical assistance.
As soon as data collection and editing are
completed, the MEPS survey data are released to the public in staged releases of
summary reports and microdata files. Summary reports are released as printed
documents and/or as electronic files on the MEPS web site (www.meps.ahrq.gov).
All microdata files are available for download from the MEPS web site in
compressed formats (zip and self-extracting executable files). Selected data
files are available on CD-ROM from the MEPS clearinghouse.
For printed documents and CD-ROMs that are
available through the AHRQ Publications Clearinghouse, write or call:
AHRQ Publications Clearinghouse
Attn: (publication number)
P.O. Box 8547
Silver Spring, MD 20907
800/358-9295
410/381-3150 (callers outside the United
States only)
888/586-6340 (toll-free TDD service;
hearing impaired only)
Be sure to specify the AHRQ number of the
document or CD-ROM you are requesting.
Additional information on MEPS is
available from the MEPS project manager or the MEPS public use data manager at
the Center for Cost and Financing Studies, Agency for Healthcare Research and
Quality.
Return To Table Of Contents
C. Technical and
Programming Information
1.0 General
Information
This documentation describes the MEPS
Public Use Release HC-026I, which is the Appendix to MEPS releases HC-026A
through HC-026H. This release contains two data files, both of which are
provided in ASCII and SAS versions: 1) the condition-event link file; and 2) the
prescribed medicines-event link file. Also included in this release are two
tables provided as PDF files: 1) the condition-event frequency table and 2) the
utilization and expenditures summary table.
This documentation offers a brief overview
of the content and structure of the files and the codebooks (provided as files
H26IF1CB.PDF and H26IF2CB.PDF). It contains the following sections:
Data File Information
Merging MEPS Data Files
Crosswalk of Clinical Classification Code
to ICD-9 Code
For more information on MEPS HC survey
design see S. Cohen, 1997; J. Cohen, 1997; and S. Cohen, 1996. For information
on the MEPS MPC design, see S. Cohen, 1998. Both reports, along with a
copy of the survey instruments used to collect the information on this file, is
available on the MEPS web site at the following address: <http://www.meps.ahrq.gov>.
Return To Table Of Contents
2.0 Data File
Information
This public use data set consists of two
data files containing variables for linkage of the MEPS 1998 event-level data
files. File 1, the H26IF1 or "CLNK" file, is used for linking the MEPS
condition file with the MEPS event files; File 2, the H26IF2 or "RXLK"
file, is used for linking the MEPS prescribed medicines event file with other
MEPS event files.
2.1 Codebook
Format
Section D of this document includes
codebooks describing the ASCII version of each data file (the data are also
provided as SAS transport files). The following codebook items are provided for
each variable on the file:
|
IDENTIFIER |
DESCRIPTION |
| Name |
Variable name (maximum of 8
characters) |
| Description |
Variable descriptor (maximum
of 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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2.2 Variable
Naming and Source
In general, variable names reflect the
content of the variable, with an 8 character limitation. All variables contained
on Files 1 and 2 were derived from the CAPI.
2.3 Contents of File 1:
Condition-Event Link File (CLNK)
File 1, (H26IF1) or the CLNK file,
contains the variables needed to link each record on the MEPS 1998 condition
file, HC-027, with one or more records on the MEPS 1998 event files, HC-026A
through HC-026H. Section 3.0 contains additional information on completing this
linkage.
The 8-character variable DUPERSID uniquely
identifies each person represented on the file. There may be more than one
record on the CLNK file for a specific DUPERSID value.
CONDIDX is the ID which uniquely
identifies each condition for a person and corresponds to a unique record on the
MEPS 1998 Condition file, HC-027. There may be more than one record on the CLNK
file for a specific CONDIDX value.
EVNTIDX is the 12-digit number which
uniquely identifies each event for a person and corresponds to a unique record
on one of the MEPS 1998 event files, HC-026B through HC-026H. (EVNTIDX is not
included on the 1998 Prescription Medicines event file, HC-026A; rather, on this
file the variable for linking with EVNTIDX on the CLNK file is LINKIDX.) There
may be more than one record on the CLNK file for a specific EVNTIDX value.
CLNKIDX is the 24-digit number which
uniquely identifies each record on the CLNK file and is the combination of
CONDIDX + EVNTIDX. There is just one record on this file for each value of
CLNKIDX, i.e., each unique combination of CONDIDX + EVNTIDX.
The variable EVENTYPE indicates the type
of event record identified by EVNTIDX, and has the following values:
1 = MVIS - office-based medical
provider visit event contained on MEPS release HC-026G
2 = OPAT - outpatient department visit
event contained on MEPS release HC-026F
3 = EROM - emergency room visit event
contained on MEPS release HC-026E
4 = STAZ - hospital inpatient stay
event contained on MEPS release HC-026D
5
= DVIS - dental visit event
contained on MEPS release
HC-026B
7
= HVIS - home health visit event
contained on MEPS release
HC-026H
8 = PMED - prescribed medicines event
contained on MEPS release HC-026A
Return To Table Of Contents
2.4 Contents of File 2:
Prescribed Medicines-Event Link File (RXLK)
File 2, (H26IF2) or the RXLK file,
contains the variables needed to link each record on the MEPS 1998 prescribed
medicines file, HC-026A, with one or more records on the MEPS 1998 event files,
HC-026B through HC-026H. Section 3.0 contains additional information on
completing this linkage.
The 8-character variable DUPERSID uniquely
identifies each person represented on the file. There may be more than one
record on the RXLK file for a specific DUPERSID value.
EVNTIDX is the 12-digit number which
uniquely identifies each event for a person and corresponds to a unique record
on one of the MEPS 1998 event files, HC-026B through HC-026H. There may be more
than one record on the RXLK file for a specific EVNTIDX value.
LINKIDX is the 12-digit number which
identifies the record(s) on the prescribed medicines file, HC-026A which link to
an event record. There may be more than one record on the RXLK file for a
specific LINKIDX value, and there may be more than one record on the HC-026A
file for a specific LINKIDX value.
RXLKIDX is the 24-digit number which
uniquely identifies each record on the RXLK file, and is the combination of
EVNTIDX + LINKIDX. There is just one record on this file for each value of
RXLKIDX, i.e., each unique combination of EVNTIDX + LINKIDX.
The variable EVENTYPE indicates the type
of event record identified by EVNTIDX, and has the following values:
1 = MVIS - office-based medical
provider visit event contained on MEPS release HC-026G
2 = OPAT - outpatient department visit
event contained on MEPS release HC-026F
3 = EROM - emergency room visit event
contained on MEPS release HC-026E
4 = STAZ - hospital inpatient stay
event contained on MEPS release HC-026D
5
= DVIS - dental visit event
contained on MEPS release
HC-026B
6 = OMED - other medical expense event
contained on MEPS release HC-026C
Return To Table Of Contents
2.5 1998 Condition-Event
Frequency Table
The file H26IT1.PDF contains the "MEPS
1998 Condition-Event Frequency" table. This table contains unweighted and
weighted counts of records on the MEPS 1998 event files, HC-026A through
HC-026H, for each of the condition, procedure and clinical classification codes
contained on the MEPS 1998 condition file, HC-027. Attachment 1 contains a
crosswalk of the clinical classification codes to ICD-9 codes. See the HC-027
document for additional information on these codes.
2.6 1998 Utilization and
Expenditures Summary Table
The file H26IT2.PDF contains the "MEPS
1998 Utilization and Expenditures Summary" table. This table contains
statistics for all of the utilization and expenditure variables contained on the
MEPS 1998 Full Year Use and Expenditure Data file, HC-028. For each of these
variables, the following statistics are provided from the HC-028 file, and from
the corresponding event-level file(s) HC-026A through HC-026H:
Number of persons with positive
person-level weight (WTDPER98) and with value GT 0 for that variable
Weighted sum of the variable
Weighted mean of the variable
The table also includes the technical
specifications used to construct each of the person-level HC-028 variables from
the event-level files.
Return To Table Of Contents
3.0 Merging/Linking MEPS Data
Files
This section provides information on using
each of the two HC-026I files, RXLK and CLNK, to link with the files contained
in MEPS releases HC-027 and HC-026A through HC-026H. The linking procedure is
described using several examples of deriving MEPS-based estimates. Also included
in this section are several caveats related to using the RXLK and CLNK files.
3.1 Example A: Using the RXLK and CLNK Files with
the Medical Conditions File
This example calculates the total
expenditures for prescribed medicines associated with office-based medical
provider visits for asthma, using these files: the condition file (HC-027),
the CLNK file, the office-based medical provider visit event file (HC-026G),
the RXLK file, and the prescribed medicines event file (HC-026A). It
includes the following major steps:
1. From HC-027 file select only
records with condition coded as asthma.
2. Use the CLNK file to obtain
unique record IDs of events which are linked to each of the selected
asthma condition records.
3. From the HC-026G file, select
only records for non-telephone office-based medical provider visits for
persons with a positive weight.
4. Using the selected record IDs
obtained from the CLNK file with the selected HC-026G records, identify
only those visits which were for asthma.
5. Use the RXLK file with the
selected visit records which were for asthma, to obtain unique record
IDs of prescribed medicine records from file HC-026A linked to those
visits.
6. Using these record IDs obtain
the linked records from the HC-026A file and calculate the weighted mean
of the expenditure variable.
Attachment 2 contains a copy of the SAS
job for this example.
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3.2 Example B: Using the CLNK File
with the Medical Conditions File (HC-027) and the Prescribed Medicines Event
File (HC-026A)
This example calculates the total
expenditure for prescribed medicines associated with asthma, using the condition
file (HC-027), the CLNK file and the prescribed medicines event file (HC-026A).
It includes the following major steps:
1. From HC-027 file select only
records with condition coded as asthma.
2. Use the CLNK file to obtain
unique record IDs of events which are linked to each of the asthma
condition records.
3. Using these record IDs, obtain
linked records from the HC-026A file and calculate the weighted mean of
the expenditure variable.
Attachment 2 contains a copy of the SAS
job for this example.
Return To Table Of Contents
3.3 Example C: Using the CLNK File
with the Medical Conditions File (HC-027) and Office-Based Medical Provider
Visits Event File (HC-026G)
This example calculates the total
expenditures for office-based medical provider visits associated with asthma,
using the condition file (HC-027), the CLNK file and the office-based medical
provider visits event file (HC-026G). It includes the following major steps:
1. From HC-027 file select only
records with condition coded as asthma.
2. Use the CLNK file to obtain
unique record IDs of events which are linked to each of the asthma
condition records.
3. From the HC-026G file,
select only records for non-telephone office-based medical provider
visits for persons with a positive weight.
4. Using the selected record IDs
obtained from the CLNK file, with the selected HC-026G records, identify
only those visits which were for asthma and calculate the weighted mean
of the expenditure variable.
Attachment 2 contains a copy of the SAS
job for this example.
Return To Table Of Contents
3.4 Example D: Using the
RXLK File with the Other Medical Expenses Event File (HC-026C)
This example calculates the total
prescription expenditures for other medical events reported by the household
with type of other medical expense indicated as insulin (OMTYPEX=2), using the
RXLK file and the other medical expenses event file (HC-026C). It includes the
following major steps:
1. From HC-026C file select only
records for other medical expense type of insulin, for persons with a
positive weight.
2. Use the RXLK file to obtain
unique record IDs of prescribed medicine events which are linked to each
of the selected other medical expense records.
3. Use the selected record IDs
from the RXLK file to obtain the linked prescribed medicines event
records from the HC-026A file, and calculate the weighted sum of the
expenditure variable.
Attachment 2 contains a copy of the SAS
job for this example.
Return To Table Of Contents
3.5 Limitations/Caveats
of the CLNK File
When using the CLNK file, analysts should
keep in mind that (1) conditions are self-reported and (2) there may be multiple
conditions associated with an event. Users should also note that not all events
link to the condition file.
3.6 Limitations/Caveats
of the RXLK File
When using RXLK, analysts should keep in
mind that one event record can link to more than one prescribed medicine record.
Conversely, a prescribed medicine record may link to more than one event record
in the same event file and/or more than one event record in other event files.
When this occurs, it is up to the analyst to determine how the prescribed
medicine expenditures should be allocated among those medical events.
Attachment 1: Clinical Classification Code to ICD-9-CM Code Crosswalk (link to separate file)
Attachment 2: Sample SAS Jobs for Linking Examples (link to separate file)
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