|
MEPS HC-033H: 1999 Home Health File
May 2002
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
Structure
2.2
Reserved Codes
2.3 Codebook
Format
2.4 Variable
Naming
2.4.1 General
2.4.2 Expenditure
and Sources of Payment Variables
2.5 File
Contents
2.5.1 Survey
Administration
2.5.1.1 Person
Identifiers (DUID, PID, DUPERSID)
2.5.1.2 Record
Identifiers (EVNTIDX)
2.5.1.3 Round
Indicators (EVENTRN, HHR2FLAG)
2.5.2
Characteristics of Home Health Events2.5.2.1 Date
Home Health Event Started (HHBEGYR, HHBEGMM)
2.5.2.2
Characteristics of Home Health Events (MPCELIG-OTHCWOS)
2.5.2.3
Treatments, Therapies and Services (HOSPITAL-OTHSVCOS)
2.5.2.4 Frequency
of Home Health Events (FREQCY-HHDAYS)
2.5.3
Condition and Procedure Codes and Clinical Classification
Codes
2.5.4 Expenditure
Data
2.5.4.1 Definition
of Expenditures
2.5.4.2 Data
Editing/Imputation Methodologies of Expenditure Variables
3.0 Sample
Weight (PERWT99F)
3.1 Overview
3.2 Details
on Person Weights Construction
3.2.1 MEPS Panel 3
Weight
3.2.2 MEPS Panel 4
Weight
3.2.3 The
Final Weight for 1999
3.2.4 Coverage
4.0 Strategies
for Estimation
4.1 Variables
with Missing Values
4.2 Basic
Estimates of Utilization, Expenditure and Sources of Payment
4.3 Estimates of
the Number of Persons with Home Health Events Due to a
Hospitalization
4.4
Person-Based Ratio Estimates
4.4.1
Person-Based Ratio Estimates Relative to Persons with Home
Health Events by Paid Independent Providers
4.4.2 Person-Based
Ratio Estimates Relative to the Entire Population
4.5 Sampling
Weights for Merging Previous Releases of MEPS Household Data
with this Event File
4.6 Variance
Estimation
5.0
Merging/Linking MEPS Data Files
5.1 Linking a
1999 Person-Level File to the 1999 Home Health Provider
Event File
5.2 Linking the
1999 Home Health Provider Event File to the 1999 Medical
Conditions File and/or the 1999 Prescribed Medicines File
5.3
Limitations/Caveats of RXLK (the 1999 Prescribed Medicine
Link File)
5.4
Limitations/Caveats of CLNK (the 1999 Medical Conditions
Link File)
References
Attachment 1
D.
Variable-Source Crosswalk
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.
Return
To Table Of Contents
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) and the National Center for
Health Statistics (NCHS).
MEPS is a family of three
surveys. The Household Component (HC) is the core survey and
forms the basis for the Medical Provider Component (MPC) and
part of the Insurance Component (IC). Together these surveys
yield comprehensive data that provide national estimates of
the level and distribution of health care use and
expenditures, support health services research, and can be
used to assess health care policy implications.
MEPS is the third in a
series of national probability surveys conducted by AHRQ on
the financing and use of medical care in the United States.
The National Medical Care Expenditure Survey (NMCES) was
conducted in 1977, and the National Medical Expenditure
Survey (NMES) was conducted in 1987. Since 1996, MEPS has
continued this series with design enhancements and
efficiencies that provide a more current data resource to
capture the changing dynamics of the health care delivery
and insurance system.
The design efficiencies
incorporated into MEPS are in accordance with the Department
of Health and Human Services (DHHS) Survey Integration Plan
of June 1995, which focused on consolidating DHHS surveys,
achieving cost efficiencies, reducing respondent burden, and
enhancing analytical capacities. To advance these goals,
MEPS includes linkage with the National Health Interview
Survey (NHIS)–a survey conducted by NCHS from which the
sample for the MEPS HC is drawn--and enhanced longitudinal
data collection for core survey components. The MEPS HC
augments NHIS by selecting a sample of NHIS respondents,
collecting additional data on their health care
expenditures, and linking these data with additional
information collected from the respondents' medical
providers, employers, and insurance providers.
Return
To Table Of Contents
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 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. NHIS provides
a nationally representative sample of the U.S. civilian
noninstitutionalized population, with oversampling of
Hispanics and blacks.
Return
To Table Of Contents
2.0 Medical Provider
Component
The MEPS MPC supplements
and/or replaces information on medical care events reported
in the MEPS HC by contacting medical providers and
pharmacies identified by household respondents. The MPC
sample includes all home health agencies and pharmacies
reported by HC respondents. Office-based physicians,
hospitals, and hospital physicians are also included in the
MPC but may be subsampled at various rates, depending on
burden and resources, in certain years.
Data are collected on
medical and financial characteristics of medical and
pharmacy events reported by HC respondents. The MPC is
conducted through telephone interviews and record
abstraction.
Return
To Table Of Contents
3.0
Insurance Component
The MEPS IC collects data
on health insurance plans obtained through private and
public-sector employers. Data obtained in the IC include the
number and types of private insurance plans offered,
benefits associated with these plans, premiums,
contributions by employers and employees, and employer
characteristics.
Establishments
participating in the MEPS IC are selected through three
sampling frames:
-
A list of employers
or other insurance providers identified by MEPS HC
respondents who report having private health insurance
at the Round 1 interview.
-
A Bureau of the
Census list frame of private-sector business
establishments.
-
The Census of
Governments from the Bureau of the Census.
To provide an integrated
picture of health insurance, data collected from the first
sampling frame (employers and other insurance providers
identified by MEPS HC respondents) are linked back to data
provided by those respondents. Data collected from the two
Census Bureau sampling frames are used to produce annual
national and State estimates of the supply and cost of
private health insurance available to American workers and
to evaluate policy issues pertaining to health insurance.
National estimates of employer contributions to group health
insurance from the MEPS IC are used in the computation of
Gross Domestic Product (GDP) by the Bureau of Economic
Analysis.
The MEPS IC is an annual
panel survey. Data are collected from the selected
organizations through a prescreening telephone interview, a
mailed questionnaire, and a telephone followup for
nonrespondents.
Return
To Table Of Contents
4.0 Survey
Management
MEPS data are collected
under the authority of the Public Health Service Act. They
are edited and published in accordance with the
confidentiality provisions of this act and the Privacy Act.
NCHS provides consultation and technical assistance.
As soon as data
collection and editing are completed, the MEPS survey data
are released to the public in staged releases of summary
reports, microdata files, and compendiums of tables. Data
are also released through MEPSnet, an online interactive
tool developed to give users the ability to statistically
analyze MEPS data in real time. Summary reports and
compendiums of tables are released as printed documents and
electronic files. Microdata files are released on CD-ROM
and/or as electronic files.
Printed documents and
selected public use file data on CD-ROMs 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.
Selected electronic files are available through the Internet
on the MEPS Web site: http://www.meps.ahrq.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 Healthcare Research and Quality.
Return
To Table Of Contents
C.
Technical and Programming Information
1.0 General
Information
This documentation
describes one in a series of public use event files from the
1999 Medical Expenditure Panel Survey Household Component
(HC) and Medical Provider Component (MPC). Released as an
ASCII data file and SAS transport file, this public use file
provides detailed information on home health events for a
nationally representative sample of the civilian
noninstitutionalized population of the United States and can
be used to make estimates of home health utilization and
expenditures for calendar year 1999. As illustrated below,
this file consists of MEPS survey data obtained in the 1999
portion of Round 3 (and Round 2 for some cases, see
HHR2FLAG), and Round 4 and 5 for Panel 3, as well as Rounds
1, 2, and the 1999 portion of Round 3 for Panel 4 of the
MEPS HC (i.e., the rounds for the MEPS panels covering
calendar year 1999).
301 Moved Permanently
301 Moved Permanently
Note:
Typically for MEPS panels, MEPS
Round 2 data collection ends in the first year of a
panel and Round 3 data collection begins in the first
year of the panel and crosses the year boundary into
the second year of the panel. The crosshatched area in
the above figure signifies that Round 2 data
collection for approximately one quarter of the Panel
3 households began in 1998, the first year of the
panel, but ended in 1999. For those households, all of
the Round 3 data collection occurred in 1999. For the
other three quarters of Panel 3 households, Round 2
data collection followed the typical pattern and began
and ended in 1998. For those households, Panel 3 Round
3 data collection took place during both the first and
second years of the panel, as is typically done for
Round 3.
Note: The
gray shaded area in the above figure indicates the portion of Panel 4 Round 3
data collection that extended into January 2000.
Counts (utilization) of
home health events are based entirely on household reports.
Agency home health providers were sampled into the MEPS MPC
(see Section B. 2.0). Only those providers for whom the
respondent signed a permission form were included in MPC.
Information from MPC was used to supplement expenditure and
payment data reported by the household.
Data from this event file
can be merged with other 1999 MEPS HC data files for
purposes of appending person characteristics, such as
demographic or health insurance coverage to each home health
record.
This file can be also
used to construct summary variables of expenditures, sources
of payment, and related aspects of home health events for
calendar year 1999. Aggregate annual person-level
information on the use of home health providers and other
health services use is provided on the 1999 Population
Characteristics file, where each record represents a MEPS
sampled person.
The following
documentation offers a brief overview of the data provided,
and the content and structure of the file and the codebook.
It contains the following sections:
Data File Information
Sample Weights
Merging MEPS Data Files
References
Variable to Source Crosswalk
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. 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
The 1999 home health
public use data set consists of one event level data file.
The file contains characteristics associated with the home
health event and imputed expenditure data. For users wanting
to impute expenditures, pre-imputed data are available
through the CCFS data center. Please visit the CCFS data
center website for details: <http://www.meps.ahrq.gov/data_stats/onsite_datacenter.jsp>.
The data user/analyst is forewarned that the imputation of
expenditures will necessitate a sizable commitment of
resources: financial; staff; and time.
This public use data set
contains characteristics associated with the home health
event and imputed expenditure data. Each record represents a
household-reported home health event. A home health event is
a MONTH of similar service provided by the same PROVIDER --
a month of home health services from a single provider
entity (i.e., paid independent, informal or agency). For
example, if a person received 4 events from a nurse, 10
events from a homemaker and 4 events from a physical
therapist all from the same provider every month for 3
months, then there will be 3 event records on the file, one
for each month (NOT 54 records). Data were collected in this
manner because agencies, hospitals, and nursing homes
provide expenditure data in this manner. In order to be
consistent with the definition of what is considered a home
health event on this file, this same definition (i.e., a
month of similar services) was applied to all types of
providers.
This public use data set
contains 3,073 home health records. Of the 3,073 records,
3,046 are associated with persons having a positive
person-level weight (PERWT99F). It includes all records
related to home health events for all household survey
respondents who resided in eligible responding households
and reported at least one home health event. Each record
represents one household-reported home health event that
occurred during calendar year 1999. Some household
respondents may have multiple events and thus will be
represented in multiple records on the file. Other household
respondents may have reported no events and thus will have
no records on this file. These data were collected during
the 1999 portion of Round 3 (Round 2 for some cases, see
HHR2FLAG), and Rounds 4 and 5 for Panel 3, as well as Rounds
1, 2, and the 1999 portion of Round 3 for Panel 4 of the
MEPS HC. The persons represented on this file had to meet
either (a) or (b):
(a) Be classified
as a key in-scope person who responded for his or her
entire period of 1999 eligibility (i.e., persons with
a positive 1999 full-year person-level sampling weight
(PERWT99F>0)), or
(b) Be classified
as either an eligible non-key person or an eligible
out-of-scope person who responded for his or her
entire period of 1999 eligibility, and belonged to a
family (i.e., all persons with the same value for
FAMID) in which all eligible family members responded
for their entire period of 1999 eligibility, and at
least one family member has a positive 1999 full-year
person weight (i.e., eligible non-key or eligible
out-of-scope persons who are members of a family all
of whose members have a positive 1999 full-year MEPS
family-level weight (WTFAM99>0)).
Please refer to
Attachment 1 for definitions of key, non-key, inscope and
eligible. Persons with no home health events for 1999 are
not included on this file but are represented on the 1999
MEPS person-level files. A codebook for the data file is
provided (in file H33HCB.PDF).
Home health providers
include formal or paid, and informal or unpaid providers.
Formal or paid providers include: home health agency,
hospital, or nursing home, and other independent paid
providers. Informal or unpaid providers include family and
friends.
For home health agencies,
hospitals, and nursing homes, it is important to distinguish
between the provider and the home health worker. In these
cases, the provider is the agency or the facility that
employs the workers. The home health workers are the people
who administer the care. Examples of home health care
workers are the following: nurses, physical therapists, home
health aides, homemakers, and hospice workers, among others.
These examples are generally the types of workers associated
with agencies, hospitals, and nursing homes. Paid
independent providers generally include companions, nursing
assistants, physicians, etc. For each record on this file,
one or more types of workers can be reported. The respondent
is asked to mention all of the types of home health workers
whom provided home health care (since records represent a
month of service, there can be more than one type of worker
on a single record). For example, an agency that provides
two types of aides that provide home health care to the same
person during a specific month is represented as one event
on the file (even though two workers employed at the same
agency provided care) -- when using this file analysts must
keep in mind that a record on the file corresponds to a
provider entity not an individual or particular worker.
Expenditure data for home
health agency events are collected exclusively in the MPC.
Expenditure data for other paid independent home health care
events are collected from the household, since these types
of events are not included in the MPC. Friends, family and
volunteers providing home health care to a person are
considered unpaid and are not included in the MPC (no
expenditure information is available for them).
Each home health record
also includes the following: date the provider started
seeing the respondent; type of provider; types of services
provided and if this was a repeat event; if care was
received due to hospitalization; whether or not a person was
taught how to use medical equipment; imputed sources of
payment, total payment and total charge for the home health
event expenditure; and a full-year person-level weight.
Data from this file can
be merged with previously released 1999 MEPS HC person-level
data using the unique person identifier, DUPERSID, to append
person-level characteristics such as demographic or health
insurance coverage to each record. The 1999 home health
event file can also be linked to the MEPS 1999 Medical
Conditions File and the MEPS 1999 Prescribed Medicines File.
Please see Section 5.0 and the 1999 Appendix File for
details on how to link MEPS data files.
Panel 3 cases (PANEL99=3
on the 1999 person-level file) can be linked back to the
1999 MEPS HC Public Use Data Files. However, the user should
be aware, at this time, no weight is being provided to
facilitate 2-year analysis of Panel 3 data.
Return
To Table Of Contents
2.1 Codebook
Structure
For each variable on the
file, both weighted and unweighted frequencies are provided
in the codebook (file H33HCB.PDF). The codebook and data
file sequence list variables in the following order:
Unique person identifiers
Unique home health event identifier
Other survey administration variables
Home health characteristic variables
Imputed expenditure variables
Weight and variance estimation variables
Return
To Table Of Contents
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. |
Generally, -1,-7, -8, and
-9 have not been edited on this file. The values of -1 and
-9 can be edited by analysts by following the skip patterns
in the questionnaire. A copy of the Household Component
questionnaire can be found on the World Wide Web at <http://www.meps.ahrq.gov/mepsweb/survey_comp/survey.jsp>.
Return
To Table Of Contents
2.3 Codebook Format
The codebook describes an
ASCII data set (although the data are also being provided in
a SAS transport file). The following codebook items are
provided for each variable:
|
Identifier |
Definition |
|
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 |
Return To Table Of
Contents
2.4 Variable Naming
In general, variable
names reflect the content of the variable, with an
8-character limitation. Generally,
imputed/edited variables end with an "X."
2.4.1 General
Variables were derived
either from the HC questionnaire itself, the MPC data
collection instrument, or from the CAPI. The source of each
variable is identified in Section D, entitled,
"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 which come from one or more
specific questions have those numbers and the questionnaire
section indicated in the "Source" column; (3)
variables constructed from multiple questions using complex
algorithms are labeled "Constructed" in the
"Source" column; and (4) variables which have been
imputed are so indicated.
Return
To Table Of Contents
2.4.2 Expenditure and
Sources of Payment Variables
The expenditure and
sources of payment variable names follow a standard naming
convention, are 7 characters in length and end in an
"X" indicating editing/imputation. Please note
that imputed means that a series of logical edits, as well
as an imputation process to account for missing data, have
been performed on the variable.
The total sum of
payments, 12 sources of payment variables and total charge
variable are named consistently in the following way:
The first two characters
indicate the type of event:
|
IP - inpatient
stay |
OB - office-based
visit |
|
ER - emergency
room visit |
OP - outpatient
visit |
|
HH - home health
event |
DV - dental visit |
|
OM - other
medical equipment |
RX - prescribed
medicine |
In the case of sources of
payment variables, the third and fourth characters indicate:
|
SF - self or
family |
OF - other
Federal Government |
|
MR - Medicare |
SL - State/local
government |
|
MD - Medicaid |
WC - Worker’s
Compensation |
|
PV - private
insurance |
OT - other
insurance |
|
VA – Veteran’s
Administration |
OR - other
private |
|
CH - CHAMPUS/CHAMPVA |
OU - other public |
|
XP - sum of
payments |
|
The fifth and sixth
characters indicate the year (99). The last character
indicates whether it is edited/imputed (X).
For example, HHSF99X is
the edited/imputed amount paid by self or family for a home
health event expenditure incurred in 1999.
Return
To Table Of Contents
2.5 File Contents
2.5.1 Survey
Administration
2.5.1.1 Person Identifiers
(DUID, PID, DUPERSID)
The dwelling unit ID (DUID)
is a 5-digit random number assigned after the case was
sampled for MEPS. The 3-digit person number (PID) uniquely
identifies each person within the dwelling unit. The
8-character variable DUPERSID uniquely identifies each
person represented on the file and is the combination of the
variables DUID and PID. For detailed information on dwelling
units and families, please refer to Attachment 1.
2.5.1.2 Record
Identifiers (EVNTIDX)
EVNTIDX uniquely
identifies each event (i.e., each record on the file).
2.5.1.3 Round Indicators
(EVENTRN, HHR2FLAG)
EVENTRN indicates the
round in which the home health event was first reported.
HHR2FLAG indicates
whether or not a Panel 3 Round 2 event occurred in 1999.
HHR2FLAG was assigned a value = 1 where an event in Round 2
of Panel 3 occurred in a portion of calendar year 1999.
Events from Panel 4 will have HHR2FLAG = -1. Typically, only
Round 3 of a MEPS panel covers two calendar years, so the
HHR2FLAG was developed to identify where data collection
procedures were modified. All utilization data for calendar
year 1999 is provided on this file regardless of the round
in which it happened to be collected. Data users/analysts
need not modify any procedures to deal with this departure
from the usual data collection process as the event
variables have been developed so that the process is
transparent.
Return
To Table Of Contents
2.5.2 Characteristics
of Home Health Events
The file contains 44
variables describing home health events reported by
respondents in the Home Health section of the MEPS-HC
questionnaire. The questionnaire contains specific probes
for determining specific details about the home health
event.
2.5.2.1 Date Home
Health Event Started (HHBEGYR, HHBEGMM)
The start date variables
(HHBEGYR and HHBEGMM) indicate the year and month that the
household respondent reported as the start date (or the
first time) for this type of home health event. An artifact
of the data collection for the variable HHBEGYR is that all
events are reported as having started in 1999 even though a
person could have started receiving that type of home health
care from that provider year(s) before 1999. These variables
should not be interpreted as "true" start dates.
2.5.2.2 Characteristics of Home Health
Events (MPCELIG-OTHCWOS)
The HC
questionnaire determined whether the respondent indicated
the home health provider event(s) for each month’s
services was an agency or whether the provider was an
independent paid provider (SELFAGEN).The response to the
SELFAGEN question dictates the skip pattern to be followed
regarding the questions in the home health section of the HC
questionnaire. Respondents were also asked if the provider
was paid or whether services were provided by a friend,
relative, or volunteer (HHTYPE). The constructed variable
MPCELIG indicates whether the home health provider event was
eligible for MPC data collection and the type of imputation
process the event went through. MPCELIG is a more accurate
variable for determining whether the event was an agency, a
paid independent or an informal care event. However,
SELFAGEN is a more accurate variable for determining the
home health questions asked of the respondent . All
respondents receiving care from an agency, hospital or
nursing home were asked to identify the type of home health
worker they saw (CNA-SPEECTHP) -- for example, certified
nursing assistant, home health aide, registered nurse, etc.
Analysts should keep in mind that these identifications by
household respondents are subjective in nature, are not
mutually exclusive or collectively exhaustive, and should
not be used to make certain estimates. For example, a person
on one type of insurance may identify an individual
providing home health care services to them as a personal
care attendant while an individual having a different type
of insurance coverage may identify that same worker as a
home care aide. To make estimates of personal care
attendants or home care aides based on the their
identification by household respondents and by treating
these types of workers as mutually exclusive groups will
result in inaccurate estimates. Respondents may also have
indicated that they were seen by more than one home health
care worker during a single event. For example, since an
event is a month of services a respondent may have reported
being seen by a nurse, a physical therapist, and/or a home
health aide during a single event. Respondents were also
asked to identify other non-skilled and skilled workers seen
during that month of care (NONSKILL-OTHCWOS). However,
"other specify" variables (SKILLWOS and OTHCWOS)
were not reconciled with the type of health care worker
variable (CNA-SPEECTHP). In addition, the type of health
care worker variables (CNA-SPEECTHP) were not reconciled
with MPCELIG, SELFAGEN and HHTYPE, so inconsistencies
between these variables are possible.
2.5.2.3 Treatments,
Therapies and Services (HOSPITAL-OTHSVCOS)
Regardless of the type of
provider, all respondents were asked if the home health
services they received were due to a hospitalization
(HOSPITAL), whether it was due to a medical condition (VSTRELCN),
if the person was helped with daily activities (DAILYACT),
if the person received companionship services (COMPANY), and
whether or not the person received any other type of
services (OTHSVCE and OTHSVCOS). Only persons receiving care
from an agency, hospital, or nursing home were asked if they
were taught how to use medical equipment (MEDEQUIP) and
whether or not they received a medical treatment (TREATMT).
2.5.2.4 Frequency of Home
Health Events (FREQCY-HHDAYS)
Several variables
identify the frequency and length of home health events (FREQCY-MINLONG)
and whether or not the same services were received during
each month (SAMESVCE). Frequency of event variables (FREQCY-
TMSPDAY) were used as building blocks to construct HHDAYS.
HHDAYS indicates the number of days the respondent received
care during that event (i.e., month of care). HHDAYS has not
been reconciled with DAYSPMO. Frequency variables can be
combined to get a measure of the intensity of care. For
example, HHDAYS used in conjunction with HRSLONG and TMSPDAY,
can be used to form a measure of intensity of care -- that
is, how many hours of care was provided in one month.
Return
To Table Of Contents
2.5.3 Condition and
Procedure Codes and Clinical Classification Codes
Information on household
reported medical conditions and procedures (including
condition codes, procedure codes, and clinical
classification codes) associated with each home health event
are NOT provided on this file. To obtain complete condition
information associated with an event, the analyst must link
to the 1999 Medical Conditions File. Details on how to link
to the MEPS 1999 Medical Conditions File are provided in the
1999 Appendix File.
Return
To Table Of Contents
2.5.4 Expenditure Data
2.5.4.1 Definition of Expenditures
Expenditures on this file
refer to what is paid for health care services. More
specifically, expenditures in MEPS are defined as the sum of
payments for care received, including out of pocket payments
and payments made by private insurance, Medicaid, Medicare
and other sources. The definition of expenditures used in
MEPS differs slightly from its predecessors, the 1987 NMES
and 1977 NMCES surveys, where "charges" rather
than sum of payments were used to measure expenditures. This
change was adopted because charges became a less appropriate
proxy for medical expenditures during the 1990’s due to
the increasingly common practice of discounting. Although
measuring expenditures as the sum of payments incorporates
discounts in the MEPS expenditure estimates, these estimates
do not incorporate any payment not directly tied to specific
medical care events, such as bonuses or retrospective
payment adjustments paid by third party payers. Another
general change from the two prior surveys is that charges
associated with uncollected liability, bad debt, and
charitable care (unless provided by a public clinic or
hospital) are not counted as expenditures because there are
no payments associated with those classifications. For
details on expenditure definitions, please reference the
following, "Informing American Health Care Policy"
(Monheit et al., 1999). AHRQ has developed factors to apply
to the 1987 NMES expenditure data to facilitate longitudinal
analysis. These factors can be accessed via the CCFS Data
Center. For more information, see the Data Center section of
the MEPS Web Site at http://www.meps.ahrq.gov/data_stats/onsite_datacenter.jsp
.
Return
To Table Of Contents
2.5.4.2 Data
Editing/Imputation Methodologies of Expenditure Variables
General Imputation Methodology
The general methodology
used for editing and imputing expenditure data is described
below. However, please note, home health events provided by
an agency, hospital or nursing home were included in the MPC,
and home health provided by paid independent providers were
not included in the MPC. Although the general procedures
remain the same for all home health events, there were some
differences in the editing and imputation methodologies
applied to those events followed in the MPC and those events
not followed in the MPC. Analysts should note that home
health care provided by friends, family, or volunteers were
assumed to be free and were not included in any imputation
process. Please see below for details on the differences
between these editing/imputation methodologies.
Home health expenditure
data for agency, hospital, and nursing home providers were
collected exclusively from the MPC (i.e., household
respondents were not asked to report home health
expenditures from these types of providers). The MPC
contacted 100 percent of the agency, hospital, and nursing
home health providers identified by household respondents.
Since paid independent home health providers were not
included in the MPC, all expenditure data from these
providers were collected from household respondents.
Logical edits were used
to resolve internal inconsistencies and other problems in
the HC and MPC survey-reported data. The edits were designed
to preserve partial payment data from households and
providers, and to identify actual and potential sources of
payment for each household-reported event. In general, these
edits accounted for outliers, co-payments or charges
reported as total payments, and reimbursed amounts that were
reported as out of pocket payments. In addition, edits were
implemented to correct for mis-classifications between
Medicare and Medicaid and between Medicare HMO’s and
private HMO’s as payment sources. These edits produced a
complete vector of expenditures for some events, and
provided the starting point for imputing missing
expenditures in the remaining events.
A weighted sequential
hot-deck procedure was used to impute for missing
expenditures, as well as total charge. The procedure uses
survey data from respondents to replace missing data, while
taking into account the respondents’ weighted distribution
in the imputation process. Classification variables vary by
event type in the hot-deck imputations, but total charge and
insurance coverage are key variables in all of the
imputations.
Return
To Table Of Contents
Imputation Methodology
for Home Health Events
Expenditures for home
health events were developed in a sequence of logical edits
and imputations. (Analysts should note that home health care
provided by friends, family, or volunteers were assumed to
not have expenditures associated with them and were not
included in any imputation process. All expenditures for
home health care provided by informal care providers were
assigned –1 (inapplicable) because those types of events
were skipped out of (never asked) the questions regarding
expenditures.) "Household" edits were applied to
sources and amounts of payment for all events reported for
paid independent providers by HC respondents. "MPC"
edits were applied to provider-reported sources and amounts
of payment for records matched to household-reported events
for all agency, hospital, and nursing home home health
providers. Both sets of edits were used to correct obvious
errors in the reporting of expenditures. Imputations for
independent paid providers and for agencies, hospitals, and
nursing homes were conducted separately. Separate
imputations also were performed for simple events.
Logical edits were used
to sort each event into a specific category for the
imputations. Events with complete expenditures were flagged
as potential donors for the hot-deck imputations while
events with missing expenditure data were assigned to
various recipient categories. Each event was assigned to a
recipient category based on its pattern of missing data. For
example, an event with a known total charge but no
expenditure information was assigned to one category, while
an event with a known total charge and some expenditure
information was assigned to a different category. Similarly,
events without a known total charge were assigned to various
recipient categories based on the amount of missing data.
The logical edits
produced eight recipient categories for events with missing
data. Expenditures were imputed through separate hot-deck
imputations for each of the eight recipient categories. The
donor pool in these imputations was restricted to events
with complete expenditures from either the HC or the MPC.
The donor pool included
"free events" because, in some instances,
providers are not paid for their services. These events
represent charity care, bad debt, provider failure to bill,
and third party payer restrictions on reimbursement in
certain circumstances. If free events were excluded from the
donor pool, total expenditures would be over-counted because
the cost of free care would be implicitly included in paid
events and explicitly included in events that should have
been treated as free from provider. (This does not include
MPCELIG=3 (informal) events. As stated previously, home
health care provided by friends, family, or volunteers
(informal, MPCELIG=3) were assumed to not have expenditures
associated with them and were not included in any imputation
process.)
Return
To Table Of Contents
Capitation Imputation
Health maintenance
organizations (HMOs) receive time-based (capitation)
payments to cover their members’ cost of health care.
Services provided by HMOs are referred to as "capitated
events" in the MEPS expenditure imputations. They are
singled out for special treatment because the payments
received by HMOs are not tied directly to individual events
and services. That is, per person per month payments to an
HMO, as opposed to fee-for-service reimbursement for health
care, pose a problem in the estimation of health care costs
because MEPS uses event-level payments for service as its
measure of expenditures. Capitated events are sent through
there own imputation procedure.
Return
To Table Of Contents
Imputation Flag
Variable (IMPFLAG)
Unlike prior data
releases, only one imputation flag was created for 1999
event files. This flag, IMPFLAG, is a six category variable
that indicates if the event contains complete Household
Component (HC) or Medical Provider Component (MPC) data, was
fully or partially imputed, or was imputed in the capitated
imputation process. Following is how the new imputation flag
is coded; the categories are mutually exclusive.
IMPFLAG=0 (not eligible
for imputation)
IMPFLAG=1 (complete HC data)
IMPFLAG=2 (complete MPC data)
IMPFLAG=3 (fully imputed)
IMPFLAG=4 (partially imputed)
IMPFLAG=5 (capitation imputation)
Return
To Table Of Contents
Zero Expenditures
There are some medical
events reported by respondents where the payments were zero.
This could occur for several reasons including (1) free care
was provided, (2) bad debt was incurred, (3) care was
covered under a flat fee arrangement beginning in an earlier
year, or (4) follow-up events were provided without a
separate charge (e.g., after a surgical procedure). If all
of the medical events for a person fell into one of these
categories, then the total annual expenditures for that
person would be zero. All expenditures for home health care
provided by informal care providers (family, friends, or
volunteers, MPCELIG=3) were assigned –1 (inapplicable)
because those types of events were skipped out of (never
asked) the questions regarding expenditures.
Return
To Table Of Contents
Discount Adjustment
Factor
An adjustment was also
applied to some HC reported expenditure data because an
evaluation of matched HC/MPC data showed that respondents
who reported that charges and payments were equal were often
unaware that insurance payments for the care had been based
on a discounted charge. To compensate for this systematic
reporting error, a weighted sequential hot-deck imputation
procedure was implemented to determine an adjustment factor
for HC reported insurance payments when charges and payments
were reported to be equal. As for the other imputations,
selected predictor variables were used to form groups of
donor and recipient events for the imputation process.
Return
To Table Of Contents
Sources of Payment
In addition to total
expenditures, variables are provided which itemize
expenditures according to major sources of payment
categories. These categories are:
-
Out of pocket by user
or family
-
Medicare
-
Medicaid
-
Private Insurance
-
Veteran’s
Administration, excluding CHAMPVA
-
CHAMPUS or CHAMPVA
-
Other Federal sources
- includes Indian Health Service, Military Treatment
Facilities, and other care by he Federal government
-
Other State and Local
sources - includes community and neighborhood clinics,
State and local health departments, and State programs
other than Medicaid.
-
Worker’s
Compensation
-
Other Unclassified
sources - includes sources such as automobile, homeowner’s,
liability, and other miscellaneous or unknown sources.
Two additional sources of
payment variables were created to classify payments for
events with apparent inconsistencies between insurance
coverage and sources of payment based on data collected in
the survey. These variables include:
-
Other Private - any
type of private insurance payments reported for persons
not reported to have any private health insurance
coverage during the year as defined in MEPS; and
-
Other Public -
Medicaid payments reported for persons who were not
reported to be enrolled in the Medicaid program at any
time during the year.
Though relatively small
in magnitude, users should exercise caution when
interpreting the expenditures associated with these two
additional sources of payment. While these payments stem
from apparent inconsistent responses to health insurance and
sources of payment questions in the survey, some of these
inconsistencies may have logical explanations. For example,
private insurance coverage in MEPS is defined as having a
major medical plan covering hospital and physician services.
If a MEPS sampled person did not have such coverage but had
a single service type insurance plan (e.g., dental
insurance) that paid for a particular episode of care, those
payments may be classified as "other private".
Some of the "other public" payments may stem from
confusion between Medicaid and other state and local
programs or may be persons who were not enrolled in
Medicaid, but were presumed eligible by a provider who
ultimately received payments from the program.
Return
To Table Of Contents
Home Health
Expenditure Variables (HHSF99X - HHXP99X)
There are 12 expenditure
variables specific to paid independent home health events (MPCELIG=2)
and 14 expenditure variables specific to agency home health
events (MPCELIG=1). Home health agency, hospital, and
nursing home events are sampled at a rate of 100% for the
MPC. Households were not asked any expenditure-related
questions in regards to these types of events; therefore,
there are no household reported expenditure data for these
events. Conversely, paid independent providers are not
included in the MPC. Household reported responses are the
only data available for these types of events. All
expenditure data for paid independent providers are fully
imputed from household reported expenditures. There are no
expenditure data for informal care providers. Informal care
(MPCELIG=3, unpaid care provided by family, friends, or
volunteers) were assigned -1 in all expenditure categories.
The constructed variable
MPCELIG is provided on this file. MPCELIG indicates whether
the home health provider event was eligible for MPC data
collection, and MPCELIG determines the imputation process
applied to that event.
All of these expenditures
have gone through an editing and imputation process and have
been rounded to the nearest penny. There is a sum of
payments variable (HHXP99X) which for each home health event
sums all the expenditures from the various sources of
payment. The 12 sources of payment expenditure variables for
each home health event are the following: amount paid by
self or family (HHSF99X), amount paid by Medicare (HHMR99X),
amount paid by Medicaid (HHMD99X), amount paid by private
insurance (HHPV99X), amount paid by Veteran’s
Administration (HHVA99X), amount paid by CHAMPUS/CHAMPVA
(HHCH99X), amount paid other Federal sources (HHOF99X),
amount paid by State and Local (non-federal) government
sources (HHSL99X), amount paid by Worker’s Compensation
(HHWC99X), and amount paid by some other source of insurance
(HHOT99X). As mentioned previously, there are two additional
expenditure variables called HHOR99X and HHOU99X (other
private and other public, respectively). These two
expenditure variables were created to maintain consistency
between what the household reported as their private and
public insurance status for hospitalization and physician
coverage. Analysts can determine if a home health event was
paid by an agency or some other paid independent provider by
subsetting the variable MPCELIG to the appropriate and
desired value.
Return
To Table Of Contents
Rounding
Expenditure
variables on the 1999 home health event file have been
rounded to the nearest penny. Person-level expenditure
information released on the 1999 person-level expenditure
file were rounded to the nearest dollar. It should be noted
that using the1999 MEPS event files to create person-level
totals will yield slightly different totals than those on
the 1999 person-level expenditure file. These differences
are due to rounding only. Moreover, in some instances, the
number of persons having expenditures on the 1999 event
files for a particular source of payment may differ from the
number of persons with expenditures on the 1999 person-level
expenditure file for that source of payment. This difference
is also an artifact of rounding only. Please see the 1999
Appendix File for details on such rounding differences.
Return
To Table Of Contents
3.0 Sample Weight
(PERWT99F)
3.1 Overview
There is a single full
year person-level weight (PERWT99F) assigned to each record
for each key, in-scope person who responded to MEPS for the
full period of time that he or she was in-scope during 1999.
A key person either was a member of an NHIS household at the
time of the NHIS interview, or became a member of such a
household after being out-of-scope at the time of the NHIS
(examples of the latter situation include newborns and
persons returning from military service, an institution, or
living outside the United States). A person is in-scope
whenever he or she is a member of the civilian
noninstitutionalized portion of the U.S. population.
Return
To Table Of Contents
3.2 Details on
Person Weights Construction
The person-level weight
PERWT99F was developed in three stages. A person level
weight for Panel 4 was created, including both an adjustment
for nonresponse over time and poststratification,
controlling to Current Population Survey (CPS) population
estimates based on five variables. Variables used in the
establishment of person-level poststratification control
figures included: census region (Northeast, Midwest, South,
West); MSA status (MSA, non-MSA); race/ethnicity (Hispanic,
black but non-Hispanic, and other); sex; and age. Then a
person level weight for Panel 3 was created, again including
an adjustment for nonresponse over time and
poststratification, again controlling to CPS population
estimates based on the same five variables. When poverty
status information derived from income variables became
available, a 1999 composite weight was formed from the Panel
3 and Panel 4 weights by multiplying the Panel weights by
.5. Then a final poststratification was done on this
composite weight variable, including poverty status (below
poverty, from 100 to 125 percent of poverty, from 125 to 200
percent of poverty, from 200 to 400 percent of poverty, at
least 400 percent of poverty) as well as the original five
poststratification variables in the establishment of control
totals.
Return
To Table Of Contents
3.2.1 MEPS Panel 3 Weight
The person level weight
for MEPS Panel 3 was developed using the 1998 full year
weight for an individual as a "base" weight for
survey participants present in 1998. For key, in-scope
respondents who joined a RU some time in 1999 after being
out of scope in 1998, the 1998 family weight associated with
the family the person joined served as a "base"
weight. The weighting process included an adjustment for
nonresponse over Rounds 4 and 5 as well as
poststratification to population control figures for
December 1999. These control figures were derived by scaling
back the population totals obtained from the March 1999 CPS
to reflect the December, 1999 CPS estimated population
distribution across age and sex categories as of December,
1999. Variables used in the establishment of person level
poststratification control figures included: census region
(Northeast, Midwest, South, West); MSA status (MSA, non-MSA);
race/ethnicity (Hispanic, black but non-Hispanic, and
other); sex, and age. Overall, the weighted population
estimate for the civilian, noninstitutionalized population
on December 31, 1999 is 273,003,778. Key, responding persons
not in-scope on December 31, 1999 but in-scope earlier in
the year retained, as their final Panel 3 weight, the weight
after the nonresponse adjustment.
Return
To Table Of Contents
3.2.2 MEPS Panel 4 Weight
The person level weight
for MEPS Panel 4 was developed using the MEPS Round 1
person-level weight as a ‘base" weight. For key,
in-scope respondents who joined a RU after Round 1, the
Round 1 family weight served as a "base" weight.
The weighting process included an adjustment for nonresponse
over Round 2 and the 1999 portion of Round 3 as well as
poststratification to the same population control figures
for December 1999 used for the MEPS Panel 3 weights. The
same five variables employed for Panel 3 poststratification
(census region, MSA status, race/ethnicity, sex, and age)
were used for Panel 4 poststratification. Similarly, for
Panel 4, key, responding persons not in-scope on December
31, 1999 but in-scope earlier in the year retained, as their
final Panel 4 weight, the weight after the nonresponse
adjustment.
Note that the MEPS round
1 weights (for both panels with one exception as noted
below) incorporated the following components: the original
household probability of selection for the NHIS;
ratio-adjustment to NHIS-based national population estimates
at the household (occupied dwelling unit) level; adjustment
for nonresponse at the dwelling unit level for Round 1; and
poststratification to figures at the family and person level
obtained from the March 1999 CPS data base.
Return
To Table Of Contents
3.2.3 The Final
Weight for 1999
Variables used in the
establishment of person level poststratification control
figures included: poverty status (below poverty, from 100 to
125 percent of poverty, from 125 to 200 percent of poverty,
from 200 to 400 percent of poverty, at least 400 percent of
poverty); census region
(Northeast, Midwest,
South, West); MSA status (MSA, non-MSA); race/ethnicity
(Hispanic, black but non-Hispanic, and other); sex, and age.
Overall, the weighted population estimate for the civilian,
noninstitutionalized population for December 31, 1999 is
273,003,778 (PERWT99F>0 and INSC1231=1). The inclusion of
key, in-scope persons who were not in-scope on December 31,
1999 brings the estimated total number of persons
represented by the MEPS respondents over the course of the
year up to 276,410,767 (PERWT99F>0). The weighting
process included poststratification to population totals
obtained from the 1996 MEPS Nursing Home Component for the
number of individuals admitted to nursing homes. For the
1999 full year file an additional poststratification was
done to population totals obtained from the 1998 Medicare
Current Beneficiary Survey (MCBS) for the number of deaths
among Medicare beneficiaries experienced in the 1999 MEPS.
Return
To Table Of Contents
3.2.4 Coverage
The target population for
MEPS in this file is the 1999 U.S. civilian,
noninstitutionalized population. However, the MEPS sampled
households are a subsample of the NHIS households
interviewed in 1998 (Panel 3) and 1999 (Panel 4). New
households created after the NHIS interviews for the
respective Panels and consisting exclusively of persons who
entered the target population after 1998 (Panel 3) or after
1999 (Panel 4) are not covered by MEPS. These would include
families consisting solely of: immigrants; persons leaving
the military; U.S. citizens returning from residence in
another country; and persons leaving institutions. It should
be noted that this set of uncovered persons constitutes only
a tiny proportion of the MEPS target population.
Return
To Table Of Contents
4.0 Strategies for Estimation
This file is constructed
for efficient estimation of utilization, expenditure, and
sources of payment for home health provider visits and to
allow for estimates of number of persons with home health
provider visits in 1999.
4.1 Variables with
Missing Values
It is essential that the
analyst examine all variables for the presence of negative
values used to represent missing values. For continuous or
discrete variables, where means or totals may be taken, it
may be necessary to set minus values to values appropriate
to the analytic needs. That is, the analyst should either
impute a value or set the value to one that will be
interpreted as missing by the computing language used. For
categorical and dichotomous variables, the analyst may want
to consider whether to recode or impute a value for cases
with negative values or whether to exclude or include such
cases in the numerator and/or denominator when calculating
proportions.
Methodologies used for
the editing/imputation of expenditure variables (e.g.
sources of payment, flat fee, and zero expenditures) are
described in Section 2.5.4.2.
Return
To Table Of Contents
4.2 Basic
Estimates of Utilization, Expenditure and Sources of Payment
While the examples
described below illustrate the use of event level data in
constructing person level total expenditures, these
estimates can also be derived from the person level
expenditure file unless the characteristic of interest is
event specific.
In order to produce
national estimates related to home health provider visits
utilization, expenditure and sources of payment, the value
in each record contributing to the estimates must be
multiplied by the weight (PERWT99F) contained on that
record.
Example 1
For example, the total
number of home health paid independent provider visits, for
the civilian non-institutionalized population of the U.S. in
1999, is estimated as the sum of the weight (PERWT99F)
across all home health paid independent provider records.
That is,
Sum of Wj = 5,890,083 across all records with
MPCELIG = 2 (1)
Example 2
Subsetting to records
based on characteristics of interest expands the scope of
potential estimates.
For example, the estimate
for the mean out-of-pocket payment per paid independent home
health provider event (for those who had such expense
greater than 0) should be calculated as the weighted mean of
the paid independent home health provider’s bill paid by
self/family. That is,
(Sum of Wj
Xj)/(Sum of Wj)
= $282.82 (2)
where
Sum of Wj
= 5,727,760 and Xj = HHSF99Xj
for all home health
visits by paid independent provider (MPCELIG=2) with
HHXP99Xj > 0
This gives $282.82 as the
estimated mean amount of out-of-pocket payment of
expenditures associated with home health events by paid
independent providers and 5,727,760 as an estimate of the
total number of home health events by paid independent
providers with expenditure. Both of these estimates are for
the civilian non-institutionalized population of the U.S. in
1999.
Example 3
Another example would be
to estimate the average proportion of total expenditures
(where event expense is greater than 0) paid by private
insurance for home health events by paid independent
providers. This should be calculated as the weighted mean of
proportion of total expenditures paid by private insurance
at the home health event level. That is
(Sum of Wj
Yj)/(Sum of Wj)
= 0.0663 (3)
where
Sum of Wj
= 5,727,760 and Yj = HHPV99Xj /
HHXP99Xj
for all home health
visits by paid independent provider (MPCELIG=2) with
HHXP99Xj > 0
This gives 0.0663 as the
estimated mean proportion of total expenditures paid by
private insurance for home health events by paid independent
providers with expenditures for the civilian
non-institutionalized population of the U.S. in 1999.
Return
To Table Of Contents
4.3 Estimates of the Number of
Persons with Home Health Events Due to a Hospitalization
When calculating an
estimate of the total number of persons with home health
events by paid independent providers, users can use a
person-level file (MEPS HC-038: Person-level Expenditures
and Utilization) or the current file. However, the current
file must be used, when the measure of interest is defined
at the event level. For example, to estimate the number of
home health events where services were provided due to a
hospitalization, the current file must be used. This would
be estimated as,
Sum of Wi Xiacross all unique persons i on this file (4)
where
Wi is
the sampling weight (PERWT99F) for person
i
and
Xi =
1 if HOSPITALj = 1 for any home health visits
by paid independent provider of person i.
= 0 otherwise
Return
To Table Of Contents
4.4 Person-Based
Ratio Estimates
4.4.1 Person-Based
Ratio Estimates Relative to Persons with Home Health Events
by Paid Independent Providers
This file may be used to
derive person-based ratio estimates. However, when
calculating ratio estimates where the denominator is
persons, care should be taken to properly define the unit of
analysis up to person-level. For example, the mean expense
for persons with home health events by paid independent
providers (MPCELIG =2) is estimated as,
(Sum of Wi
Zi)/(Sum of Wi) across all
unique persons i on this file (5)
where
Wi is
the sampling weight (PERWT99F) for person
i
and
Zi =
Sum of HHXP99Xj across all home health visits
by paid independent provider for person i.
4.4.2 Person-Based Ratio
Estimates Relative to the Entire Population
If the ratio relates to
the entire population, this file cannot be used to calculate
the denominator, as only those persons with at least one
home health provider event are represented on this data
file. In this case MEPS File HC-038, which has data for all
sampled persons, must be used to estimate the total number
of persons (i.e. those with events and those without
events).
For example, to estimate
the proportion of civilian non-institutionalized population
of the U.S. with at least one home health event by a paid
independent provider, the numerator would be derived from
data on the current file, and the denominator should be
derived from data on the MEPS HC-038 person-level file. That
is,
(Sum of Wi
Zi)/(Sum of Wi) across all
unique persons i on the MEPS HC-038 file (6)
where
Wi is
the sampling weight (PERWT99F) for person
i
and
Zi =
1 if MPCELIG j = 2 for any home health visits
by paid independent provider of person i.
= 0 otherwise.
Return
To Table Of Contents
4.5 Sampling Weights for
Merging Previous Releases of MEPS Household Data with this
Event File
There have been several
previous releases of MEPS Household Survey public use data.
Unless a variable name common to several files is provided,
the sampling weights contained on these data files are
file-specific. The file-specific weights reflect minor
adjustments to eligibility and response indicators due to
birth, death, or institutionalization among respondents.
For estimates from a MEPS
data file that do not require merging with variables from
other MEPS data files, the sampling weight(s) provided on
that data file are the appropriate weight(s). When merging a
MEPS Household data file to another, the major analytical
variable (i.e. the dependent variable) determines the
correct sampling weight to use.
Return
To Table Of Contents
4.6 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. Various approaches can be
used to develop such estimates of variance including use of
the Taylor series or various replication methodologies.
Replicate weights have not been developed for the MEPS 1999
data. Variables needed to implement a Taylor series
estimation approach are provided in the file and are
described in the paragraph below.
Using a Taylor Series
approach, variance estimation strata and the variance
estimation PSUs within these strata must be specified. The
corresponding variables on the MEPS full year utilization
database are VARSTR99 and VARPSU99, respectively. Specifying
a "with replacement" design in a computer software
package such as SUDAAN (Shah, 1996) should provide 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 actual number available. For MEPS sample estimates for
characteristics generally distributed throughout the country
(and thus the sample PSUs), there are over 100 degrees of
freedom associated with the corresponding estimates of
variance. The following illustrates these concepts using two
examples from section 4.2.
Examples 2 and 3 from Section 4.2
Using a Taylor Series
approach, specifying VARSTR99 and VARPSU99 as the variance
estimation strata and PSUs (within these strata)
respectively and specifying a Awith replacement@ design in a
computer software package SUDAAN will yield standard error
estimates of $67.45 and 0.0256 for the estimated mean of
out-of-pocket payment and the estimated mean proportion of
total expenditures paid by private insurance respectively.
Return
To Table Of Contents
5.0 Merging/Linking MEPS
Data Files
Data from this
file can be used alone or in conjunction with other files.
This section provides instructions, or the details on where
to find the instructions, for linking the 1999 home health
provider events with other 1999 MEPS public use files,
including the 1999 conditions file, the 1999 prescribed
medicines file, and a 1999 person-level file.
5.1
Linking a 1999 Person-Level File to the 1999 Home Health
Provider Event File
Merging characteristics
of interest from other 1999 MEPS files (e.g., the 1999 Full
Year Population Characteristics File or the 1999 Prescribed
Medicines File) expands the scope of potential estimates.
For example, to estimate the total number of home health
provider events of persons with specific characteristics
(e.g., age, race, and sex), population characteristics from
a person-level file need to be merged onto the home health
provider file. This procedure is illustrated below. The 1999
Appendix File provides additional details on how to merge
1999 MEPS data files.
-
Create data set
PERS by sorting a Full Year Population Characteristics
File, (file HCXXX), by the person identifier, DUPERSID.
Keep only variables to be merged on to the home health
provider event file and DUPERSID.
-
Create data set
HVIS by sorting the home health provider event file by
person identifier, DUPERSID.
-
Create final date
set NEWHVIS by merging these two files by DUPERSID,
keeping only records on the home health provider event
file.
The following is an
example of SAS code, which completes these steps:
PROC SORT DATA=HCXXX(KEEP=DUPERSID
AGE SEX RACEX) OUT=PERSX;
BY DUPERSID;
RUN;
PROC SORT DATA=HVIS;
BY DUPERSID;
RUN;
DATA NEWHVIS;
MERGE HVIS (IN=A) PERSX(IN=B);
BY DUPERSID;
IF A;
RUN;
5.2 Linking the 1999
Home Health Provider Event File to the 1999 Medical
Conditions File and/or the 1999 Prescribed Medicines File
Due to survey design
issues, there are limitations/caveats that an analyst must
keep in mind when linking the different files. This
limitations/caveats are listed below. For detailed linking
examples, including SAS code, analysts should refer to the
1999 Appendix file.
5.3
Limitations/Caveats of RXLK (the 1999 Prescribed Medicine
Link File)
The RXLK file provides a
link from the 1999 prescribed medicine records to the other
1999 event files. When using RXLK, analysts should keep in
mind that one home health event can link to more than one
prescribed medicine record. Conversely, a prescribed
medicine record may link to more than one home health event
or different types of events. When this occurs, it is up to
the analyst to determine how the prescribed medicine
expenditures should be allocated among those medical events.
5.4
Limitations/Caveats of CLNK (the 1999 Medical Conditions
Link File)
The CLNK provides a link
from 1999 MEPS event files to the 1999 Medical Conditions
File. When using the CLNK, analysts should keep in mind that
(1) conditions are self-reported and (2) there may be
multiple conditions associated with a home health provider
event. Users should also note that not all home health
provider events link to the condition file.
Return
To Table Of Contents
References
Cohen, S.B. (1998).
Sample Design of the 1996 Medical Expenditure Panel Survey
Medical Provider Component. Journal of Economic and
Social Measurement. Vol 24, 25-53.
Cohen, S.B. (1997).
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.
Cohen, J.W. (1997).
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.B. (1996). 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.
Cox, B.G. and Cohen, S.B.
(1985). Chapter 8: Imputation Procedures to Compensate for
Missing Responses to Data Items. In Methodological Issues
for Health Care Surveys. Marcel Dekker, New York.
Monheit, A.C., Wilson,
R., and Arnett, III, R.H. (Editors). Informing American
Health Care Policy. (1999). Jossey-Bass Inc, San Francisco.
Shah, B.V., Barnwell, B.G.,
Bieler, G.S., Boyle, K.E., Folsom, R.E., Lavange, L.,
Wheeless, S.C., and Williams, R. (1996). Technical
Manual: Statistical Methods and Algorithms Used in SUDAAN
Release 7.0, Research Triangle Park, NC: Research
Triangle Institute.
Return
To Table Of Contents
Attachment 1
Definitions
Dwelling Units, Reporting Units, Families,
and Persons - 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 is the combination of the variables
DUID and PID.
A Reporting Unit (RU) is a person or a
group of persons in the sampled dwelling unit who is related by blood, marriage,
adoption or other family association, and who is to be interviewed as a group in
MEPS. Thus, the RU serves chiefly as a family-based "survey
operations" unit rather than an analytic unit. 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.
Unmarried college students under 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 Round 1 MEPS interview, were treated as a
Reporting Unit separate from that of their parents for the purpose of data
collection. These variables can be found on MEPS person-level files.
In-Scope - A
person was classified as in-scope (INSCOPE) if he or she was a member of the
U.S. civilian, non-institutionalized population at some time during the Round 1
interview. This variable can be found on MEPS person-level files.
Keyness - The
term "keyness" is related to an individual’s chance of being
included in MEPS. A person is key if that person is appropriately linked 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 became a member of such a household after being out-of-scope prior
to joining that household (examples of the latter situation include newborns and
persons returning from military service, persons returning from an institution,
or persons 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 that was
eligible but not sampled for the NHIS, who happened to have become a member of a
MEPS reporting unit by the time of the MEPS Round 1 interview. 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 permit family level analyses. However, non-key
persons who leave a sample household would not be recontacted for subsequent
interviews. Non-key individuals are not part of the target sample used to obtain
person-level national estimates.
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 be 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 receive a person-level sample weight so long as he or she was
in the military. All key persons who participated in the first round of a MEPS
panel received a person-level sample weight except those who were in the
military. The variable indicating "keyness" is KEYNESS. This variable
can be found on MEPS person-level files.
Eligibility - The
eligibility of a person for MEPS pertains to whether or not data were to be
collected for that person. All key, in-scope persons of a sampled RU were
eligible for data collection. The only non-key persons eligible for data
collection were those who happened to be living in the same RU as one or more
key persons, and their eligibility continued only for the time that they were
living with a key person. The only out-of-scope persons eligible for data
collection were those who were living with key in-scope persons, again only for
the time they were living with a key person. Only military persons meet this
description. A person was considered eligible if they were eligible at any time
during Round 1. The variable indicating "eligibility" is ELIGRND1,
where 1 is coded for persons eligible for data collection for at least a portion
of the Round 1 reference period, and 2 is coded for persons not eligible for
data collection at any time during the first round reference period. This
variable can be found on MEPS person-level files.
Pre-imputed - This means that only a series of logical edits were applied to the HC data to
correct for several problems including outliers, co-payments or charges reported
as total payments, and reimbursed amounts counted as out-of-pocket payments.
Missing data remains.
Unimputed -
This means that only a series of logical edits were applied to the MPC data to
correct for several problems including outliers, co-payments or charges reported
as total payments, and reimbursed amounts counted as out-of-pocket payments.
These data were used as the imputation source to account for missing HC data.
Imputation -
A method of estimating values for cases with missing data. Hot-deck imputation
creates a data set with complete data for all nonrespondent cases, by
substituting the data from a respondent case that resembles the nonrespondent on
certain known variables.
Return
To Table Of Contents
D.
Variable-Source Crosswalk
VARIABLE-SOURCE CROSSWALK
FOR MEPS HC-033H: 1999 HOME HEALTH EVENTS
PUBLIC USE FILE RELEASE
Survey
Administration Variables - Public Use
| Variable |
Description |
Source |
|
DUID |
Dwelling unit ID
(encrypted) |
Assigned in sampling |
|
PID |
Person number
(encrypted) |
Assigned in sampling |
|
DUPERSID |
Sample person ID (DUID + PID)
(encrypted) |
Assigned in sampling |
|
EVNTIDX |
Event ID
(encrypted) |
Assigned in Sampling |
|
EVENTRN |
Event round number |
CAPI derived |
|
HHR2FLAG |
Flag indicating whether or not
a Panel 3 Round 2 event occurred in 1999 |
CAPI derived/ Constructed |
Return
To Table Of Contents
Home Health Events
Variables - Public Use
| Variable |
Description |
Source |
|
HHBEGYR |
Event start date – year |
EV04/EV05 |
|
HHBEGMM |
Event start date – month |
EV04/EV05 |
|
MPCELIG |
MPC eligibility flag |
Constructed |
|
SELFAGEN |
Does provider work for agency
or self |
EV06A |
|
HHTYPE |
Home health event type |
EV06 |
|
CNA |
Type of health care worker –
certified nurse assistant |
HH01 |
|
COMPANN |
Type of health care worker –
companion |
HH01 |
|
DIETICN |
Type of health care worker –
dietitian/nutritionist |
HH01 |
|
HHAIDE |
Type of health care worker –
home health/home care aide |
HH01 |
|
HOSPICE |
Type of health care worker –
hospice worker |
HH01 |
|
HMEMAKER |
Type of health care worker-
homemaker |
HH01 |
|
IVTHP |
Type of health care worker –
IV or infusion therapist |
HH01 |
|
MEDLDOC |
Type of health care worker –
medical doctor |
HH01 |
|
NURPRACT |
Type of health care worker –
nurse/nurse practitioner |
HH01 |
|
NURAIDE |
Type of health care worker –
nurse’s aide |
HH01 |
|
OCCUPTHP |
Type of health care worker –
occupational therapist |
HH01 |
|
PERSONAL |
Type of health care worker –
personal care attendant |
HH01 |
|
PHYSLTHP |
Type of health care worker –
physical therapist |
HH01 |
|
RESPTHP |
Type of health care worker –
respiratory therapist |
HH01 |
|
SOCIALW |
Type of health care worker –
social worker |
HH01 |
|
SPEECTHP |
Type of health care worker –
speech therapist |
HH01 |
|
OTHRHCW |
Type of health care worker –
other |
HH01 |
|
NONSKILL |
Type of health care worker –
non-skilled |
HH02 |
|
SKILLED |
Type of health care worker –
skilled |
HH02 |
|
SKILLWOS |
Specify type of skilled worker |
HH02 |
|
OTHCW |
Type of health care worker –
some other type of health care worker |
HH02 |
|
OTHCWOS |
Specify other type of health
care worker |
HH02 |
|
HOSPITAL |
Any home health care provider
event due to hospitalization |
HH03 |
|
VSTRELCN |
Any home health care provider
event related to a health condition |
HH04 |
|
TREATMT |
Person received medical
treatment |
HH06 |
|
MEDEQUIP |
Person was taught how to use
medical equipment |
HH07 |
|
DAILYACT |
Person was helped with daily
activities |
HH08 |
|
COMPANY |
Person received companionship
services |
HH09 |
|
OTHSVCE |
Person received other home
health care services |
HH10 |
|
OTHSVCOS |
Specify other home health care
service received |
HH10 |
|
FREQCY |
Provider helped person every
week/some weeks |
HH11 |
|
DAYSPWK |
Number of days per week
provider came (agency events only) |
HH12 |
|
DAYSPMO |
Number of days per month
provider came (agency events only) |
HH13 |
|
HOWOFTEN |
Provider came once per day or
more than once per day |
HH14 |
|
TMSPDAY |
Times per day provider came to
home to help |
HH15 |
|
HRSLONG |
Hours each visit lasted |
HH16 |
|
MINLONG |
Minutes each visit lasted |
HH16 |
|
SAMESVCE |
Any other months person
received services |
HH17 |
|
HHDAYS |
Number of days person received
care per month for that event |
Constructed |
Return
To Table Of Contents
Imputed Expenditure
Variables – Public Use
| Variable |
Description |
Source |
|
HHSF99X |
Amount paid, family
note: rounded to cents |
CP11 (Edited/Imputed) |
|
HHMR99X |
Amount paid, Medicare
note: rounded to cents |
CP09
(Edited/Imputed) |
|
HHMD99X |
Amount paid, Medicaid
note: rounded to cents |
CP07 (Edited/Imputed) |
|
HHPV99X |
Amount paid, private insurance
note: rounded to cents |
CP07
(Edited/Imputed) |
|
HHVA99X |
Amount paid, Veterans
note: rounded to cents |
CP07
(Edited/Imputed) |
|
HHCH99X |
Amount paid, CHAMPUS/CHAMPVA
note: rounded to cents |
CP07
(Edited/Imputed) |
|
HHOF99X |
Amount paid, other federal
note: rounded to cents |
CP07
(Edited/Imputed) |
|
HHSL99X |
Amount paid, state and local
government
Note: rounded to cents |
CP07
(Edited/Imputed) |
|
HHWC99X |
Amount paid, worker’s
compensation
Note: rounded to cents |
CP07
(Edited/Imputed) |
|
HHOR99X |
Amount paid, other private
Note: rounded to cents |
Constructed |
|
HHOU99X |
Amount paid, other public
Note: rounded to cents |
Constructed |
|
HHOT99X |
Amount paid, other insurance
Note: rounded to cents |
CP07
(Edited/Imputed) |
|
HHXP99X |
Sum of payments HHSF99X –
HHOT99X
Note: rounded to cents |
Constructed |
|
HHTC99X |
Total charge for visit
Note: rounded to cents |
CP09
(Edited/Imputed) |
|
IMPFLAG |
Flag indicating if the event
contains complete HC or MPC data, was fully or
partially imputed, or was imputed in the capitated
imputation process |
Constructed |
Return
To Table Of Contents
Weights - Public Use
| Variable |
Description |
Source |
|
PERWT99F |
Final person level weight,
1999 (poverty/mortality/nursing home adjusted) |
Constructed |
|
VARPSU99 |
Variance estimation PSU 1999 |
Constructed |
|
VARSTR99 |
Variance estimation stratum,
1999 |
Constructed |
Return To Table Of Contents
Return to the
MEPS Homepage
|
Back
Email Updates
