MEPS HC-033I: Appendix to MEPS 1999 Event Files HC-033A - HC-033H
October 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 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 1999 Condition-Event Frequency Table
2.6 1999 Utilization and Expenditures Summary Table
3.0 Merging/Linking MEPS Data Files
3.1 Example A:
Using the RXLK and CLNK Files with the Medical Conditions
File (HC-037), the Prescribed Medicines and Office-Based Medical Provider
Visits Event Files (HC-033A and HC-033G)
3.2 Example B: Using the CLNK File with the Medical Conditions File (HC-037) and the Prescribed
Medicines Event File (HC-033A)
3.3 Example C: Using the CLNK File with the Medical Conditions File (HC-037) and Office-Based Medical Provider Visits Event File (HC-033G)
3.4 Example D: Using the RXLK File with the Other Medical Expenses Event File (HC-033C)
3.5 Limitations/Caveats of the CLNK File
3.6 Limitations/Caveats of the RXLK File
Attachment 1 Clinical Classification Code to ICD-9 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.
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C. Technical and Programming Information
1.0 General Information
This documentation describes the MEPS Public Use Release HC-033I, which is the Appendix to
MEPS releases HC-033A through HC-033H. 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 H33IF1CB.PDF and H33IF2CB.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, are available on the MEPS
web site at the following address: <http://www.meps.ahrq.gov>.
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2.0 Data File Information
This public use data set consists of two data files containing variables for linkage of the MEPS 1999
event-level data files. File 1, the H33IF1 or "CLNK" file, is used for linking the MEPS condition
file with the MEPS event files; File 2, the H33IF2 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 |
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.
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2.3 Contents of File 1: Condition-Event Link File
(CLNK)
File 1, (H33IF1) or the CLNK file, contains the variables needed to link each record on the MEPS
1999 condition file, HC-037, with one or more records on the MEPS 1999 event files, HC-033A
through HC-033H. 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 1999 Condition file, HC-037. 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 1999 event files, HC-033B through HC-033H. (EVNTIDX
is not included on the 1999 Prescription Medicines event file, HC-033A; 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-033G
2 = OPAT - outpatient department visit event contained on MEPS release HC-033F
3 = EROM - emergency room visit event contained on MEPS release HC-033E
4 = STAZ - hospital inpatient stay event contained on MEPS release HC-033D
5 = DVIS - dental visit event contained on MEPS release HC-033B
7 = HVIS - home health visit event contained on MEPS release HC-033H
8 = PMED - prescribed medicines event contained on MEPS release HC-033A
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2.4 Contents of File 2: Prescribed Medicines-Event Link File
(RXLK)
File 2, (H33IF2) or the RXLK file, contains the variables needed to link each record on the MEPS
1999 prescribed medicines file, HC-033A, with one or more records on the MEPS 1999 event files,
HC-033B through HC-033H. 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 1999 event files, HC-033B through HC-033H. 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-033A 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-033A 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-033G
2 = OPAT - outpatient department visit event contained on MEPS release HC-033F
3 = EROM - emergency room visit event contained on MEPS release HC-033E
4 = STAZ - hospital inpatient stay event contained on MEPS release HC-033D
5 = DVIS - dental visit event contained on MEPS release HC-033B
6 = OMED - other medical expense event contained on MEPS release HC-033C
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2.5 1999 Condition-Event Frequency Table
The file H33IT1.PDF contains the "MEPS 1999 Condition-Event Frequency" table. This table
contains unweighted and weighted counts of records on the MEPS 1999 event files, HC-033A
through HC-033H, for each of the condition, procedure and clinical classification codes contained
on the MEPS 1999 condition file, HC-037. Attachment 1 contains a crosswalk of the clinical
classification codes to ICD-9 codes. See the HC-037 document for additional information on these
codes.
2.6 1999 Utilization and Expenditures Summary Table
The file H33IT2.PDF contains the "MEPS 1999 Utilization and Expenditures Summary" table. This
table contains statistics for all of the utilization and expenditure variables contained on the MEPS
1999 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-033A
through HC-033H:
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.
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3.0 Merging/Linking MEPS Data Files
This section provides information on using each of the two HC-033I files, RXLK and CLNK, to link
with the files contained in MEPS releases HC-037 and HC-033A through HC-033H. 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
(HC-037), the Prescribed Medicines and Office-Based Medical Provider Visits
Event Files (HC-033A and HC-033G)
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-037), the CLNK file, the
office-based medical provider visit event file (HC-033G), the RXLK file, and the prescribed
medicines event file (HC-033A). It includes the following major steps:
- From HC-037 file select only records with condition coded as asthma.
- Use the CLNK file to obtain unique record IDs of events which are linked to each of
the selected asthma condition records.
- From the HC-033G file, select only records for non-telephone office-based medical
provider visits for persons with a positive weight.
- Using the selected record IDs obtained from the CLNK file with the selected HC-033G records, identify only those visits which were for asthma.
- 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-033A linked to those
visits.
- Using these record IDs obtain the linked records from the HC-033A 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-037) and
the Prescribed Medicines Event File (HC-033A)
This example calculates the total expenditure for prescribed medicines associated with asthma, using
the condition file (HC-037), the CLNK file and the prescribed medicines event file (HC-033A). It
includes the following major steps:
- From HC-037 file select only records with condition coded as asthma.
- Use the CLNK file to obtain unique record IDs of events which are linked to each of
the asthma condition records.
- Using these record IDs, obtain linked records from the HC-033A file and calculate the
weighted mean of the expenditure variable.
Attachment 2 contains a copy of the SAS job for this example.
3.3 Example C: Using the CLNK File with the Medical Conditions File (HC-037) and
Office-Based Medical Provider Visits Event File (HC-033G)
This example calculates the total expenditures for office-based medical provider visits associated with
asthma, using the condition file (HC-037), the CLNK file and the office-based medical provider visits
event file (HC-033G). It includes the following major steps:
- From HC-037 file select only records with condition coded as asthma.
- Use the CLNK file to obtain unique record IDs of events which are linked to each of
the asthma condition records.
- From the HC-033G file, select only records for non-telephone office-based medical
provider visits for persons with a positive weight.
- Using the selected record IDs obtained from the CLNK file, with the selected HC-033G records, identify only those visits which were for asthma and calculate the
weighted mean of the expenditure variable.
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Attachment 2 contains a copy of the SAS job for this example.
3.4 Example D: Using the RXLK File with the Other Medical Expenses Event File
(HC-033C)
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-033C). It includes the following major steps:
- From HC-033C file select only records for other medical expense type of insulin, for
persons with a positive weight.
- 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.
- Use the selected record IDs from the RXLK file to obtain the linked prescribed
medicines event records from the HC-033A file, and calculate the weighted sum of
the expenditure variable.
Attachment 2 contains a copy of the SAS job for this example.
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.
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Attachment 1
Clinical Classification Code to ICD-9 Code Crosswalk (link to separate file)
Attachment 2
Sample SAS Jobs for Linking Examples
(link to separate file)
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