MEPS HC-077H:
2003 Home Health Visits
August 2005
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 Using MEPS Data for Trend and Longitudinal
Analysis
2.2 Codebook Structure
2.3 Reserved Codes
2.4 Codebook Format
2.5 Variable Source and Naming Conventions
2.5.1 Variable-Source Crosswalk
2.5.2 Expenditure and Source of Payment
Variables
2.6 File Contents
2.6.1 Survey Administration Variables
2.6.1.1 Person Identifiers (DUID, PID,
DUPERSID)
2.6.1.2 Record Identifier (EVNTIDX)
2.6.1.3 Round Indicator (EVENTRN)
2.6.2 Home Health Event Variables
2.6.2.1 Date of Event (HHDATEYR, HHDATEMM)
2.6.2.2 Characteristics of Event (MPCELIG-OTHCWOS)
2.6.2.3 Treatments, Therapies, and Services
(HOSPITAL-OTHSVCOS)
2.6.2.4 Frequency of Event (FREQCY-HHDAYS)
2.6.3 Condition, Procedure, and Clinical
Classification Codes
2.6.4 Expenditure Data
2.6.4.1 Definition of Expenditures
2.6.4.2 Data Editing and Imputation
Methodologies of Expenditure Variables
2.6.4.2.1 General Data Editing Methodology
2.6.4.2.2 General Hot-Deck Imputation
2.6.4.2.3 Home Health Data Editing and
Imputation
2.6.4.3 Imputation Flag Variable (IMPFLAG)
2.6.4.4 Zero Expenditures
2.6.4.5 Sources of Payment
2.6.4.6 Home Health Expenditure Variables
(HHSF03X - HHXP03X)
2.6.4.7 Rounding
3.0 Sample Weight (PERWT03F)
3.1 Overview
3.2 Details on Person Weight Construction
3.2.1 MEPS Panel 7 Weight
3.2.2 MEPS Panel 8 Weight
3.2.3 The Final Weight for 2003
3.2.4 Coverage
4.0 Strategies for Estimation
4.1 Variables with Missing Values
4.2 Basic Estimates of Utilization, Expenditures,
and Sources of Payment
4.3 Estimates of the Number of Persons with Home
Health Events Due to 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 (VARPSU, VARSTR)
5.0 Merging/Linking MEPS Data Files
5.1 Linking a 2003 Person-Level File to the 2003
Home Health Event File
5.2 Linking the 2003 Home Health Event File to the
2003 Medical Conditions File
5.2.1 Limitations/Caveats of CLNK (the 2003
Medical Conditions Link File)
References
D. Variable-Source Crosswalk
A. Data Use
Agreement
Individual identifiers have been removed from the
micro-data contained in these files. 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; and
- 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; and
- 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 Title 18 part 1
Chapter 47 Section 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
The Medical Expenditure Panel Survey (MEPS) provides
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, also known as
NMES-1) was conducted in 1977 and the National Medical Expenditure Survey
(NMES-2) in 1987. Since 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 systems.
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.
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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 2 ˝-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. 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/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.
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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,
eligibility requirements, 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 Bureau of the Census.
To provide an integrated picture of health insurance, data
collected from the first sampling frame (employers and insurance providers
identified by MEPS HC respondents) are linked back to data provided by those
respondents. Data 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
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 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, microdata files and compendiums of tables. Data are 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 as electronic files.
Selected printed documents 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 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 Financing,
Access and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither
Road, Rockville, MD 20850 (301-427-1406).
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C. Technical and
Programming Information
1.0 General Information
This documentation describes one in a series of public use
event files from the 2003 Medical Expenditure Panel Survey (MEPS) Household
Component (HC) and Medical Provider Component (MPC). Released as an ASCII data
file (with related SAS and SPSS programming statements) and a SAS transport
file, the 2003 Home Health public use file provides detailed information on home
health events for a nationally representative sample of the civilian
noninstitutionalized population of the United States. Data from the Home Health
event file can be used to make estimates of home health event utilization and
expenditures for calendar year 2003. As illustrated below, this file consists of
MEPS survey data obtained in the 2003 portion of Round 3, and Rounds 4 and 5 for
Panel 7, as well as Rounds 1, 2, and the 2003 portion of Round 3 for Panel 8
(i.e., the rounds for the MEPS panels covering calendar year 2003).
301 Moved Permanently
301 Moved Permanently
Counts of home health utilization 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, and does not
affect use estimates.
Data from this event file can be merged with other 2003
MEPS HC data files for the purposes of appending person-level data such as
demographic characteristics or health insurance coverage to each home health
record.
This file can also be used to construct summary variables
for expenditures, sources of payment, and related aspects of home health events
for calendar year 2003. Aggregate annual person-level information on the use of
home health providers and other health services use is provided on the 2003
Population Characteristics File, where each record represents a MEPS sampled
person.
The following documentation offers a brief overview of the
types and levels of data provided, and the content and structure of the file and
the codebook. It contains the following sections:
Data File Information
Sample Weight
Strategies for Estimation
Merging/Linking MEPS Data Files
References
Variable - 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, 1999. 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.
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2.0 Data File Information
The 2003 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 Center for Financing,
Access and Cost Trends (CFACT) Data Center. Please visit the CFACT Data Center
web site for details: http://www.meps.ahrq.gov/mepsweb/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.
The Home Health 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 services 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 four events from a nurse, ten
events from a homemaker and four events from a physical therapist each from the
same provider every month for three months, then there will be three event
records (NOT 54 records) on the file, one for each month. 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 home health providers.
This public use data set contains 5,045 home health
records; of the records, 4,906 are associated with persons having a positive
person-level weight (PERWT03F). 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
2003. 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 2003 portion of Round 3, and Rounds 4 and 5 for Panel
7, as well as Rounds 1, 2, and the 2003 portion of Round 3 for Panel 8 of the
MEPS HC. The persons represented on this file had to meet either (a) or (b):
- Be classified as a key in-scope person who
responded for his or her entire period of 2003 eligibility (i.e.,
persons with a positive 2003 full-year person-level weight (PERWT03F >
0)), or
- Be an eligible member of a family all of whose
key in-scope members have a positive person-level weight (PERWT03F >
0). (Such a family consists of all persons with the same value for
FAMIDYR.) That is, the person must a positive full-year family-level
weight (FAMWT03F > 0). Note that FAMIDYR and FAMWT03F are variables on
the 2003 Population Characteristics file.
Persons with no home health events for 2003 are not
included on this event-level HH file but are represented on the person-level 2003 Full Year Population Characteristics file.
Home health providers include formal or paid, and informal
or unpaid providers. Formal or paid providers include: home health agency and
other independent paid providers. Informal or unpaid providers include family
and friends.
For home health agencies 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. 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 who 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: the
month the provider visited the household; type of provider; types of services
provided and if this was a repeat event; whether or not 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
2003 MEPS HC person-level data, such as the MEPS 2003 Full-Year Population
Characteristics file, using the unique person identifier, DUPERSID, to append
person-level information, such as demographic or health insurance coverage, to
each record. Home Health events can also be linked to the MEPS 2003 Medical
Conditions File. Please see Section 5.0 or the MEPS 2003 Appendix File, HC-077I,
for details on how to link MEPS data files.
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2.1 Using MEPS Data for Trend and Longitudinal
Analysis
MEPS began in 1996 and several annual data files have been
released. As more years of data are produced, MEPS will become increasingly
valuable for examining health care trends. However, it is important to consider
a variety of factors when examining trends over time using MEPS. Statistical
significance tests should be conducted to assess the likelihood that observed
trends are attributable to sampling variation. MEPS expenditure estimates are
especially sensitive to sampling variation due to the underlying skewed
distribution of expenditures. For example, 1 percent of the population accounts
for about one-quarter of all expenditures. The extent to which observations with
extremely high expenditures are captured in the MEPS sample varies from year to
year (especially for smaller population subgroups), which can produce
substantial shifts in estimates of means or totals that are simply an artifact
of the sample(s). The length of time being analyzed should also be considered.
In particular, large shifts in survey estimates over short periods of time (e.g.
from one year to the next) that are statistically significant should be
interpreted with caution, unless they are attributable to known factors such as
changes in public policy or MEPS survey methodology. Looking at changes over
longer periods of time can provide a more complete picture of underlying trends.
Analysts may wish to consider using techniques to smooth or stabilize trend
analyses of MEPS data such as pooling time periods for comparison (e.g. 1996-97
versus 1998-99), working with moving averages, or using modeling techniques with
several consecutive years of MEPS data to test the fit of specified patterns
over time. Finally, researchers should be aware of the impact of multiple
comparisons on Type I error because performing numerous statistical significance
tests of trends increases the likelihood of inappropriately concluding a change
is statistically significant.
The records on this file can be
linked to all other 2003 MEPS-HC public use data sets by the sample person
identifier (DUPERSID).
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2.2 Codebook Structure
For each variable on the Home Health event file, both
weighted and unweighted frequencies are provided in the codebook (files
H77HCB.PDF and H77HCB.ASP). The codebook and data file sequence list variables
in the following order:
Unique person identifier
Unique home health event identifier
Home health characteristic variables
Imputed expenditure variables
Weight and variance estimation variables
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2.3 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, values of -1, -7, -8, and -9 for
non-expenditure variables have not been edited on this file. The values of -1
and -9 can be edited by the data users/analysts by following the skip patterns
in the HC survey questionnaire (located on the MEPS web site:
http://www.meps.ahrq.gov/mepsweb/survey_comp/survey.jsp).
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2.4 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 |
Description |
| Name |
Variable name (maximum of 8 characters)
|
| Description |
Variable descriptor (maximum of 40 characters)
|
| Format |
Number of bytes
|
| Type |
Type of data: numeric (indicated by NUM) or character (indicated by CHAR)
|
| Start |
Beginning column position of variable in record
|
| End |
Ending column position of variable in record
|
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2.5 Variable Source and
Naming Conventions
In general, variable names reflect the content of the
variable, with an eight-character limitation. Generally, imputed/edited
variables end with an "X".
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2.5.1 Variable-Source
Crosswalk
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 "Variable - Source Crosswalk" in one of four
ways:
- Variables derived from CAPI or assigned in sampling
are so indicated as "CAPI derived" or "Assigned in sampling,"
respectively;
- Variables which come from one or more specific
questions have those questionnaire sections and question numbers indicated
in the "Source" column; questionnaire sections are identified as:
- EV – Event Roster section
- HH – Home Health Event section
- CP – Charge Payment section
- Variables constructed from multiple questions using
complex algorithms are labeled "Constructed" in the "Source" column; and
- Variables that have been edited or imputed are so indicated.
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2.5.2 Expenditure and Source
of Payment Variables
The names of the expenditure and source of payment
variables follow a standard convention, are seven characters in length, and end
in an "X" indicating edited/imputed. 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 and the 12 source of payment are
named 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 visit |
DV - dental visit
|
| OM - other medical equipment |
RX - prescribed medicine
|
In the case of source 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 - Workers’ Compensation |
| PV - private insurance |
OT - other insurance |
| VA - Veterans Administration |
OR - other private |
| TR - TRICARE |
OU - other public |
|
XP - sum of payments |
In addition, the total charge variable is indicated by TC
in the variable name.
The fifth and sixth characters indicate the year (03). The
seventh character, "X", indicates the variable is edited/imputed.
For example, HHSF03X is the edited/imputed amount paid by
self or family for 2003 home health expenditures.
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2.6 File Contents
2.6.1 Survey Administration
Variables
2.6.1.1 Person Identifiers (DUID,
PID, DUPERSID)
The dwelling unit ID (DUID) is a five-digit random number
assigned after the case was sampled for MEPS. The three-digit person number (PID)
uniquely identifies each person within the dwelling unit. The eight-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 the documentation for the 2003 Full
Year Population Characteristics file.
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2.6.1.2 Record Identifier (EVNTIDX)
EVNTIDX uniquely identifies each event (i.e., each record
on the home health file) and is the variable required to link home health events
to data files containing details on conditions (MEPS 2003 Medical Conditions
File). For details on linking see Section 5.0 or the MEPS 2003 Appendix File,
HC-077I.
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2.6.1.3 Round Indicator (EVENTRN)
EVENTRN indicates the round in which the home health event
was reported. Please note: Rounds 3, 4, and 5 are associated with MEPS survey
data collected from Panel 7. Likewise, Rounds 1, 2, and 3 are associated with
data collected from Panel 8.
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2.6.2 Home Health Event Variables
This file contains variables describing home health events
reported by household respondents in the Home Health Section of the MEPS HC
survey questionnaire.
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2.6.2.1 Date of Event (HHDATEYR,
HHDATEMM)
The date variables (HHDATEYR and HHDATEMM) indicate the
year and month that the household respondent reported as the year and month of
occurrence for this type of home health event. An artifact of the data
collection for the variable HHDATEYR is that a person may have started receiving
that type of home health care from that provider prior to 2003. These variables
should not be interpreted as "true" start dates.
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2.6.2.2 Characteristics of
Event (MPCELIG-OTHCWOS)
The HC questionnaire asked the respondent to
indicate whether the home health provider event(s) for each month’s services
were provided through an agency or an independent paid provider (SELFAGEN). The
response to the SELFAGEN question dictated the skip pattern CAPI followed
regarding the questions in the home health section of the HC questionnaire. The
questionnaire also asked respondents if the provider was paid or whether a
friend, relative, or volunteer (HHTYPE) provided the home health services. 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. Making estimates of personal care attendants or home
care aides based on their identification by household respondents and 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, skilled, and other 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.
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2.6.2.3 Treatments,
Therapies, and Services (HOSPITAL-OTHSVCOS)
Regardless of the type of provider, all respondents were
asked if the home health services received were due to a hospitalization
(HOSPITAL), whether services were 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 were asked if they were taught how to use medical equipment (MEDEQUIP)
and whether or not they received a medical treatment (TREATMT).
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2.6.2.4 Frequency of Event (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 person 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 can be used in
conjunction with HRSLONG and TMSPDAY to form a measure of intensity of care,
that is, how many hours of care were provided in one month.
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2.6.3 Condition, Procedure, 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 2003 Medical Conditions File. Details on how to
link to the MEPS 2003 Medical Conditions File are provided in the MEPS 2003
Appendix File, HC-077I.
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2.6.4 Expenditure Data
2.6.4.1 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 1990s 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. While
charge data are provided on this file, data users/analysts should use caution
when working with this data because a charge does not typically represent actual
dollars exchanged for services or the resource costs of those services, nor are
they directly comparable to the expenditures defined in the 1987 NMES (for
details on expenditure definitions, see Monheit et al, 1999). For details on
expenditure definitions, please refer to the following, "Informing American
Health Care Policy" (Monheit et al., 2000). AHRQ has developed factors to apply
to the 1987 NMES expenditure data to facilitate longitudinal analysis. These
factors can be accessed via the CFACT Data Center. For more information, see the
Data Center section of the MEPS web site at http://www.meps.ahrq.gov/mepsweb/data_stats/onsite_datacenter.jsp.
If examining trends in MEPS expenditures or performing longitudinal analysis on
MEPS expenditures, please refer to section C, sub-section 2.1 for more
information.
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2.6.4.2 Data Editing and Imputation Methodologies of
Expenditure Variables
The general methodology used for editing and imputing
expenditure data is described below. However, please note, the MPC included home
health events provided by an agency and did not include home health care
provided by paid independent providers. 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 was assumed to be free and was 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.
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2.6.4.2.1 General Data Editing Methodology
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 HMOs and private HMOs 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.
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2.6.4.2.2 General Hot-Deck Imputation
A weighted sequential hot-deck procedure was used to
impute for missing expenditures, as well as total charge. This 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. Separate
imputations were performed for nine categories of medical provider care:
inpatient hospital stays, outpatient hospital department visits, emergency room
visits, visits to physicians, visits to non-physician providers, dental
services, home health care by certified providers, home health care by paid
independents, and other medical expenses. Within each file, flat fee and simple
events were imputed separately. After the imputations were finished, visits to
physician and non-physician providers were combined into a single medical
provider file. The two categories of home care also were combined into a single
home health file.
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2.6.4.2.3 Home Health Data Editing and Imputation
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 was assumed not to have
associated expenditures and was 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
(never asked) of the questions regarding expenditures.) "Household" edits were
applied to sources and amounts of payment for all household-reported events for
paid independent providers and unmatched agency providers. "MPC" edits were
applied to provider-reported sources and amounts of payment for records matched
to household-reported events for all agency 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 were conducted
separately. Within each event type file, separate imputations were performed for
flat fee and 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 with
missing expenditure data was assigned to a recipient category based on the
extent of its missing charge and expenditure 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 partial expenditure information was
assigned to a different category. Similarly, events without a known total charge
and no or partial expenditure information were assigned to various recipient
categories.
The logical edits produced eight recipient categories for
HHP and eight recipient categories for HHA 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 includes events
with complete expenditures from the HC for HHP or the MPC for HHA.
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. (This does not include
MPCELIG=3 (informal) events. As stated previously, home health care provided by
friends, family, or volunteers (informal, MPCELIG=3) was assumed not to have
expenditures associated with it and was not included in any imputation process.)
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2.6.4.3 Imputation Flag Variable (IMPFLAG)
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. The following list identifies how the imputation flag is coded; the
categories are mutually exclusive.
IMPFLAG=0 not eligible for imputation
(includes zeroed out and flat fee leaf events)
IMPFLAG=1 complete HC data
IMPFLAG=2 complete MPC data
IMPFLAG=3 fully imputed
IMPFLAG=4 partially imputed
IMPFLAG=5 complete MPC data through capitation
imputation (not applicable to HH)
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2.6.4.4 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 (never asked) of the questions regarding expenditures.
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2.6.4.5 Sources of Payment
In addition to total expenditures, variables are provided
which itemize expenditures according to major source of payment categories.
These categories are:
- Out-of-pocket by user or family,
- Medicare,
- Medicaid,
- Private Insurance,
- Veterans Administration, excluding TRICARE,
- TRICARE,
- Other Federal sources - includes Indian Health
Service, Military Treatment Facilities, and other care by the 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, and
- Other Unclassified sources - includes sources such
as automobile, homeowner’s, and liability insurance, and other
miscellaneous or unknown sources.
Two additional source 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 - Medicare/Medicaid payments reported
for persons who were not reported to be enrolled in the Medicare/Medicaid
program at any time during the year.
Though relatively small in magnitude, data users/analysts
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 source 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 from
persons who were not enrolled in Medicaid, but were presumed eligible by a
provider who ultimately received payments from the public payer.
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2.6.4.6 Home Health Expenditure Variables (HHSF03X -
HHXP03X)
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) was assigned -1, "INAPPLICABLE", 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. HHSF03X - HHOT03X
are the 12 sources of payment. HHTC03X is the total charge, and HHXP03X is the
sum of the 12 sources of payment for the home health expenditures. The 12
sources of payment are: self/family (HHSF03X), Medicare (HHMR03X), Medicaid
(HHMD03X), private insurance (HHPV03X), Veterans Administration (HHVA03X),
TRICARE (HHTR03X), other Federal sources (HHOF03X), State and Local
(non-federal) government sources (HHSL03X), Worker’s Compensation (HHWC03X),
other private insurance (HHOR03X), other public insurance (HHOU03X), and other
insurance (HHOT03X). 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.
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2.6.4.7 Rounding
Expenditure variables on the 2003 home health event file
have been rounded to the nearest penny. Person-level expenditure information
released on the 2003 Person-Level Expenditure File was rounded to the nearest
dollar. It should be noted that using the 2003 MEPS event files to create
person-level totals will yield slightly different totals than those on the
person-level expenditure file. These differences are due to rounding only.
Moreover, in some instances, the number of persons having expenditures on the
event files for a particular source of payment may differ from the number of
persons with expenditures on the person-level expenditure file for that source
of payment. This difference is also an artifact of rounding only. Please see the
MEPS 2003 Appendix File, HC-077I, for details on such rounding differences.
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3.0 Sample Weight (PERWT03F)
3.1 Overview
There is a single full year person-level weight (PERWT03F)
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 2003. A key person
either was a member of an NHIS household at the time of the NHIS interview, or
became a member of a family associated with 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.
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3.2 Details on Person Weight
Construction
The person-level weight PERWT03F was developed in several
stages. Person-level weights for Panels 7 and 8 were created separately. The
weighting process for each panel included an adjustment for nonresponse over
time and calibration to independent population figures. The calibration was
initially accomplished separately for each panel by raking the corresponding
sample weights to Current Population Survey (CPS) population estimates based on
five variables. The five variables used in the establishment of the initial
person-level control figures were: census region (Northeast, Midwest, South,
West); MSA status (MSA, non-MSA); race/ethnicity (Hispanic, non-Hispanic with
black as sole reported race, non-Hispanic with Asian as sole reported race,and other); sex; and age. A 2003 composite weight was
then formed by multiplying each weight from Panel 7 by the factor .49 and each
weight from Panel 8 by the factor .51. The choice of factors reflected the
relative sample sizes of the two panels, helping to limit the variance of
estimates obtained from pooling the two samples. The composite weight was again
raked to the same set of CPS-based control totals. When poverty status
information derived from income variables became available, a final raking was
undertaken on the previously established weight variable. Control totals were
established using 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 variables used in
the previous calibrations.
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3.2.1 MEPS Panel 7 Weight
The person-level weight for MEPS Panel 7 was developed
using the 2002 full year weight for an individual as a "base" weight for survey
participants present in 2002. For key, in-scope respondents who joined an RU
some time in 2003 after being out-of-scope in 2002, the 2002 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 raking to population control figures for December 2003. These control
figures were derived by scaling back the population totals obtained from the
March 2004 CPS to correspond to a national estimate for the civilian
noninstitutionalized population provided by the Census Bureau for December 2003.
Variables used in the establishment of person-level control figures included:
census region (Northeast, Midwest, South, West); MSA status (MSA, non-MSA);
race/ethnicity (Hispanic, black but non-Hispanic, Asian but non-Hispanic,and other); sex; and age. Overall, the weighted
population estimate for the civilian noninstitutionalized population on December
31, 2003 is 286,779,677. Key, responding persons not in-scope on December 31,
2003 but in-scope earlier in the year retained, as their final Panel 7 weight,
the weight after the nonresponse adjustment.
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3.2.2 MEPS Panel 8 Weight
The person-level weight for MEPS Panel 8 was developed
using the MEPS Round 1 person-level weight as a "base" weight. For key, in-scope
respondents who joined an 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 2003 portion of Round 3 as well as raking to the same
population control figures for December 2003 used for the MEPS Panel 7 weights.
The same five variables employed for Panel 7 raking (census region, MSA status,
race/ethnicity, sex, and age) were used for Panel 8 raking. Similarly, for panel
8, key, responding persons not in-scope on December 31, 2003 but in-scope
earlier in the year retained, as their final panel 8 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 2003 CPS data base.
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3.2.3 The Final Weight for
2003
Variables used in the establishment of person-level
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, non-Hispanic
with black as sole reported race, non-Hispanic with Asian as sole reported race,and other); sex; and age. Overall, the weighted
population estimate for the civilian noninstitutionalized population for
December 31, 2003 is 286,779,677 (PERWT03F>0 and INSC1231=1). The weights of
some persons out-of-scope on December 31, 2003 were also calibrated, this time
using poststratification. Specifically, the weights of persons out-of-scope on
December 31, 2003 who were in-scope some time during the year and also entered a
nursing home during the year were poststratified to a corresponding control
total obtained from the 1996 MEPS Nursing Home Component. The weights of persons
who died while in-scope during 2003 were poststratified to corresponding
estimates derived using data obtained from the Medicare Current Beneficiary
Survey (MCBS) and Vital Statistics information provided by the National Center
for Health Statistics (NCHS). Separate control totals were developed for the "65
and older" and "under 65" civilian noninstitutionalized populations. The sum of
the person-level weights across all persons assigned a positive person level
weight is 290,604,436.
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3.2.4 Coverage
The target population for MEPS in this file is the 2003
U.S. civilian noninstitutionalized population. However, the MEPS sampled
households are a subsample of the NHIS households interviewed in 2001 (Panel 7)
and 2002 (Panel 8). New households created after the NHIS interviews for the
respective Panels and consisting exclusively of persons who entered the target
population after 2001 (Panel 7) or after 2002 (Panel 8) are not covered by MEPS.
Neither are previously out-of-scope persons who join an existing household but
are unrelated to the current household residents. Persons not covered by a given
MEPS panel thus include some members of the following groups: immigrants;
persons leaving the military; U.S. citizens returning from residence in another
country; and persons leaving institutions. The set of uncovered persons
constitutes only a small segment of the MEPS target population.
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4.0 Strategies for Estimation
This file is constructed for efficient estimation of
utilization, expenditures, and sources of payment for home health provider
visits and to allow for estimates of number of persons with home health provider
visits in 2003.
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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 2.6.4.2.
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4.2 Basic Estimates of
Utilization, Expenditures, 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, expenditures, and sources of payment, the
value in each record contributing to the estimates must be multiplied by the
weight (PERWT03F) contained on that record.
Example 1
For example, the total number of home health paid
independent provider visits, for the civilian noninstitutionalized population of
the U.S. in 2003, is estimated as the sum of the weight (PERWT03F) across all
home health paid independent provider records. That is,
Sum of Wj = 5,110,669 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 (where the
visit has a total 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
WjXj)/(Sum of
Wj) = $271.70 (2)
where Sum of Wj =
5,020,876 and Xj = HHSF03Xj
for all home health visits by paid independent provider (MPCELIG=2)
with HHXP03Xj > 0
This gives $271.70 as the estimated mean amount of
out-of-pocket payment of expenditures associated with home health events by paid
independent providers and 5,020,876 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 noninstitutionalized population of the U.S. in
2003.
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 the proportion of total
expenditures paid by private insurance at the home health event-level. That is
(Sum of
WjYj)/(Sum of
Wj) = 0.0291 (3)
where
S Wj =
5,020,876 and Yj = HHPV03Xj
/ HHXP03Xj
for all home health visits by paid independent
provider (MPCELIG=2) with HHXP03Xj > 0
This gives 0.0291 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 noninstitutionalized
population of the U.S. in 2003.
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4.3 Estimates of the Number
of Persons with Home Health Events Due to 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 or this event file. However, this event 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
hospitalization, this event file must be used. This would be estimated as,
Sum of
WiXi across all unique
persons i on this file (4)
where
Wi is the sampling weight
(PERWT03F) for person i
and
Xi = 1
if HOSPITALi
= 1 for any home health visits by paid independent provider of
person i
and = 0 otherwise.
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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 and estimate 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 ofWiZi)/(Sum of
Wi) across all unique persons i on this file (5)
where
Wi is the sampling weight
(PERWT03F) for person i
and
Zi =
S HHXP03Xi across all home health visits
by paid independent providers for person i.
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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,
the Full Year Consolidated, 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 the civilian
noninstitutionalized 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 this
event file, and the denominator would be derived from data on the person-level
file. That is,
(Sum of
WiZi)/(Sum of
Wi) across all unique persons i (6)
on the
MEPS HC FY person-level file
where
Wi is the sampling weight
(PERWT03F) for person i
and
Zi = 1 if MPCELIG i
= 2 for any home health visits by paid independent provider of
person i
and = 0 otherwise.
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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 one MEPS
Household data file to another, the major analytical variable (i.e., the
dependent variable) determines the correct sampling weight to use.
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4.6 Variance Estimation (VARPSU,
VARSTR)
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 2003 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 VARSTR
and VARPSU, respectively. Prior to 2002, MEPS variance strata and PSUs were
developed independently from year to year, and the last two characters of the
strata and PSU variable names denoted the year. However, beginning with the 2002
Point-in-Time PUF, the variance strata and PSUs have been developed to be
compatible with all future PUFs. Thus, data from future years can be pooled and
the variance strata and PSU variables provided can be used without modification
for variance estimation purposes for estimates covering multiple years of data.
There are 203 variance estimation strata, each stratum with either two or three
variance estimation PSUs. 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 VARSTR and
VARPSU as the variance estimation strata and PSUs (within these strata)
respectively and specifying a "with replacement" design in a computer software
package (i.e., SUDAAN will yield standard error estimates of $55.10 and 0.0209
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 2003 home health provider events with
other 2003 MEPS public use files, including the 2003 conditions file and a 2003
person-level file.
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5.1 Linking a 2003
Person-Level File to the 2003 Home Health Event File
Merging characteristics of interest from other 2003 MEPS
files (e.g., the 2003 Full Year Population Characteristics File or the 2003
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 MEPS 2003 Appendix File,
HC-077I, provides additional details on how to merge 2003 MEPS data files.
- Create data set PERSX by sorting the 2003 Full
Year Population Characteristics File 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 data 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 AGE31X AGE42X
AGE53X SEX RACEX EDUCYR) 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;
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5.2 Linking the 2003 Home
Health Event File to the 2003 Medical Conditions File
Due to survey design issues, there are limitations/caveats
that data users/analysts must keep in mind when linking the different files.
These limitations/caveats are listed below. For detailed linking examples,
including SAS code, data users/analysts should refer to the MEPS 2003 Appendix
File, HC-077I.
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5.2.1 Limitations/Caveats of
CLNK (the 2003 Medical Conditions Link File)
The CLNK provides a link from 2003 MEPS event files to the
2003 Medical Conditions File. When using the CLNK, data users/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. Data users/analysts
should also note that not all home health provider events link to the condition
file.
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References
Cohen, S.B. (1999). 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)
(1999). Informing American Health Care Policy. 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.
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D. Variable-Source
Crosswalk
VARIABLE-SOURCE CROSSWALK
FOR MEPS HC-077H: 2003 HOME HEALTH VISITS
Survey Administration Variables
| Variable |
Description |
Source |
DUID |
Dwelling unit ID |
Assigned in sampling |
PID |
Person number |
Assigned in sampling |
DUPERSID |
Person ID (DUID + PID) |
Assigned in sampling |
EVNTIDX |
Event ID |
Assigned in sampling |
EVENTRN |
Event round number |
CAPI derived |
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Home Health Events Variables
| Variable |
Description |
Source |
HHDATEYR |
Event date – year |
CAPI derived |
HHDATEMM |
Event date – month |
CAPI derived |
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 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 therapist |
HH01 |
MEDLDOC |
Type of health care worker – medical doctor |
HH01 |
NURPRACT |
Type of health care worker – 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 therapy |
HH01 |
RESPTHP |
Type of health care worker – respiratory therapy |
HH01 |
SOCIALW |
Type of health care worker – social worker |
HH01 |
SPEECTHP |
Type of health care worker – speech therapy |
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 |
HH02OV1 |
OTHCW |
Type of health care worker – some other |
HH02 |
OTHCWOS |
Specify other type health care worker |
HH02OV2 |
HOSPITAL |
Any home health care service due to hospitalization |
HH03 |
VSTRELCN |
Any Home Health Care Service Related to Health Condition |
HH04 |
TREATMT |
Person received medical treatment |
HH06 |
MEDEQUIP |
Person was taught use of medical equipment |
HH07 |
DAILYACT |
Person was helped with daily activities |
HH08 |
COMPANY |
Person received companionship services |
HH09 |
OTHSVCE |
Person received other home care services |
HH10 |
OTHSVCOS |
Specify other home care services received |
HH10OV |
FREQCY |
Provider helped every week/some weeks |
HH11 |
DAYSPWK |
# days per week provider came (agency only) |
HH12 |
DAYSPMO |
# days per month provider came (agency only) |
HH13 |
HOWOFTEN |
Provider came once per day/more than once per day |
HH14 |
TMSPDAY |
Times/day provider came to home to help |
HH15 |
HRSLONG |
Hours each visit lasted |
HH16_01 |
MINLONG |
Minutes each visit lasted |
HH16_02 |
SAMESVCE |
Any other months person received same services |
HH17 |
HHDAYS |
Days per month in home health, 2003 |
Constructed |
Return To Table Of Contents
Imputed Expenditure Variables
| Variable |
Description |
Source |
HHSF03X |
Amount paid, self/family (Imputed) |
CP Section (Edited) |
HHMR03X |
Amount paid, Medicare (Imputed) |
CP Section (Edited) |
HHMD03X |
Amount paid, Medicaid (Imputed) |
CP Section (Edited) |
HHPV03X |
Amount paid, private insurance (Imputed) |
CP Section (Edited) |
HHVA03X |
Amount paid, Veterans Administration (Imputed) |
CP Section (Edited) |
HHTR03X |
Amount paid, TRICARE (Imputed) |
CP Section (Edited) |
HHOF03X |
Amount paid, other federal (Imputed) |
CP Section (Edited) |
HHSL03X |
Amount paid, state & local government (Imputed) |
CP Section (Edited) |
HHWC03X |
Amount paid, workers’ compensation (Imputed) |
CP Section (Edited) |
HHOR03X |
Amount paid, other private insurance (Imputed) |
Constructed |
HHOU03X |
Amount paid, other public insurance (Imputed) |
Constructed |
HHOT03X |
Amount paid, other insurance (Imputed) |
CP Section (Edited) |
HHXP03X |
Sum of HHSF03X – HHOT03X (Imputed) |
Constructed |
HHTC03X |
Household reported total charge (Imputed) |
CP Section (Edited) |
IMPFLAG |
Imputation status |
Constructed |
Return To Table Of Contents
Weights
| Variable |
Description |
Source |
PERWT03F |
Expenditure file person weight, 2003 |
Constructed |
VARSTR |
Variance estimation stratum, 2003 |
Constructed |
VARPSU |
Variance estimation PSU, 2003 |
Constructed |
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