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Survey Questionnaires

Household (HC) Questionnaire Sections

Each MEPS-HC interview consists of sections covering specific topics. Each section contains a series of CAPI (computer-assisted personal interview) computer screens with questions, interviewing instructions, and skip patterns based on the specific topics. Major changes to sections are made by calendar year, and data released on full-year files are based on the questions being asked during that year (regardless of panel).

Select questionnaire section and year:

For more information on the Household Component questionnaire sections, go to Summary of HC Questionnaire Sections and MEPS-HC Panel Design and Data Collection Process.

The F1 Help Text Key is the collection of terms used during the course of the MEPS-HC CAPI. These terms and their definitions are accessible to the interviewer via the F1 function key. To access terms used in Rounds 1, 3 and 5, go to the F1 Help Text Key Rounds 1/3/5 (PDF, 461 KB) or HTML. To access terms used in Rounds 2 and 4, go to the F1 Help Text Key Rounds 2/4 (PDF, 373 KB) or HTML.

MEPS-HC is a panel survey conducted over five rounds of data collection periods. Not all of the questionnaire sections are included in each round; some are periodically rotated in and out of the survey.

For each interview, the questionnaire flow varies slightly. Go to Questionnaire context/flow for the context/flow detailed specifications for each panel, information on the specific order in which sections were asked during each interview, and for an example of how to reconstruct the structure of an interview for a particular panel and round.

HC Supplemental Paper Questionnaires

MEPS periodically administers paper questionnaires to supplement the data collected by interviewers. These questionnaires are available in both English and Spanish and include the following:

Adult Self-Administered Questionnaire (SAQ): The SAQ is administered to all household respondents 18 years old and older during Rounds 2 and Rounds 4. The SAQ is a mail-back survey and includes questions from the Consumer Assessment of Health Plans (CAHPS®), the SF-12, the EuroQol 5D, and attitude items. The Adult SAQ was first fielded in 2000.

The 2000 Parent Administered Questionnaire (PAQ). The PAQ is a self-administered and mail-back questionnaire administered to parents of children under 18 years of age. The PAQ was fielded only in 2000, during Round 4 of Panel 4 and Round 2 of Panel 5 and included questions from the Consumer Assessment of Health Plans (CAHPS®) and the Living with Illness Measure (LWIM). In 2001, the content of this PAQ was added as the Child Preventive Health section of the CAPI instrument.

A Survey About Your Diabetes Care: The Diabetes Care Survey (DCS). The DCS is a self-administered paper-and-pencil questionnaire first fielded in 2000. Households receive a DCS based on their response to a question in the Priority Condition section of the CAPI instrument, which asks whether or not the respondent was ever told by a doctor or health professional that he/she had diabetes.

The 2011 Cancer Self-Administered Questionnaire. AHRQ, in collaboration with the National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society developed a self-administered questionnaire (SAQ) for current cancer patients and cancer survivors identified in the Medical Expenditure Panel Survey. Fielded in the spring of 2012 (MEPS Panel 16 Round 3 and Panel 15 Round 5), the Cancer SAQ asked respondents questions about the burden of cancer, long lasting effects of the disease, financial impacts, and employment outcomes for cancer survivors and their families. The data collected were used to supplemented MEPS 2011 data.

The 2014 Preventive Care Self-Administered Questionnaire. This SAQ is a paper-and-pencil questionnaire fielded during Panel 18 Round 5 of the 2014 Medical Expenditure Panel Survey (MEPS). The survey was designed to collect a variety of person-level preventive health care data for adults. A subset of adults age 35 and older as of the Round 5 interview date in MEPS households were asked to complete the PSAQ. The questionnaires were administered in early 2015.

Select questionnaire and year:

Medical Provider Component (MPC) Questionnaires

MEPS also includes a Medical Provider Component (MPC) that requests data from hospitals, physicians, home health care providers, and pharmacies identified by MEPS-HC respondents. Its purpose is to supplement and/or replace information received from the MEPS-HC respondents about the health care that was provided to sampled household members in the course of the survey year. The MPC Questionnaires are designed to obtain information on both the medical and financial characteristics of medical events. Beginning in 2009, the paper-based system for collecting data was replaced with a computer-based Integrated Data Collection System (IDCS) that allows for data collection specialists to gather data through either telephone or through hardcopy record abstraction directly into one central database. The most current data years of the MPC questionnaires are available below. MPC Questionnaires from previous data years are available upon request to the MEPS project director at mepspd@ahrq.gov.

Select MPC questionnaire and year:

MPC Contact Guides

The MPC Contact Guides for hospitals, physicians, home health care providers, and pharmacies each contain a script that guides the data collection specialist through an explanation of the MEPS MPC, its purpose, and the data we would like to collect. The guide also obtains contact information for data collection itself after patient authorization forms have been sent to the provider. The most current data year of the contact guides are available below. Contact guides from previous data years are available upon request to the MEPS project director at mepspd@ahrq.gov.

Select contact guides used for medical provider data collection and year:

MPC Authorization Forms

The MPC Authorization Forms, signed by patients interviewed by MEPS, permit the Medical Provider Component staff to contact medical providers and pharmacies and authorize providers to release medical information about their patients. The most current data years of the authorization forms are available below. Please note that the Spanish authorization forms are for Spanish-speaking respondents to read; they sign the English forms.

MPC Authorization Forms from previous data years are available upon request to the MEPS project director at mepspd@ahrq.gov.

Select authorization forms used for medical provider data collection and year: