MEPS HC-135H: 2010 Home Health Visits
June 2012
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 Survey Management and Data Collection
C. Technical and Programming Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Source and Naming Conventions
2.4.1 Variable-Source Crosswalk
2.4.2 Expenditure and Source of Payment Variables
2.5 File Contents
2.5.1 Survey Administration Variables
2.5.1.1 Person Identifiers (DUID, PID, DUPERSID)
2.5.1.2 Record Identifier (EVNTIDX)
2.5.1.3 Round Indicator (EVENTRN)
2.5.1.4 Panel Indicator (PANEL)
2.5.2 Home Health Event Variables
2.5.2.1 Date of Event (HHDATEYR, HHDATEMM)
2.5.2.2 Characteristics of Event (MPCELIG-OTHCWOS)
2.5.2.3 Treatments, Therapies, and Services (HOSPITAL-OTHSVCOS)
2.5.2.4 Frequency of Event (FREQCY-HHDAYS)
2.5.3 Flat Fee Variables
2.5.4 Condition, Procedure, and Clinical Classification Codes
2.5.5 Expenditure Data
2.5.5.1 Definition of Expenditures
2.5.5.2 Data Editing and Imputation Methodologies of Expenditure Variables
2.5.5.2.1 General Data Editing Methodology
2.5.5.2.2 Imputation Methodologies
2.5.5.2.3 Home Health Data Editing and Imputation
2.5.5.3 Imputation Flag Variable (IMPFLAG)
2.5.5.4 Flat Fee Expenditures
2.5.5.5 Zero Expenditures
2.5.5.6 Sources of Payment
2.5.5.7 Home Health Expenditure Variables (HHSF10X – HHXP10X)
2.5.5.8 Rounding
3.0 Sample Weight (PERWT10F)
3.1 Overview
3.2 Details on Person Weight Construction
3.2.1 MEPS Panel 14 Weight
3.2.2 MEPS Panel 15 Weight
3.2.3 The Final Weight for 2010
3.2.4 Coverage
3.3 Using MEPS Data for Trend Analysis
4.0 Strategies for Estimation
4.1 Developing Event-Level Estimates
4.2 Person-Based Estimates for Home Health Care
4.3 Variables with Missing Values
4.4 Variance Estimation (VARPSU, VARSTR)
5.0 Merging/Linking MEPS Data Files
5.1 Linking to the Person-Level File
5.2 Linking to the Prescribed Medicines File
5.3 Linking to the Medical Conditions 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
1.0 Household Component
The Medical Expenditure Panel Survey (MEPS) provides
nationally representative estimates of health care use, expenditures, sources of
payment, and health insurance coverage for the U.S. civilian
non-institutionalized population. The MEPS Household Component (HC) also
provides estimates of respondents’ health status, demographic and socio-economic
characteristics, employment, access to care, and satisfaction with health care.
Estimates can be produced for individuals, families, and selected population
subgroups. The panel design of the survey, which includes 5 Rounds of interviews
covering 2 full calendar years, provides data for examining person level changes
in selected variables such as expenditures, health insurance coverage, and
health status. Using computer assisted personal interviewing (CAPI) technology,
information about each household member is collected, and the survey builds on
this information from interview to interview. All data for a sampled household
are reported by a single household respondent.
The MEPS-HC was initiated in 1996. Each year a new
panel of sample households is selected. Because the data collected are
comparable to those from earlier medical expenditure surveys conducted in 1977
and 1987, it is possible to analyze long-term trends. Each annual MEPS-HC sample
size is about 15,000 households. Data can be analyzed at either the person or
event level. Data must be weighted to produce national
estimates.
The set of households selected for each panel of the
MEPS HC is a subsample of households participating in the previous year’s
National Health Interview Survey (NHIS) conducted by the National Center for
Health Statistics. The NHIS sampling frame provides a nationally representative
sample of the U.S. civilian non-institutionalized population and reflects an
oversample of blacks and Hispanics. In 2006, the NHIS implemented a new sample
design, which included Asian persons in addition to households with black and
Hispanic persons in the oversampling of minority populations. MEPS further
oversamples additional policy relevant sub-groups such as low income households.
The linkage of the MEPS to the previous year’s NHIS provides additional data for
longitudinal analytic purposes.
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2.0 Medical Provider Component
Upon completion of the household CAPI interview and
obtaining permission from the household survey respondents, a sample of medical
providers are contacted by telephone to obtain information that household
respondents can not accurately provide. This part of the MEPS is called the
Medical Provider Component (MPC) and information is collected on dates of visit,
diagnosis and procedure codes, charges and payments. The Pharmacy Component
(PC), a subcomponent of the MPC, does not collect charges or diagnosis and
procedure codes but does collect drug detail information, including National
Drug Code (NDC) and medicine name, as well as date filled and sources and
amounts of payment. The MPC is not designed to yield national estimates. It is
primarily used as an imputation source to supplement/replace household reported
expenditure information.
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3.0 Survey Management and Data Collection
MEPS HC and MPC data are collected under the authority
of the Public Health Service Act. Data are collected under contract with Westat,
Inc. (MEPS HC) and Research Triangle Institute (MEPS MPC). Data sets and summary
statistics are edited and published in accordance with the confidentiality
provisions of the Public Health Service Act and the Privacy Act. The National
Center for Health statistics (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, micro data files, and tables via the MEPS Web site:
meps.ahrq.gov.
Selected data can be analyzed through MEPSnet, an on-line interactive tool
designed to give data users the capability to statistically analyze MEPS data in
a menu-driven environment.
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 2010 Medical Expenditure Panel Survey (MEPS) Household
Component (HC) and Medical Provider Component (MPC). Released as an ASCII data
file (with related SAS, SPSS, and Stata programming statements) and a SAS
transport file, the 2010 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 2010. The file contains 68
variables and has a logical record length of 305 with an additional 2-byte
carriage return/line feed at the end of each record. As illustrated below, this
file consists of MEPS survey data obtained in the 2010 portion of Round 3, and
Rounds 4 and 5 for Panel 14, as well as Rounds 1, 2, and the 2010 portion of
Round 3 for Panel 15 (i.e., the rounds for the MEPS panels covering calendar
year 2010).
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 the MPC. Information from the 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
2010 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 2010. Aggregate annual person-level information
on the use of home health providers and other health services is provided on the
2010 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 T.
Ezzati-Rice, et al. (1998-2007) and S. Cohen, 1996. For information on
the MEPS MPC design, see S. Cohen, 1998. A copy of the survey instruments
used to collect the information on this file is available on the MEPS Web site
at the following address:
meps.ahrq.gov.
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2.0 Data File Information
The 2010 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.
The home health services represented on this file are
provided by three kinds of home health providers: formal (paid) home health
agency providers, paid independent providers (self-employed), and informal
providers who do not reside in the same household as the MEPS sampled person
(care from informal providers who live in the same household as the sampled
person are not represented on this file).
Each record on this file represents a
household-reported home health event. A home health event is a MONTH of similar
services provided to a sampled person by the same PROVIDER (i.e., an employer in
the case of formal agency care and an individual in the case of paid independent
and informal care providers). For example, if a person received, from Provider
Agency A, four visits from a nurse, ten visits from a homemaker, and four visits
from a physical therapist each month during the months of January, February, and
March, and also received, from Provider B, a physician visit in the months of
January and February, there would be five event records on the file (NOT 56
records). There would be one event record representing all the visits from
Provider A for the month of January, another record for Provider A February
visits, a third Provider A record for the March visits, a fourth record
representing the Provider B physician visit in January and a fifth representing
the Provider B physician visit in February. Data were collected (and represented
on this file) in this manner because agencies, hospitals, and nursing homes
provide MEPS 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 4,021 home health
records; of the records, 3,954 are associated with persons having a positive
person-level weight (PERWT10F). It includes all records related to home health
events for all household members who resided in eligible responding households
and for whom at least one home health event was reported. Each record represents
one household-reported home health event that occurred during calendar year
2010. Some persons may have been reported to have multiple events and thus will
be represented in multiple records on the file. Other persons may have been
reported to have no events and thus will have no records on this file. These
data were collected during the 2010 portion of Round 3, and Rounds 4 and 5 for
Panel 14, as well as Rounds 1, 2, and the 2010 portion of Round 3 for Panel 15
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 2010 eligibility (i.e., persons with a
positive 2010 full-year person-level weight (PERWT10F > 0)), or
- Be an eligible member of a family all of whose key in-scope
members have a positive person-level weight (PERWT10F > 0).
(Such a family consists of all persons with the same value for
FAMIDYR.) That is, the person must have a positive full-year
family-level weight (FAMWT10F > 0). Note that FAMIDYR and
FAMWT10F are variables on the 2010 Population Characteristics file.
Persons with no home health events for 2010 are not
included on this event-level HH file but are represented on the person-level
2010 Full Year Population Characteristics file.
Home health providers include formal, i.e., paid, and
informal, i.e., unpaid, providers. Formal or paid providers include: home health
agency and other independent paid providers. Informal or unpaid providers
include family and friends that reside outside of the sampled person’s
household.
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.
To append person-level information such as demographic
or health insurance coverage to each event record, data from this file can be
merged with 2010 MEPS HC person-level data (e.g. Full Year Consolidated or Full
Year Population Characteristics files) using the person identifier, DUPERSID.
Home Health events can also be linked to the MEPS 2010 Medical Conditions File.
Please see Section 5.0 or the MEPS 2010 Appendix File, HC-135I, for details on
how to link MEPS data files.
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2.1 Codebook Structure
For each variable on the Home Health event file, both
weighted and unweighted frequencies are provided in the accompanying codebook.
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
Note that the person identifier is unique within this
data year.
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2.2 Reserved Codes
The following reserved code values are used:
| Value |
Definition |
| -1 INAPPLICABLE |
Question was not asked due to skip pattern |
| -7 REFUSED |
Question was asked and respondent refused to answer question |
| -8 DK |
Question was asked and respondent did not know answer |
| -9 NOT ASCERTAINED |
Interviewer did not record the data |
Generally, 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:
meps.ahrq.gov/survey_comp/survey_questionnaires.jsp).
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2.3 Codebook Format
The codebook describes an ASCII data set (although the
data are also being provided in a SAS transport file). The following codebook
items are provided for each variable:
| Identifier |
Description |
| Name |
Variable name (maximum of 8 characters) |
| Description |
Variable descriptor (maximum 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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2.4 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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2.4.1 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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2.4.2 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
variables are named in the following way:
The first two characters indicate the type of event:
IP - inpatient stay
ER - emergency room visit
HH - home health event
OM - other medical equipment
OB - office-based visit
OP - outpatient visit
DV - dental visit
RX - prescribed medicine
In the case of source of payment variables, the third
and fourth characters indicate:
SF - self or family
MR - Medicare
MD - Medicaid
PV - private insurance
VA - Veterans Administration/CHAMPVA
TR - TRICARE
OF - other Federal Government
SL - State/local government
WC - Workers’ Compensation
OT - other insurance
OR - other private
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 (10).
The seventh character, "X", indicates the variable is edited/imputed.
For example, HHSF10X is the edited/imputed amount paid
by self or family for 2010 home health expenditures.
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2.5 File Contents
2.5.1 Survey Administration Variables
2.5.1.1 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 2010 Full Year Population Characteristics file.
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2.5.1.2 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 2010 Medical
Conditions File). For details on linking see Section 5.0 or the MEPS 2010
Appendix File, HC-135I.
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2.5.1.3 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 14. Likewise, Rounds 1, 2, and 3 are associated
with data collected from Panel 15.
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2.5.1.4 Panel Indicator (PANEL)
PANEL is a constructed variable used to specify the
panel number for the person. PANEL will indicate either Panel 14 or Panel 15 for
each person on the file. Panel 14 is the panel that started in 2009, and Panel
15 is the panel that started in 2010.
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2.5.2 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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2.5.2.1 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 2010. These variables
should not be interpreted as "true" start dates.
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2.5.2.2 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. For all members receiving care from an agency, hospital
or nursing home, the respondent was asked to identify the type of home health
worker (CNA-SPEECTHP) they saw – 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 a
person was 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 that a person was 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, or HHTYPE, so inconsistencies between these
variables are possible.
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2.5.2.3 Treatments, Therapies, and Services (HOSPITAL-OTHSVCOS)
Regardless of the type of provider, all respondents
were asked if the home health services 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 if persons were reported as
receiving care from a formal provider was the respondent 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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2.5.2.4 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).
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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2.5.3 Flat Fee Variables
A flat fee is the fixed dollar amount a person is
charged for a package of health care services provided during a defined period
of time. Because MEPS does not collect flat fee information about home health
events, no flat fee variables are included in this file.
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2.5.4 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 2010 Medical Conditions File. Details on how to
link to the MEPS 2010 Medical Conditions File are provided in the MEPS 2010
Appendix File, HC-135I.
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2.5.5 Expenditure Data
2.5.5.1 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
meps.ahrq.gov/data_stats/onsite_datacenter.jsp.
If examining trends in MEPS expenditures, please refer to section C, sub-section
3.3 for more information.
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2.5.5.2 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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2.5.5.2.1 General Data Editing Methodology
Logical edits were used to resolve internal
inconsistencies and other problems in the HC and the 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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2.5.5.2.2 Imputation Methodologies
For events in this file that were eligible for the
MEPS-MPC (i.e. home health agency events where MPCELIG = 1), a predictive mean
matching imputation method was used to impute missing expenditures. This
procedure uses regression models (based on events with completely reported
expenditure data) to predict total expenses for each event. Then, for each event
with missing payment information, a donor event with the closest predicted
payment with the same pattern of expected payment sources as the event with
missing payment was used to impute the missing payment value. For events in this
file that were not eligible for the MEPS-MPC (i.e. home health paid independent
events where MPCELIG = 2), a weighted sequential hot-deck procedure was used to
impute missing expenditures. This procedure uses survey data from respondents to
replace missing data while taking into account the
persons’ weighted distribution in the imputation process. Classification
variables vary by type of provider in the hot-deck imputations, but total
charge (when available) and insurance coverage are key variables in all of the
imputations. The weighted sequential hot-deck procedure was also used to impute
the missing total charges for both home health agency events and home health
paid independent events. After the imputations were finished, the two categories
of home care also were combined into a single home health file.
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2.5.5.2.3 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 of
(never asked) 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 this file, separate imputations were performed for simple
events.
Logical edits were used to sort each event into a
specific category for the imputations. Events with complete expenditures were
flagged as potential donors 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 (Home Healthcare Paid Independents) and eight recipient categories for
HHA (Home Healthcare Agency) for events with missing data. Expenditures were
imputed through separate predictive mean matching or 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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2.5.5.3 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 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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2.5.5.4 Flat Fee Expenditures
A flat fee is the fixed dollar amount a person is
charged for a package of health care services provided during a defined period
of time. Because MEPS does not collect flat fee information about home health
events, there are no flat fee expenditure data included in this file.
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2.5.5.5 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) follow-up events were
provided without a separate charge (e.g., after a surgical procedure), or (4)
the event was paid for through government or privately-funded research or
clinical trials. If all of the medical events for a person fell into one of
these categories, then the total annual expenditures for that person would be
zero. All expenditures for home health care provided by informal care providers
(family, friends, or volunteers, MPCELIG=3) were assigned –1 "INAPPLICABLE"
because those types of events were skipped out of (never asked) questions
regarding expenditures.
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2.5.5.6 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/CHAMPVA, 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,
- Workers’ 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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2.5.5.7 Home Health Expenditure Variables (HHSF10X - HHXP10X)
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 regarding 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. HHSF10X -
HHOT10X are the 12 sources of payment. HHTC10X is the total charge, and HHXP10X
is the sum of the 12 sources of payment for the home health expenditures. The 12
sources of payment are: self/family (HHSF10X), Medicare (HHMR10X), Medicaid
(HHMD10X), private insurance (HHPV10X), Veterans Administration/CHAMPVA
(HHVA10X), TRICARE (HHTR10X), other Federal sources (HHOF10X), State and Local
(non-federal) government sources (HHSL10X), Workers’ Compensation (HHWC10X),
other private insurance (HHOR10X), other public insurance (HHOU10X), and other
insurance (HHOT10X). Analysts can determine if a home health event was provided
by an agency or by some other paid independent provider by subsetting the
variable MPCELIG to the appropriate and desired value.
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2.5.5.8 Rounding
Expenditure variables on the 2010 home health event
file have been rounded to the nearest penny. Person-level expenditure
information released on the 2010 Person-Level Use and Expenditure File was
rounded to the nearest dollar. It should be noted that using the 2010 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 2010 Appendix File, HC-135I, for details on such
rounding differences.
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3.0 Sample Weight (PERWT10F)
3.1 Overview
There is a single full year person-level weight
(PERWT10F) 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 2010. A
key person was either a member of a responding NHIS household at the time of
interview or joined a family associated with such a household after being
out-of-scope at the time of the NHIS (the latter circumstance includes newborns
as well as those returning from military service, an institution, or residence
in a foreign country). 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 PERWT10F was developed in
several stages. Person-level weights for Panel 14 and Panel 15 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;
black, non-Hispanic; Asian non-Hispanic; and other); sex; and age. A 2010
composite weight was then formed by multiplying each weight from Panel 14 by the
factor .51 and each weight from Panel 15 by the factor .49. 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 (five categories: 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.
The raking process also incorporated two additional
raking dimensions (sets of control totals) described below.
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3.2.1 MEPS Panel 14 Weight
The person-level weight for MEPS Panel 14 was
developed using the 2009 full year weight for an individual as a "base" weight
for survey participants present in 2009. For key, in-scope members who joined an
RU sometime in 2010 after being out-of-scope in 2009, the initially assigned
person-level weight was the corresponding 2009 family weight. The weighting
process included an adjustment for nonresponse over Rounds 4 and 5 as well as
raking to population control figures for December 2010. These control figures
were derived by scaling back the population totals obtained from the March 2011
CPS to correspond to a national estimate for the civilian noninstitutionalized
population provided by the Census Bureau for December 2010. 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. The final weight for key, responding persons
who were not in-scope on December 31, 2010 but were in-scope earlier in the year
was the person weight, the weight after the nonresponse adjustment.
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3.2.2 MEPS Panel 15 Weight
The person-level weight for MEPS Panel 15 was
developed using the MEPS Round 1 person-level weight as a "base" weight. For
key, in-scope RU members 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 2010 portion of Round 3 as well as raking
to the same population control figures for December 2010 used for the MEPS Panel
14 weights. The same five variables employed for Panel 14 raking (census region,
MSA status, race/ethnicity, sex, and age) were used for Panel 15 raking. Again,
the final weight for key, responding persons who were not in-scope on December
31, 2010 but were in-scope earlier in the year was the person weight after the
nonresponse adjustment.
Note that the MEPS Round 1 weights 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 CPS data base of the corresponding year
(i.e., 2009 for Panel 14 and 2010 for Panel 15).
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3.2.3 The Final Weight for 2010
The composite weights of two groups of persons who
were out-of-scope on December 31, 2010 were poststratified. Specifically, the
weights of those who were in-scope sometime during the year, out-of-scope on
December 31, and entered a nursing home during the year were poststratified to a
corresponding control total obtained from the 1996 MEPS Nursing Home Component.
Those who died while in-scope during 2010 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 decedent control totals were developed
for the "65 and older" and "under 65" civilian noninstitutionalized populations.
In developing the final person-level weight for 2010
(PERWT10F), additional raking dimensions were added that reflected the MEPS
2008-09 estimated average annual distributions of office-based visits by age
(under 65, 65 and over) and the proportion of persons age 65 and over with care
from home health agencies. These additional adjustments were included to better
reflect benchmark trends in office-based and home health care utilization. For
each marginal category of the dimensions, the table below shows the ratio of the
weighted number of persons that resulted from including the additional raking
dimensions to that of the corresponding estimate without the additional raking
dimensions.
Ratio of Adjusted to Unadjusted Weights
| Number of Visits |
Nonelderly (AGE10X < 65) |
Elderly (AGE10X ≥ 65) |
| OFFICE-BASED |
| 0 |
0.9169 |
0.8737 |
| 1-5 |
1.0137 |
0.9270 |
| 6-10 |
1.0415 |
1.0581 |
| > 10 |
1.1905 |
1.1058 |
| HOME HEALTH AGENCY |
| 0 |
-- |
0.9882 |
| > 0 |
-- |
1.1564 |
Overall, the weighted population estimate for the
civilian noninstitutionalized population for December 31, 2010 is 304,842,384
(PERWT10F>0 and INSC1231=1). The sum of the person-level weights across all
persons assigned a positive person-level weight is 308,573,977.
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3.2.4 Coverage
The target population for MEPS in this file is the
2010 U.S. civilian noninstitutionalized population. However, the MEPS sampled
households are a subsample of the NHIS households interviewed in 2008 (Panel 14)
and 2009 (Panel 15). New households created after the NHIS interviews for the
respective Panels and consisting exclusively of persons who entered the target
population after 2008 (Panel 14) or after 2009 (Panel 15) 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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3.3 Using MEPS Data for Trend Analysis
MEPS began in 1996, and the utility of the survey for
analyzing health care trends expands with each additional year of data. 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 may be attributable to sampling variation. 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,
economic conditions, or MEPS survey methodology. Looking at changes over longer
periods of time can provide a more complete picture of underlying trends.
Analysts of MEPS data may wish to consider using techniques to evaluate, smooth,
or stabilize estimates of trends. Such techniques include comparing pooled time
periods (e.g. 1996-97 versus 2004-05), 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 (i.e., the chance of declaring an
observed difference to be statistically significant when there is no difference
in the population parameters). Performing numerous statistical significance
tests increases the likelihood of a Type I error.
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4.0 Strategies for Estimation
4.1 Developing Event-Level Estimates
The data in this file can be used to develop national
2010 event level (i.e., monthly) estimates for the U.S. civilian
noninstitutionalized population on expenditures and sources of payment for home
health care medical provider visits. The weight assigned to each home health
care medical provider event reported is the person-level weight of the person
who was visited. If a person had several events reported, each event is assigned
that individual’s person-level weight. Estimates must be weighted by PERWT10F to
be nationally representative. For example, the appropriate estimate for the
overall mean out-of-pocket payment per month of care is computed as follows (the
subscript ‘j’ identifies each event and represents a numbering of events from 1
through the total number of events in the file):
(ĺ Wj Xj)/(ĺ Wj), where
Wj = PERWT10Fj (full year person weight for the person associated with event j) and
Xj = HHSF10Xj (amount paid by self/family for event j)
Estimates and corresponding standard errors (SE) can
be derived using an appropriate computer software package for complex survey
analysis such as SAS, Stata, SUDAAN or SPSS
(meps.ahrq.gov/survey_comp/standard_errors.jsp).
The tables below contain the correct event-level
estimates for several key variables on this file. Informal care (MPCELIG = 3) is
not included in the tables because, by definition, there are no payments for
those events and, therefore, no expenditure data are collected.
Selected Event-Level Estimates
Expenditures: Home Health Agency & Paid Independents (MPCELIG = 1, 2):
| Estimate of Interest |
Variable |
Estimate (SE) |
Estimate Excluding
Zero Payment Events
(SE) |
| Proportion of events with expenditures>0* |
HHXP10X |
0.980 (0.0050) |
----- |
| Mean total payments per month of care |
HHXP10X |
$1,196 (80.8000) |
$1,221 (80.7000) |
| Mean out-of-pocket payments per month of care |
HHSF10X |
$47 (12.9000) |
$48 (13.2000) |
Mean proportion of total monthly expenditures
paid
out of pocket |
HHSF10X/
HHXP10X |
----- |
0.079 (0.0178) |
Mean total payments per month where any services
provided due to hospitalization (HOSPITAL=1) |
HHXP10X |
$1,244 (96.0000) |
$1,276 (95.0000) |
Expenditures: Home Health Agency Providers only (MPCELIG=1)
| Estimate of Interest |
Variable |
Estimate (SE) |
Estimate Excluding
Zero Payment Events
(SE) |
| Proportion of events with expenditures>0* |
HHXP10X |
0.981 (0.0051) |
----- |
| Mean total payments per month |
HHXP10X |
$1,258 (86.3000) |
$1,282 (87.0000) |
| Mean out-of-pocket payments per month |
HHSF10X |
$3 (2.1000) |
$3 (2.2000) |
Mean proportion of total monthly expenditures
paid
out of pocket |
HHSF10X/
HHXP10X |
----- |
0.008 (0.0041) |
Mean total payments per month where any services
provided due to hospitalization (HOSPITAL=1) |
HHXP10X |
$1,258 (101.3000) |
$1,290 (100.1000) |
Expenditures: Paid Independent Providers only (MPCELIG=2)
| Estimate of Interest |
Variable |
Estimate (SE) |
Estimate Excluding
Zero Payment Events
(SE) |
| Proportion of events with expenditures>0* |
HHXP10X |
0.964 (0.0187) |
----- |
| Mean total payments per month |
HHXP10X |
$617 (139.4000) |
$640 (141.4000) |
| Mean out-of-pocket payments per month of care |
HHSF10X |
$461 (90.6000) |
$478 (90.9000) |
Mean proportion of total monthly expenditures
paid
out of pocket |
HHSF10X/
HHXP10X |
----- |
0.755 (0.0575) |
Mean total payments per month where any services
provided due to hospitalization (HOSPITAL=1) |
HHXP10X |
$848 (265.4000) |
$868 (270.7000) |
*Zero payment events can occur in MEPS for the
following reasons: (1) there was no charge for a follow-up event, (2) the
provider was never paid by an individual, insurance plan, or other source for
services provided, (3) charges were included in another bill, or (4) the event
was paid for through government or privately-funded research or clinical trials.
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4.2 Person-Based Estimates for Home Health Care
To enhance analyses of home health care, analysts may
link information about the home health care received by sample persons in this
file to the annual full year consolidated file (which has data for all MEPS
sample persons), or conversely, link person-level information from the full year
consolidated file to this event level file. Both this file and the full year
consolidated file may be used to derive estimates relative to persons with home
health care and annual estimates of total expenditures. However, if the estimate
relates to the entire population, this file cannot be used to calculate the
denominator, as only those persons with at least one month in which home health
care was provided are represented on this data file. Therefore, the full year
consolidated file must be used for person-level analyses that include both those
with and without home health care.
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4.3 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 negative 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 and zero expenditures) are described in Section 2.5.5.2.
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4.4 Variance Estimation (VARPSU, VARSTR)
MEPS has a complex sample design. To obtain estimates
of variability (such as the standard error of sample estimates or corresponding
confidence intervals) for MEPS estimates, analysts need to take into account the
complex sample design of MEPS for both person-level and family-level analyses.
Several methodologies have been developed for estimating standard errors for
surveys with a complex sample design, including the Taylor-series linearization
method, balanced repeated replication, and jackknife replication. Various
software packages provide analysts with the capability of implementing these
methodologies. Replicate weights have not been developed for the MEPS data.
Instead, the variables needed to calculate appropriate standard errors based on
the Taylor-series linearization method are included on this file as well as all
other MEPS public use files. Software packages that permit the use of the
Taylor-series linearization method include SUDAAN, Stata, SAS (version 8.2 and
higher), and SPSS (version 12.0 and higher). For complete information on the
capabilities of each package, analysts should refer to the corresponding
software user documentation.
Using the Taylor-series linearization method, variance
estimation strata and the variance estimation PSUs within these strata must be
specified. The variance strata variable is named VARSTR, while the variance PSU
variable is named VARPSU. Specifying a "with replacement" design in a computer
software package, such as SUDAAN, provides 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), one can expect at least 100 degrees of
freedom for the 2010 full year data associated with the corresponding estimates
of variance and usually substantially more.
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 were developed to be compatible
with MEPS data associated with the NHIS sample design used through 2006. Such
data 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.
As a result of the change in the NHIS sample design in
2006, a new set of variance strata and PSUs have been established for variance
estimation purposes for use with MEPS Panel 12 and subsequent MEPS panels. There
were 165 variance strata associated with both MEPS Panel 14 and Panel 15,
providing a substantial number of degrees of freedom for subgroups as well as
the nation as a whole. Each variance stratum contains either two or three
variance estimation PSUs.
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5.0 Merging/Linking MEPS Data Files
Data from this file can be used alone or in
conjunction with other files for different analytic purposes. This section
provides instructions, or the details on where to find the instructions, for
linking the 2010 home health provider events with other 2010 MEPS public use
files, including the 2010 person-level and conditions files. Each MEPS panel can
also be linked back to the previous years’ National Health Interview Survey
public use data files. For information on obtaining MEPS/NHIS link files please see
meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.
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5.1 Linking to the Person-Level File
Merging characteristics of interest from other 2010
MEPS files (e.g., the 2010 Full Year Consolidated File or the 2010 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 2010 Appendix File, HC-135I,
provides additional details on how to merge 2010 MEPS data files.
- Create data set PERSX by sorting the 2010 Full Year
Consolidated 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;
Return To Table Of Contents
5.2 Linking to the Prescribed Medicines File
The RXLK provides a link from 2010 MEPS event files to
the 2010 Prescribed Medicines File. Because prescribed medicines data are not
collected for home health events, this Home Health File cannot be linked to the
2010 Prescribed Medicines File.
Return To Table Of Contents
5.3 Linking to the Medical Conditions File
The CLNK provides a link from 2010 MEPS event files to
the 2010 Medical Conditions File. When using the CLNK, data users/analysts
should keep in mind that (1) conditions are household-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. For detailed linking examples, including SAS code, data
users/analysts should refer to the MEPS 2010 Appendix File, HC-135I.
Return To Table Of Contents
References
Cohen, S.B. (1998). Sample Design of the 1996 Medical
Expenditure Panel Survey Medical Provider Component. Journal of Economic and
Social Measurement. Vol. 24, 25-53.
Cohen, S.B. (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.
Ezzati-Rice, T.M., Rohde, F., Greenblatt, J., Sample
Design of the Medical Expenditure Panel Survey Household Component, 1998–2007.
Methodology Report No. 22. March 2008. Agency for Healthcare Research and
Quality, Rockville, MD.
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.
Return To Table Of Contents
D. Variable-Source Crosswalk
VARIABLE-SOURCE CROSSWALK
FOR MEPS HC-135H: 2010 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 |
| PANEL |
Panel Number |
Constructed |
Return To Table Of Contents
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 hlth care wrkr – cert nurse asst |
HH01 |
| COMPANN |
Type of hlth care wrkr – companion |
HH01 |
| DIETICN |
Type of hlth care wrkr – dietitian/nutrt |
HH01 |
| HHAIDE |
Type of hlth care wrkr – home care aide |
HH01 |
| HOSPICE |
Type of hlth care wrkr – hospice worker |
HH01 |
| HMEMAKER |
Type of hlth care wrkr - homemaker |
HH01 |
| IVTHP |
Type of hlth care wrkr – IV therapist |
HH01 |
| MEDLDOC |
Type of hlth care wrkr – medical doctor |
HH01 |
| NURPRACT |
Type of hlth care wrkr – nurse/practr |
HH01 |
| NURAIDE |
Type of hlth care wrkr – nurse’s aide |
HH01 |
| OCCUPTHP |
Type of hlth care wrkr – occup therap |
HH01 |
| PERSONAL |
Type of hlth care wrkr – pers care attdt |
HH01 |
| PHYSLTHP |
Type of hlth care wrkr – physicl therapy |
HH01 |
| RESPTHP |
Type of hlth care wrkr – respira therapy |
HH01 |
| SOCIALW |
Type of hlth care wrkr – social worker |
HH01 |
| SPEECTHP |
Type of hlth care wrkr – speech therapy |
HH01 |
| OTHRHCW |
Type of hlth care wrkr – other |
HH01 |
| NONSKILL |
Type of hlth care wrkr – non-skilled |
HH02 |
| SKILLED |
Type of hlth care wrkr – skilled |
HH02 |
| SKILLWOS |
Specify type of skilled worker |
HH02OV1 |
| OTHCW |
Type of hlth care wrkr – some other |
HH02 |
| OTHCWOS |
Specify other type health care worker |
HH02OV2 |
| HOSPITAL |
Any hh care svce due to hospitalization |
HH04 |
| VSTRELCN |
Any hh care svce Related to Hlth Cond |
HH04 |
| TREATMT |
Person received medical treatment |
HH06 |
| MEDEQUIP |
Person was taught use of med equipment |
HH07 |
| DAILYACT |
Person was helped with daily activities |
HH08 |
| COMPANY |
Person received companionship services |
HH09 |
| OTHSVCE |
Person received oth home care services |
HH10 |
| OTHSVCOS |
Specify other home care srvce received |
HH10OV |
| FREQCY |
Provider helped every week/some weeks |
HH11 |
| DAYSPWK |
# days / week provider came |
HH12 |
| DAYSPMO |
# days / month provider came |
HH13 |
| HOWOFTEN |
Prov came once per day/more than once |
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 oth mons per received same services |
HH17 |
| HHDAYS |
Days per month in home health, 2010 |
Constructed |
Return To Table Of Contents
Imputed Expenditure Variables
| Variable |
Description |
Source |
| HHSF10X |
Amount paid, family (Imputed) |
CP Section (Edited) |
| HHMR10X |
Amount paid, Medicare (Imputed) |
CP Section (Edited) |
| HHMD10X |
Amount paid, Medicaid (Imputed) |
CP Section (Edited) |
| HHPV10X |
Amount paid, private insurance (Imputed) |
CP Section (Edited) |
| HHVA10X |
Amount paid, Veterans/CHAMPVA (Imputed) |
CP Section (Edited) |
| HHTR10X |
Amount paid, TRICARE (Imputed) |
CP Section (Edited) |
| HHOF10X |
Amount paid, other federal (Imputed) |
CP Section (Edited) |
| HHSL10X |
Amount paid, state & local gov (Imputed) |
CP Section (Edited) |
| HHWC10X |
Amount paid, workers comp (Imputed) |
CP Section (Edited) |
| HHOR10X |
Amount paid, other private (Imputed) |
Constructed |
| HHOU10X |
Amount paid, other public (Imputed) |
Constructed |
| HHOT10X |
Amount paid, other insurance (Imputed) |
CP Section (Edited) |
| HHXP10X |
Sum of HHSF10X – HHOT10X (Imputed) |
Constructed |
| HHTC10X |
Hhld reported total charge (Imputed) |
CP Section (Edited) |
| IMPFLAG |
Imputation status |
Constructed |
Return To Table Of Contents
Weights
| Variable |
Description |
Source |
| PERWT10F |
Expenditure file person weight, 2010 |
Constructed |
| VARSTR |
Variance estimation stratum, 2010 |
Constructed |
| VARPSU |
Variance estimation PSU, 2010 |
Constructed |
Return To Table Of Contents
|
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