MEPS HC-033B: 1999 Dental Visits
May 2002
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406
Table of
Contents
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Insurance Component
4.0 Survey Management
C. Technical and Programming
Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Naming
2.4.1 General
2.4.2 Expenditure and Sources
of Payment Variables
2.5 File Contents
2.5.1 Survey Administration and ID
Variables
2.5.1.1 Person Identifiers (DUID -
DUPERSID)
2.5.1.2 Record Identifiers (EVNTIDX
- FFEEIDX)
2.5.1.3 Record Indicators (EVENTRN
- DVR2FLAG)
2.5.2 Characteristics of
Dental Events
2.5.2.1 Date of Dental Visit (DVDATEYR
DVDATEDD)
2.5.2.2 Type of Provider Seen (GENDENT
- DENTYPE)
2.5.2.3 Treatment, Procedures,
and Services (EXAMINE - DENTMED)
2.5.3 Flat Fee Variables (FFDVTYPE,
FFBEF99, FFTOT00)
2.5.3.1 Definition of Flat Fee
Payments
2.5.3.2 Flat Fee Variable
Descriptions
2.5.3.3 Caveats of Flat Fee Groups
2.5.4 Expenditure Data
2.5.4.1 Definition of
Expenditures
2.5.4.2 Imputation and Data
Editing Methodologies of Expenditure Variables
2.5.4.2.1 General Data Editing
Methodology
2.5.4.2.2 General Hot-Deck
Imputation
2.5.4.2.3 Dental Data Editing and
Imputation
2.5.4.3 Capitation Imputation
2.5.4.4 Imputation Flag
Variable (IMPFLAG)
2.5.4.5 Flat Fee Expenditures
2.5.4.6 Zero Expenditures
2.5.4.7 Sources of Payment
2.5.4.8 Dental Expenditure
Variables (DVFS99X- DVTC99X)
2.5.4.9 Rounding
3.0 Sample Weight (PERWT99F)
3.1 Overview
3.2 Details on Person Weights
Construction
3.2.1 MEPS Panel 3 Weight
3.2.2 MEPS Panel 4 Weight
3.2.3 The Final Weight for 1999
3.2.4 Coverage
4.0 Strategies for Estimation
4.1 Variables with Missing Values
4.2 Basic Estimates of Utilization,
Expenditure and Sources of Payment
4.3 Estimates of the Number of
Persons with Dental Visits
4.4 Person-Based Ratio Estimates
4.4.1 Person-Based Ratio Estimates
Relative to Persons with Dental Visits
4.4.2 Person-Based Ratio Estimates
Relative to the Entire Population
4.5 Sampling Weights for Merging
Previous Releases of MEPS Household Data with this Event
File
4.6 Variance Estimation
5.0 Merging/Linking MEPS Data Files
5.1 Linking a Person-Level File to
the Dental File
5.2 Linking the Dental File to the
Medical Conditions File and/or the Prescribed Medicines File
5.2.1 Limitations/Caveats of
RXLK (the Prescribed Medicine Link File)
5.2.2 Limitations/Caveats of
CLNK (the Medical Conditions Link File)
References
Attachment 1
D. Variable-Source Crosswalk
A. Data Use Agreement
Individual identifiers have been removed from the
microdata contained in the files on this CD-ROM.
Nevertheless, under sections 308 (d) and 903 (c) of the
Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299
a-1), data collected by the Agency for Healthcare Research
and Quality (AHRQ) and/or the National Center for Health
Statistics (NCHS) may not be used for any purpose other than
for the purpose for which they were supplied; any effort to
determine the identity of any reported cases, is prohibited
by law.
Therefore in accordance with the above referenced Federal
statute, it is understood that:
- No one is to use the data in this data set in any way
except for statistical reporting and analysis.
- If the identity of any person or establishment should
be discovered inadvertently, then (a) no use will be
made of this knowledge, (b) the Director, Office of
Management, AHRQ will be advised of this incident, (c)
the information that would identify any individual or
establishment will be safeguarded or destroyed, as
requested by AHRQ, and (d) no one else will be informed
of the discovered identity.
- No one will attempt to link this data set with
individually identifiable records from any data sets
other than the Medical Expenditure Panel Survey or the
National Health Interview Survey.
By using these data you signify your agreement to comply
with the above-stated statutorily based requirements, with
the knowledge that deliberately making a false statement in
any matter within the jurisdiction of any department or
agency of the Federal Government violates 18 U.S.C. 1001 and
is punishable by a fine of up to $10,000 or up to 5 years in
prison.
The Agency for Healthcare Research and Quality requests
that users cite AHRQ and the Medical Expenditure Panel
Survey as the data source in any publications or research
based upon these data.
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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) was conducted in 1977, and the
National Medical Expenditure Survey (NMES) was conducted in
1987. Since 1996, MEPS has continued this series with design
enhancements and efficiencies that provide a more current
data resource to capture the changing dynamics of the health
care delivery and insurance system.
The design efficiencies incorporated into MEPS are in
accordance with the Department of Health and Human Services
(DHHS) Survey Integration Plan of June 1995, which focused
on consolidating DHHS surveys, achieving cost efficiencies,
reducing respondent burden, and enhancing analytical
capacities. To advance these goals, MEPS includes linkage
with the National Health Interview Survey (NHIS)a survey
conducted by NCHS from which the sample for the MEPS HC is
drawn -- and enhanced longitudinal data collection for core
survey components. The MEPS HC augments NHIS by selecting a
sample of NHIS respondents, collecting additional data on
their health care expenditures, and linking these data with
additional information collected from the respondents'
medical providers, employers, and insurance providers.
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1.0 Household Component
The MEPS HC, a nationally representative survey of the
U.S. civilian noninstitutionalized population, collects
medical expenditure data at both the person and household
levels. The HC collects detailed data on demographic
characteristics, health conditions, health status, use of
medical care services, charges and payments, access to care,
satisfaction with care, health insurance coverage, income,
and employment.
The HC uses an overlapping panel design in which data are
collected through a preliminary contact followed by a series
of five rounds of interviews over a 2½-year period. Using
computer-assisted personal interviewing (CAPI) technology,
data on medical expenditures and use for 2 calendar years
are collected from each household. This series of data
collection rounds is launched each subsequent year on a new
sample of households to provide overlapping panels of survey
data and, when combined with other ongoing panels, will
provide continuous and current estimates of health care
expenditures.
The sampling frame for the MEPS HC is drawn from
respondents to NHIS. NHIS provides a nationally
representative sample of the U.S. civilian
noninstitutionalized population, with oversampling of
Hispanics and blacks.
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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,
and employer characteristics.
Establishments participating in the MEPS IC are selected
through three sampling frames:
- A list of employers or other insurance providers
identified by MEPS HC respondents who report having
private health insurance at the Round 1 interview.
- A Bureau of the Census list frame of private-sector
business establishments.
- The Census of Governments from the Bureau of the
Census.
To provide an integrated picture of health insurance,
data collected from the first sampling frame (employers and
other insurance providers identified by MEPS HC respondents)
are linked back to data provided by those respondents. Data
collected from the two Census Bureau sampling frames are
used to produce annual national and State estimates of the
supply and cost of private health insurance available to
American workers and to evaluate policy issues pertaining to
health insurance. National estimates of employer
contributions to group health insurance from the MEPS IC are
used in the computation of Gross Domestic Product (GDP) by
the Bureau of Economic Analysis.
The MEPS IC is an annual panel survey. Data are collected
from the selected organizations through a prescreening
telephone interview, a mailed questionnaire, and a telephone
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 also released through
MEPSnet, an online interactive tool developed to give users
the ability to statistically analyze MEPS data in real time.
Summary reports and compendiums of tables are released as
printed documents and electronic files. Microdata files are
released on CD-ROM and/or as electronic files.
Printed documents and selected public use file data on
CD-ROMs are available through the AHRQ Publications
Clearinghouse. Write or call:
AHRQ Publications Clearinghouse
Attn: (publication number)
P.O. Box 8547
Silver Spring, MD 20907
800-358-9295
410-381-3150 (callers outside the United States only)
888-586-6340 (toll-free TDD service; hearing, impaired
only)
Be sure to specify the AHRQ number of the document or
CD-ROM you are requesting. Selected electronic files are
available through the Internet on the MEPS Web site: http://www.meps.ahrq.gov/
Additional information on MEPS is available from the MEPS
project manager or the MEPS public use data manager at the
Center for Cost and Financing Studies, Agency for Healthcare
Research and Quality.
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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 1999 Medical Expenditure Panel
Survey (MEPS) Household Component (HC). Released as an ASCII
data file and SAS transport file, this public use file
provides detailed information on dental events for a
nationally representative sample of the civilian
noninstitutionalized population of the United States. Data
from the dental file can be used to make estimates of dental
event utilization and expenditures for calendar year 1999.
As illustrated below, this file consists of MEPS survey data
obtained in the 1999 portion of Round 3 (Round 2 for some
cases, see DVR2FLAG) and Rounds 4 and 5 for Panel 3, as well
as Rounds 1, 2 and the 1999 portion of Round 3 for Panel 4
(i.e., the rounds for the MEPS panels covering calendar year
1999).
301 Moved Permanently
301 Moved Permanently
Note:
Typically for MEPS panels, MEPS
Round 2 data collection ends in the first year of a
panel and Round 3 data collection begins in the first
year of the panel and crosses the year boundary into
the second year of the panel. The crosshatched area in
the above figure signifies that Round 2 data
collection for approximately one quarter of the Panel
3 households began in 1998, the first year of the
panel, but ended in 1999. For those households, all of
the Round 3 data collection occurred in 1999. For the
other three quarters of Panel 3 households, Round 2
data collection followed the typical pattern and began
and ended in 1998. For those households, Panel 3 Round
3 data collection took place during both the first and
second years of the panel, as is typically done for
Round 3.
Note: The
gray shaded area in the above figure indicates the portion of Panel 4 Round 3
data collection that extended into January 2000.
Each record on this event file represents a unique dental
event; that is, a dental event reported by the household
respondent. Counts of dental event utilization are based
entirely on household reports. Dental events were not
included in the Medical Provider Component (MPC); therefore,
the household reports all expenditure and payment data on
the dental file.
Data from this event file can be merged with other 1999
MEPS HC data files, for the purposes of appending
person-level data such as demographic characteristics or
health insurance coverage to each dental event record on the
current file.
This file can be also used to construct summary variables
of expenditures, sources of payment, and related aspects of
the dental event. Aggregate annual person-level information
on the use of dental events and other health services use is
provided on the MEPS 1999 full year Person Level Expenditure
file where each record represents a MEPS sampled person.
The following documentation offers a brief overview of
the types and levels of data provided the content and
structure of the files and the codebooks. It contains the
following sections:
Data File Information
Sample Weights and Variance Estimation Variables
Strategies for Estimation
Merging/linking MEPS Data Files
References
Attachment 1: Definitions
Codebooks
Variable to Source Crosswalk
For more information on MEPS HC survey design, see S.
Cohen, 1997; J. Cohen, 1997; and S. Cohen, 1996. A copy of
the MEPS HC survey instrument used to collect the
information on the dental 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 1999 dental public use data set consists of one event
level data file. The file contains characteristics
associated with the dental event and imputed expenditure
data. For users wanting to impute expenditures, pre-imputed
data are available through the CCFS data center. Please
visit the CCFS data center website for details: http://www.meps.ahrq.gov/data_stats/onsite_datacenter.jsp.
The data user/analyst is forewarned that the imputation of
expenditures will necessitate a sizable commitment of
resources: financial; staff; and time.
The 1999 dental public use data set contains 23,169
dental event records; of these records, 22,757 are
associated with persons having a positive person-level
weight (PERWT99F). This file includes dental event records
for all household survey respondents who resided in eligible
responding households and reported at least one dental
event. Each record represents one household-reported dental
event that occurred during calendar year 1999. Dental visits
known to have occurred after December 31, 1999 are not
included on this file. Some household respondents may have
multiple dental events and thus will be represented in
multiple records on this file. Other household respondents
may have reported no dental events and thus will have no
records on this file. These data were collected during the
1999 portion of Round 3 (Round 2 for some cases, see
DVR2FLAG), and Rounds 4 and 5 for Panel 3, as well as Rounds
1, 2, and the 1999 portion of Round 3 for Panel 4 of the
MEPS HC. The persons represented on this file had to meet
either (a) or (b) below:
- Be classified as a key in-scope person who responded
for his or her entire period of 1999 eligibility (i.e.,
persons with a positive 1999 full-year person-level
sampling weight (PERWT99F > 0)), or
- Be classified as either an eligible non-key person or
an eligible out-of-scope person who responded for his or
her entire period of 1999 eligibility, and belonged to a
family (i.e., all persons with the same value for FAMID)
in which all eligible family members responded for their
entire period of 1999 eligibility, and at least one
family member had a positive 1999 full-year person
weight (i.e., eligible non-key or eligible out-of-scope
persons who are members of a family all of whose members
have a positive 1999 full-year family-level weight
(WTFAM99>0)).
Please refer to Attachment 1
for definitions of keyness, in-scope, and eligibility.
Each dental event record includes the following: date of
the dental event; type of provider seen, if visit was due to
an accident; reason for dental event; procedure(s)
associated with the dental event; whether or not medicines
were prescribed; flat fee information; imputed sources of
payment; total payment and total charge of the dental event
expenditure; and a full-year person-level weight.
Data from this file can be merged the MEPS 1999 Full Year
Population Characteristics file using the unique person
identifier, DUPERSID, to append person characteristics such
as demographic or health insurance characteristics to each
record. Dental events can also be linked to the MEPS 1999
Prescribed Medicine File. Please see section 5.0 for details
on how to merge MEPS data files.
Panel 3 cases (PANEL99 = 3 on 1999 person level file) can
also be linked back to the 1998 MEPS HC public use data
files. However, the user should be aware that at this time
no weight is being provided to facilitate 2-year analysis of
Panel 3 data.
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2.1 Codebook Structure
For each variable on the Dental Visits files, both
weighted and unweighted frequencies are provided in the
codebook. The codebook and data file sequence list variables
in the following order:
Unique person identifiers
Unique dental event identifiers
Other survey administration variables
Dental characteristics
Imputed expenditure variables
Weight and variance estimation variables
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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 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/survey_comp/survey.jsp).
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2.3 Codebook Format
The dental 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 Naming
In general, variable names reflect the content of the
variable, with an 8 character limitation. All imputed/edited
variables end with an "X."
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2.4.1 General
Variables were derived from the HC survey questionnaire.
The source of each variable is identified in Section D, the
"Variable - Source Crosswalk." Sources for each
variable are indicated in one of four ways:
- variables which are derived from CAPI or assigned in
sampling are so indicated as "capi derived" or
"assigned in sampling;"
- variables which come from one or more specific
questions have those questionnaire sections and question
numbers indicated in the "Source" column
- EV-Event Roster section
- FF- Flat Fee section
- CP- Charge Payment section;
- variables constructed from multiple questions using
complex algorithms are labeled "Constructed"
in the "Source" column; and
- variables which have been edited or imputed are so
indicated.
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2.4.2 Expenditure and Sources of
Payment Variables
These variable names follow a standard naming convention,
are 7 characters in length and end with an "X"
indicating they are fully edited and imputed.
The total sum of payments variables, 12 sources of
payment variables, and the total charge variables are named
consistently in the following way:
The
first two characters indicate the type of event: |
|
|
|
IP -
inpatient stay |
OB -
office-based visit |
|
ER -
emergency room visit |
OP -
outpatient visit |
|
HH -
home health visit |
DV -
dental visit |
|
OM -
other medical equipment |
RX -
prescribed medicine |
|
|
In the
case of the source of payment variables, the third and
fourth characters indicate: |
|
SF -
self or family |
OF -
other Federal Government |
XP - sum
of payments |
MR -
Medicare |
SL -
State/local government |
|
MD -
Medicaid |
WC -
Workers Compensation |
|
PV -
private insurance |
OT -
other insurance |
|
VA -
Veterans |
OR -
other private |
|
CH -
CHAMPUS/CHAMPVA |
OU -
other public |
|
|
The
fifth and sixth characters indicate the year (99). The
seventh character ('X') indicates the variable was
edited/imputed. |
For example: DVSF99X is the edited/imputed amount paid by
self or family for 1999 dental expenditures.
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2.5 File Contents
2.5.1 Survey Administration and ID
Variables
2.5.1.1 Person Identifiers (DUID -
DUPERSID)
The dwelling unit ID (DUID) is a 5-digit random number
assigned after the case was sampled for MEPS. The 3-digit
person number (PID) uniquely identifies each person within
the dwelling unit. The 8-character variable DUPERSID
uniquely identifies each person represented on the file and
is the combination of the variables DUID and PID. For
detailed information on dwelling units and families, please
refer to the documentation for the 1999 Full Year Population
Characteristics file or to definitions listed in Attachment
1.
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2.5.1.2 Record Identifiers (EVNTIDX
- FFEEIDX)
EVNTIDX uniquely identifies each dental event (i.e., each
record on the dental file) and is the variable required to
link dental events to data files containing details on
conditions and/or prescribed medicines (MEPS 1999 Medical
Condition File and MEPS 1999 Prescribed Medicines file;
respectively). For details on linking see Section 5.0 or the
Appendix File MEPS 1999.
FFEEIDX is a constructed variable, which uniquely
identifies a flat fee group, that is, all events that were
part of a flat fee payment situation. For example, a charge
for orthodontia is typically covered in a flat fee
arrangement where all visits are covered under one flat fee
dollar amount. These events would have the same value for
FFEEIDX. FFEEIDX identifies a flat fee payment situation
that was identified using information from the Household
Component. Please note that FFEEIDX should be used to link
up all MEPS event files (excluding prescribed medicines) in
order to determine the full set of events that are part of a
flat fee group.
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2.5.1.3 Record Indicators (EVENTRN -
DVR2FLAG)
EVENTRN indicates the round in which the dental event was
first reported. Please note: Rounds 3 (Round 2 for some
cases, see DVR2FLAG), 4, and 5 are associated with MEPS
survey data collected from Panel 3. Likewise, Round 1, 2,
and 3 are associated with data collected from Panel 4.
DVR2FLAG indicates whether or not a Panel 3 Round 2 event
occurred in 1999. DVR2FLAG was assigned a value of 1 where
an event in Round 2 of Panel 3 occurred in a portion of
calendar year 1999. Events from Panel 4 will have HHR2FLAG =
-1. Typically, only Round 3 of a MEPS panel covers two
calendar years, so the DVR2FLAG was developed to identify
where data collection procedures were modified. All
utilization data for calendar year 1999 is provided on this
file regardless of the round in which it happened to be
collected. Data users/analysts need not modify any
procedures to deal with this departure from the usual data
collection process as the event variables have been
developed so that the process is transparent.
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2.5.2 Characteristics of
Dental Events
2.5.2.1 Date of Dental Visit (DVDATEYR
DVDATEDD)
This file contains variables describing dental events
reported by household respondents in the Dental Section of
the MEPS HC survey questionnaire. There are three variables
which indicate the day, month and year a dental event
occurred (DVDATEDD, DVDATEMM, DVDATEYR, respectively). These
variables have not been edited or imputed.
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2.5.2.2 Type of Provider Seen (GENDENT
- DENTYPE)
Respondents were asked about the type of provider seen
during the dental visit, e.g. general dentist, dental
hygienist, or orthodontist. More than one type of provider
may have been identified on an event record.
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2.5.2.3 Treatment, Procedures,
and Services (EXAMINE - DENTMED)
Respondents were asked about the types of services or
treatments they received during the visit (EXAMINE - TMDTMJ),
such as root canal or x-rays, and whether or not the visit
was because of an accident (DENTINJ). More than one type of
service or treatment may have been identified on an event
record. Some procedures or services identified in DENTOTHR
as "Dental services other specify" have been
edited to appropriate procedure and service categories. Both
the edited and unedited versions of these variables are
included on the file. DENTMED indicates whether or not the
respondent received a prescription medication, including
free samples, during the dental visit.
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2.5.3 Flat Fee Variables (FFDVTYPE,
FFBEF99, FFTOT00)
2.5.3.1 Definition of Flat Fee
Payments
A flat fee is the fixed dollar amount a person is charged
for a package of services provided during a defined period
of time. Examples would be an orthodontists fee, which
covers multiple visits; or a dental surgeons fee covering
surgical procedure and post-surgical care. A flat fee group
is the set of medical services that are covered under the
same flat fee payment situation. The flat fee groups
represented on the dental file, includes flat fee groups
where at least one of the health care events, as reported by
the HC respondent, occurred during 1999. By definition, a
flat fee group can span multiple years. Furthermore, a
single person can have multiple flat fee groups.
There are four variables on the dental file that describe
a flat fee payment situation and the number of medical
events that are part of a flat fee group.
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2.5.3.2 Flat Fee Variable Descriptions
Flat Fee ID (FFEEIDX)
As noted earlier in the Section 2.5.1.2 "Record
Identifiers," for a person, the variable FFEEIDX can be
used to uniquely identify all events that are part of the
same flat fee group. It can identify such events from all of
the1999 MEPS event files (excluding the prescribed medicines
file) because FFEEIDX is the same value on all of the MEPS
event files. For the dental events that are not part of a
flat fee payment situation, the flat fee variables described
below are all set to 1 INAPPLICABLE.
Flat Fee Type (FFDVTYPE)
FFDVTYPE indicates whether the 1999 dental event is the
"stem" or "leaf" of a flat fee group. A
stem (records with FFDVTYPE = 1) is the initial dental
service (event) which is followed by other dental events
that are covered under the same flat fee payment. The leaves
of the flat fee group (records with FFDVTYPE = 2) are those
dental events that are tied back to the initial medical
event (the stem) in the flat fee group. These
"leaf" records have their expenditure variables
set to zero.
Counts of Flat Fee Events that Cross Years
(FFBEF99-FFTOT00)
As described in Section 2.5.3.1, a flat fee payment
situation covers multiple events and the multiple events
could span multiple years. For situations where a 1999
dental visit is part of a group of events, and some of the
events occurred before or after 1999, counts of the known
events are provided on the dental record. Indicator
variables are provided if some of the events occurred before
or after 1999. These variables are:
FFBEF99 -- total number of pre-1999 events in the same
flat fee group as the 1999 dental event. This count would
not include 1999 dental events.
FFTOT00 -- indicates whether or not there are 2000
medical events in the same flat fee group as the 1999
dental event record.
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2.5.3.3 Caveats of Flat Fee Groups
Data users/analysts should note that flat fee payment
situations are common on the dental file. There are 4,416
dental events that are identified as being part of a flat
fee payment group.
In general, every flat fee group should have an initial
visit (stem) and at least one subsequent visit (leaf). There
are some situations where this is not true. For some of
these flat fee groups, the initial visit reported occurred
in 1999, but the remaining visits that were part of this
flat fee group occurred in 2000. In this case, the 1999 flat
fee group represented on this file would consist of one
event (the stem). The 2000 "leaf" events that are
part of this flat fee group are not represented on the file.
Similarly, the household respondent may have reported a flat
fee group where the initial visit began in 1998 but
subsequent visits occurred during 1999. In this case, the
initial visit would not be represented on the file. This
1999 flat fee group would then only consist of one or more
leaf records and no stem.
Return To Table Of Contents
2.5.4 Expenditure Data
2.5.4.1 Definition of
Expenditures
Expenditures refer to what is paid for dental services.
More specifically, expenditures in MEPS are defined as the
sum of payments for care received, including out of pocket
payments and payments made by private insurance, Medicaid,
Medicare and other sources. The definition of expenditures
used in MEPS differs slightly from its predecessors: the
1987 NMES and 1977 NMCES surveys where "charges"
rather than sum of payments were used to measure
expenditures. This change was adopted because charges became
a less appropriate proxy for medical expenditures during the
1990's due to the increasingly common practice of
discounting. Although measuring expenditures as the sum of
payments incorporates discounts in the MEPS expenditure
estimates, the estimates do not incorporate any payment not
directly tied to specific medical care visits, 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
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).
AHRQ has developed factors to apply to the 1987 NMES
expenditure data to facilitate longitudinal analysis. These
factors can be assessed via CCFS data center. For more
information see the data center section of the MEPS web site http://www.meps.ahrq.gov.
Return To Table Of Contents
2.5.4.2 Imputation and Data
Editing Methodologies of Expenditure Variables
The general methodology used for editing and imputing
expenditure data is described below. Neither the dental
events nor other medical expenditures (such as glasses,
contact lenses, and hearing devices) were included in the
MPC. Therefore, although the general procedures remain the
same, for dental and other medical expenditures, editing and
imputation methodologies were applied only to
household-reported data. Specific methodologies for editing
and imputing dental expenditure follows.
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2.5.4.2.1 General Data Editing
Methodology
Logical edits were used to resolve internal
inconsistencies and other problems in the HC 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,
copayments 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
misclassifications 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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2.5.4.2.2 General Hot-Deck
Imputation
A weighted sequential hot-deck procedure was used to
impute for missing expenditures as well as total charge. The
procedure uses survey data from respondents to correct for
missing non-respondent data, while preserving 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. 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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2.5.4.2.3 Dental Data Editing and
Imputation
Expenditures on visits to dentists were developed in a
sequence of logical edits and imputations. The household
edits were used to correct obvious errors in the reporting
of expenditures, and to identify actual and potential
sources of payments. Some of the edits were global (i.e.,
applied to all events). Others were hierarchical and
mutually exclusive. One of the more important edits
separated flat fee events from simple events. This edit was
necessary because groups of events covered by a flat fee
(i.e., a flat fee bundle) were edited and imputed separately
from individual events covered by a single charge (i.e.,
simple events). Dental services were imputed as flat fee
events if the charges covered a package of health care
services (e.g., orthodontia), and all of the services were
part of the same event type (i.e., a pure bundle). If a
bundle contained more than one type of event, the services
were treated as simple events in the imputations (See
Section 2.5.3 for more detail on the definition and
imputation of events in flat fee bundles.)
Logical edits also were used to sort each event into a
specific category for the imputations. Events with complete
expenditures were flagged as potential donors for the
hot-deck imputations, while events with missing expenditure
data were assigned to various recipient categories. Each
event was assigned to a recipient category based on its
pattern of missing data. For example, an event with a known
total charge but no expenditures information was assigned to
one category, while an event with a known total charge and
some expenditures information was assigned to a different
category. Similarly, events without a known total charge
were assigned to various recipient categories based on the
amount of missing data.
The logical edits produced nine recipient categories for
events with missing data. Eight of the categories were for
events with a common pattern of missing data and a primary
payer other than Medicaid. These events were imputed
separately because persons on Medicaid rarely know the
providers charge for services or the amount paid by the
state Medicaid program. As a result, the total charge for
Medicaid-covered services was imputed and discounted to
reflect the amount that a state program would pay for the
care.
Separate hot-deck imputations were used to impute for
missing data in each of the other eight recipient
categories. The donor pool included "free events"
because, in some instances, providers are not paid for their
services. These events represent charity care, bad debt,
provider failure to bill, and third party payer restrictions
on reimbursement in certain circumstances. If free events
were excluded from the donor pool, total expenditures would
be over-counted because the cost of free care would be
implicitly included in paid events and explicitly included
in events that should have been treated as free from
provider.
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2.5.4.3 Capitation Imputation
Health maintenance organizations (HMOs) receive
time-based (capitation) payments to cover their members
cost of health care. Services provided by HMOs are referred
to as "capitated events" in the MEPS expenditure
imputations. They are singled out for special treatment
because the payments received by HMOs are not tied directly
to individual events and services. That is, per person per
month payments to an HMO, as opposed to fee-for-service
reimbursement for health care, pose a problem in the
estimation of health care costs because MEPS uses
event-level payments for service as its measure of
expenditures. Capitated events are sent through there own
imputation procedure.
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2.5.4.4 Imputation Flag Variable
(IMPFLAG)
Unlike prior data releases, only one imputation flag was
created for 1999 event files. This variable, IMPFLAG, is a
six-category variable that indicates if the event contains
complete Household Component (HHC) or Medical Provider
Component (MPC) data, was fully or partially imputed, or was
imputed in the capitated imputation process. Following is
how the new imputation flag is coded; the categories are
mutually exclusive.
IMPFLAG= 0 (not eligible for imputation)
IMPFLAG=1 (complete HC data)
IMPFLAG=2 (complete MPC data)
IMPFLAG=3 (fully imputed)
IMPFLAG=4 (partially imputed)
IMPFLAG=5 (capitation imputation)
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2.5.4.5 Flat Fee Expenditures
The approach used to count expenditures for flat fees was
to place the expenditure on the first visit of the flat fee
group. The remaining visits have zero payments. Thus, if the
first visit in the flat fee group occurred prior to 1999,
all of the events that occurred in 1999 will have zero
payments. Conversely, if the first event in the flat fee
group occurred at the end of 1999, the total expenditure for
the entire flat fee group will be on that event, regardless
of the number of events it covered after 1999.
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2.5.4.6 Zero Expenditures
As noted above, there are some dental 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 visits were provided without a separate charge
(e.g. after a surgical procedure). If all of the dental
events for a person fell into one of these categories, then
the total annual expenditures for that person would be zero.
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2.5.4.7 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 CHAMPVA
-
CHAMPUS or CHAMPVA
-
Other Federal sources -
includes Indian Health Service, Military Treatment
Facilities, and other care by the Federal government
-
Other State and Local
Source - includes community and neighborhood clinics,
State and local health departments, and State programs
other than Medicaid.
-
Workers Compensation
-
Other Unclassified Sources
- includes sources such as automobile, homeowners,
liability, and other miscellaneous or unknown sources.
Two additional source of payment variables were created
to classify payments for particular persons that appear
inconsistent due to differences between survey questions
on health insurance coverage and sources of payment for
medical events. These variables include:
-
Other Private - any type of
private insurance payments reported for persons not
reported to have any private health insurance coverage
during the year as defined in MEPS; and
- Other Public - Medicaid payments reported for persons
who were not reported to be enrolled in the Medicaid
program at any time during the year.
Though relatively small in magnitude, 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 program.
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2.5.4.8 Dental Expenditure Variables
(DVFS99X- DVTC99X)
Dental expenditures were obtained only through the
Household Component Survey. For cases with missing
expenditure data, dental expenditures were imputed using the
procedures described above. DVFS99X - DVOT99X are the 12
sources of payment, DVTC99X is the total charge, and DVXP99X
is the sum of the 12 sources of payments for the dental
expenditure. The 12 sources of payment are: self/family,
Medicare, Medicaid, private insurance, Veterans
Administration, CHAMPUS/CHAMPVA, other federal, state/local
governments, Workmans Compensation, other private
insurance, other public insurance and other insurance.
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2.5.4.9 Rounding
Expenditure variables have been rounded to the nearest
penny. Person level expenditure information to be released
on the MEPS 1999 Person Level Expenditure File will be
rounded to the nearest dollar. It should be noted that using
the MEPS event files to create person level totals will
yield slightly different totals than those found 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 1999 Appendix File
for details on such rounding differences.
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3.0 Sample Weight (PERWT99F)
3.1 Overview
There is a single full year person-level weight
(PERWT99F) assigned to each record for each key, in-scope
person who responded to MEPS for the full period of time
that he or she was in-scope during 1999. A key person either
was a member of an NHIS household at the time of the NHIS
interview, or became a member of such a household after
being out-of-scope at the time of the NHIS (examples of the
latter situation include newborns and persons returning from
military service, an institution, or living outside the
United States). A person is in-scope whenever he or she is a
member of the civilian noninstitutionalized portion of the
U.S. population.
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3.2 Details on Person Weights
Construction
The person-level weight PERWT99F was developed in three
stages. A person level weight for Panel 4 was created,
including both an adjustment for nonresponse over time and
poststratification, controlling to Current Population Survey
(CPS) population estimates based on five variables.
Variables used in the establishment of person-level
poststratification control figures included: census region
(Northeast, Midwest, South, West); MSA status (MSA, non-MSA);
race/ethnicity (Hispanic, black but non-Hispanic, and
other); sex; and age. Then a person level weight for Panel 3
was created, again including an adjustment for nonresponse
over time and poststratification, again controlling to CPS
population estimates based on the same five variables. When
poverty status information derived from income variables
became available, a 1999 composite weight was formed from
the Panel 3 and Panel 4 weights by multiplying the Panel
weights by .5. Then a final poststratification was done on
this composite weight variable, including poverty status
(below poverty, from 100 to 125 percent of poverty, from 125
to 200 percent of poverty, from 200 to 400 percent of
poverty, at least 400 percent of poverty) as well as the
original five poststratification variables in the
establishment of control totals.
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3.2.1 MEPS Panel 3 Weight
The person level weight for MEPS Panel 3 was developed
using the 1998 full year weight for an individual as a
"base" weight for survey participants present in
1998. For key, in-scope respondents who joined a RU some
time in 1999 after being out of scope in 1998, the 1998
family weight associated with the family the person joined
served as a "base" weight. The weighting process
included an adjustment for nonresponse over Rounds 4 and 5
as well as poststratification to population control figures
for December 1999. These control figures were derived by
scaling back the population totals obtained from the March
1999 CPS to reflect the December, 1999 CPS estimated
population distribution across age and sex categories as of
December, 1999. Variables used in the establishment of
person level poststratification control figures included:
census region (Northeast, Midwest, South, West); MSA status
(MSA, non-MSA); race/ethnicity (Hispanic, black but
non-Hispanic, and other); sex, and age. Overall, the
weighted population estimate for the civilian,
noninstitutionalized population on December 31, 1999 is
273,003,778. Key, responding persons not in-scope on
December 31, 1999 but in-scope earlier in the year retained,
as their final Panel 3 weight, the weight after the
nonresponse adjustment.
Return To Table Of Contents
3.2.2 MEPS Panel 4 Weight
The person level weight for MEPS Panel 4 was developed
using the MEPS Round 1 person-level weight as a base"
weight. For key, in-scope respondents who joined a RU after
Round 1, the Round 1 family weight served as a
"base" weight. The weighting process included an
adjustment for nonresponse over Round 2 and the 1999 portion
of Round 3 as well as poststratification to the same
population control figures for December 1999 used for the
MEPS Panel 3 weights. The same five variables employed for
Panel 3 poststratification (census region, MSA status,
race/ethnicity, sex, and age) were used for Panel 4
poststratification. Similarly, for Panel 4, key, responding
persons not in-scope on December 31, 1999 but in-scope
earlier in the year retained, as their final Panel 4 weight,
the weight after the nonresponse adjustment.
Note that the MEPS round 1 weights (for both panels with
one exception as noted below) incorporated the following
components: the original household probability of selection
for the NHIS; ratio-adjustment to NHIS-based national
population estimates at the household (occupied dwelling
unit) level; adjustment for nonresponse at the dwelling unit
level for Round 1; and poststratification to figures at the
family and person level obtained from the March 1999 CPS
data base.
Return To Table Of Contents
3.2.3 The Final Weight for 1999
Variables used in the establishment of person level
poststratification control figures included: poverty status
(below poverty, from 100 to 125 percent of poverty, from 125
to 200 percent of poverty, from 200 to 400 percent of
poverty, at least 400 percent of poverty); census region
(Northeast, Midwest, South, West); MSA status (MSA, non-MSA);
race/ethnicity (Hispanic, black but non-Hispanic, and
other); sex, and age. Overall, the weighted population
estimate for the civilian, noninstitutionalized population
for December 31, 1999 is 273,003,778 (PERWT99F>0 and
INSC1231=1). The inclusion of key, in-scope persons who were
not in-scope on December 31, 1999 brings the estimated total
number of persons represented by the MEPS respondents over
the course of the year up to 276,410,767 (PERWT99F>0).
The weighting process included poststratification to
population totals obtained from the 1996 MEPS Nursing Home
Component for the number of individuals admitted to nursing
homes. For the 1999 full year file an additional
poststratification was done to population totals obtained
from the 1998 Medicare Current Beneficiary Survey (MCBS) for
the number of deaths among Medicare beneficiaries
experienced in the 1999 MEPS.
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3.2.4 Coverage
The target population for MEPS in this file is the 1999
U.S. civilian, noninstitutionalized population. However, the
MEPS sampled households are a subsample of the NHIS
households interviewed in 1998 (Panel 3) and 1999 (Panel 4).
New households created after the NHIS interviews for the
respective Panels and consisting exclusively of persons who
entered the target population after 1998 (Panel 3) or after
1999 (Panel 4) are not covered by MEPS. These would include
families consisting solely of: immigrants; persons leaving
the military; U.S. citizens returning from residence in
another country; and persons leaving institutions. It should
be noted that this set of uncovered persons constitutes only
a tiny proportion of the MEPS target population
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4.0 Strategies for Estimation
This file is constructed for efficient estimation of
utilization, expenditure, and sources of payment for dental
events and to allow for estimates of number of persons with
dental utilization in 1999.
Return To Table Of Contents
4.1 Variables with Missing Values
It is essential that the analyst examine all variables
for the presence of negative values used to represent
missing values. For continuous or discrete variables, where
means or totals may be taken, it may be necessary to set
minus values to values appropriate to the analytic needs.
That is, the analyst should either impute a value or set the
value to one that will be interpreted as missing by the
computing language used. For categorical and dichotomous
variables, the analyst may want to consider whether to
recode or impute a value for cases with negative values or
whether to exclude or include such cases in the numerator
and/or denominator when calculating proportions.
Methodologies used for the editing/imputation of
expenditure variables (e.g. sources of payment, flat fee,
and zero expenditures) are described in Section 2.5.4.
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4.2 Basic Estimates of Utilization,
Expenditure and Sources of Payment
While the examples described below illustrate the use of
event level data in constructing person level total
expenditures, these estimates can also be derived from the
person level expenditure file unless the characteristic of
interest is event specific.
In order to produce national estimates related to dental
visits utilization, expenditure and sources of payment, the
value in each record contributing to the estimates must be
multiplied by the weight (PERWT99F) contained on that
record.
Example 1
For example, the total number of dental visits, for the
civilian non-institutionalized population of the U.S. in
1999 is estimated as the sum of the weight (PERWT99F) across
all dental visit event records. That is,
301 Moved Permanently
301 Moved Permanently
|
= 295,912,020 |
(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
dental visit (for those who had such expense greater than 0)
should be calculated as the weighted mean of amount paid by
self/family. That is,
301 Moved Permanently
301 Moved Permanently
|
= $109.60 |
(2) |
where
301 Moved Permanently
301 Moved Permanently
|
= 239,005,940 and Xj =
DVSF99Xj |
|
for all records with DVXP99Xj > 0
This gives $109.60 as the estimated mean amount of
out-of-pocket payment of expenditures associated with dental
visits and 239,005,940 as an estimate of the total number of
dental visits with expenditure. Both of these estimates are
for the civilian non-institutionalized population of the
U.S. in 1999.
Example 3
Another example would be to estimate the average
proportion of total expenditures (where event expense is
greater than 0) paid by private insurance per dental visit.
This should be calculated as the weighted mean of the
proportion of the total dental visit expenditures paid by
private insurance at the dental visit level. That is,
301 Moved Permanently
301 Moved Permanently
|
=
0.4613 |
(3) |
where
301 Moved Permanently
301 Moved Permanently
|
= 239,005,940
and Yj = DVPV99Xj / DVXP99Xj |
for all records with DVXP99Xj > 0
This gives 0.4613 as the estimated mean proportion of total
expenditures paid by private insurance for dental visits
with expenditure for the civilian non-institutionalized
population of the U.S. in 1999.
Return To Table Of Contents
4.3 Estimates of the Number of
Persons with Dental Visits
When calculating an estimate of the total number of
persons with dental visits, 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 persons in the
civilian non-institutionalized population of the U.S., with
a dental visit in 1999 because of accident or injury, this
event file must be used. This would be estimated as
301 Moved Permanently
301 Moved Permanently
|
across all unique
persons i on this file |
(4) |
where
Wi is
the sampling weight (PERWT99F) for
person i |
and
Xi =
1 if DENTINJj = 1 for any dental visit
record of person i. |
= 0 otherwise
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4.4 Person-Based Ratio Estimates
4.4.1 Person-Based Ratio Estimates
Relative to Persons with Dental Visits
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 dental visits
is estimated as,
301 Moved Permanently
301 Moved Permanently
across
all unique persons i on this file |
(5) |
where
Wi is
the sampling weight (PERWT99F) for
person i |
and
Zi = |
301 Moved Permanently
301 Moved Permanently
|
DVXP98Xj
across all dental visit events of 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 dental visit are represented on
this data file. In this case the 1999 person level file,
which has data for all sampled persons, must be used to
estimate the total number of persons (i.e. those with use
and those without use). For example, to estimate the
proportion of civilian non-institutionalized population of
the U.S. with at least one dental visit due to accident or
injury, 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,
301 Moved Permanently
301 Moved Permanently
across all
unique persons i on the MEPS HC-person level file |
(6) |
where
Wi is
the sampling weight (PERWT99F) for
person i |
and
Zi =
1 if DENTINJj = 1 for any dental visit
record of person i. |
= 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 a 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
To obtain estimates of variability (such as the standard
error of sample estimates or corresponding confidence
intervals) for estimates based on MEPS survey data, one
needs to take into account the complex sample design of MEPS.
Various approaches can be used to develop such estimates of
variance including use of the Taylor series or various
replication methodologies. Replicate weights have not been
developed for the MEPS 1999 data. Variables needed to
implement a Taylor series estimation approach are provided
in the file and are described in the paragraph below.
Using a Taylor Series approach, variance estimation
strata and the variance estimation PSUs within these strata
must be specified. The corresponding variables on the MEPS
full year utilization database are VARSTR99 and VARPSU99,
respectively. Specifying a "with replacement"
design in a computer software package such as SUDAAN (Shah,
1996) should provide standard errors appropriate for
assessing the variability of MEPS survey estimates. It
should be noted that the number of degrees of freedom
associated with estimates of variability indicated by such a
package may not appropriately reflect the actual number
available. For MEPS sample estimates for characteristics
generally distributed throughout the country (and thus the
sample PSUs), there are over 100 degrees of freedom
associated with the corresponding estimates of variance. The
following illustrates these concepts using two examples from
section 4.2.
Examples 2 and 3 from Section 4.2
Using a Taylor Series approach, specifying VARSTR99 and
VARPSU99 as the variance estimation strata and PSUs (within
these strata) respectively and specifying a "with replacement"
design in a computer software package SUDAAN will yield standard error estimate
of $4.02 and 0.0096 for the estimated mean of out-of-pocket
payment and the estimated mean proportion of total
expenditures paid by private insurance respectively.
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5.0 Merging/Linking MEPS Data Files
Data from the dental file can be used alone or in
conjunction with other files. This section provides
instructions for linking the dental file with other MEPS
public use files, including: the conditions file, the
prescribed medicines file, and a person-level file.
Return To Table Of Contents
5.1 Linking a Person-Level File to
the Dental File
Data from the dental event file can be used alone or in
conjunction with other files. Merging characteristics of
interest from other MEPS files (e.g., 1999 Full Year
Population Characteristics File or 1999 Prescribed Medicines
File) expands the scope of potential estimates. For example,
to estimate the total number of dental events of persons
with specific demographic characteristics (such as age,
race, and sex), population characteristics from a
person-level file need to be merged onto the dental file.
This procedure is shown below.
- Create data set PERSX by sorting the 1999 Full Year
Population Characteristics File, by the person
identifier, DUPERSID. Keep only variables to be merged
onto the dental file and DUPERSID.
- Create data set DENT by sorting the dental events file
by person identifier, DUPERSID.
- Create final data set NEWDENT by merging these two
files by DUPERSID, keeping only records on the dental
file.
The following is an example of SAS code which completes
these steps:
PROC SORT DATA=1999 Full Year Population
Characteristics File (KEEP=DUPERSID AGE SEX EDUC)
OUT=PERSX;
BY DUPERSID;
RUN;
PROC SORT DATA=DENT;
BY DUPERSID;
RUN;
DATA NEWDENT;
MERGE DENT (IN=A) PERSX(IN=B);
BY DUPERSID;
IF A;
RUN;
The 1999 Appendix File provides examples of how to merge
other MEPS data files.
Return To Table Of Contents
5.2 Linking the Dental File to the
Medical Conditions File and/or the Prescribed Medicines File
Due to survey design issues, there are
limitations/caveats that data users/analyst must keep in
mind when linking the different files. Those
limitations/caveats are listed below. For detailed linking
examples, including SAS code, data users/analysts should
refer to the 1999 Appendix File.
Return To Table Of Contents
5.2.1 Limitations/Caveats of
RXLK (the Prescribed Medicine Link File)
The RXLK file provides a link from the MEPS event files
to the prescribed medicine records on the 1999 Prescribed
Medicine Event File. When using RXLK, analysts should keep
in mind that one dental visit can link to more than one
prescribed medicine record. Conversely, a prescribed
medicine event may link to more than one dental visit or
different types of events. When this occurs, it is up to the
analyst to determine how the prescribed medicine
expenditures should be allocated among those dental and/or
medical events.
Return To Table Of Contents
5.2.2 Limitations/Caveats of
CLNK (the Medical Conditions Link File)
The CLNK provides a link from MEPS event files to the
Medical Conditions File. When using the CLNK, analysts
should keep in mind that (1) conditions are self-reported
and (2) there may be multiple conditions associated with a
dental visit. Users should also note that not all dental
visits link to the condition file.
Return To Table Of Contents
References
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.
Monheit, A.C., Wilson, R., and Arnett, III, R.H.
(Editors). Informing American Health Care Policy. (1999).
Jossey-Bass Inc, San Francisco.
Shah, B.V., Barnwell, B.G., Bieler, G.S., Boyle, K.E.,
Folsom, R.E., Lavange, L., Wheeless, S.C., and Williams, R.
(1996). Technical Manual: Statistical Methods and
Algorithms Used in SUDAAN Release 7.0, Research Triangle
Park, NC: Research Triangle Institute.
Return To Table Of Contents
Attachment 1
Definitions
Dwelling Units, Reporting Units, Families,
and Persons - The definitions of Dwelling Units (DUs)
and Group Quarters in the MEPS Household Survey are generally consistent with
the definitions employed for the National Health Interview Survey. The dwelling
unit ID (DUID) is a five-digit random ID number assigned after the case was
sampled for MEPS. The person number (PID) uniquely identifies all persons within
the dwelling unit. The variable DUPERSID is the combination of the variables
DUID and PID.
A Reporting Unit (RU) is a person or a
group of persons in the sampled dwelling unit who is related by blood, marriage,
adoption or other family association, and who is to be interviewed as a group in
MEPS. Thus, the RU serves chiefly as a family-based "survey
operations" unit rather than an analytic unit. Regardless of the legal
status of their association, two persons living together as a "family"
unit were treated as a single reporting unit if they chose to be so identified.
Unmarried college students under 24 years
of age, who usually live in the sampled household but were living away from home
and going to school at the time of the Round 1 MEPS interview, were treated as a
Reporting Unit separate from that of their parents for the purpose of data
collection. These variables can be found on MEPS person-level files.
In-Scope - A
person was classified as in-scope (INSCOPE) if he or she was a member of the
U.S. civilian, non-institutionalized population at some time during the Round 1
interview. This variable can be found on MEPS person-level files.
Keyness - The
term "keyness" is related to an individual’s chance of being
included in MEPS. A person is key if that person is appropriately linked to the
set of NHIS sampled households designated for inclusion in MEPS. Specifically, a
key person either was a member of an NHIS household at the time of the NHIS
interview or became a member of such a household after being out-of-scope prior
to joining that household (examples of the latter situation include newborns and
persons returning from military service, persons returning from an institution,
or persons living outside the United States).
A non-key person is one whose chance of
selection for the NHIS (and MEPS) was associated with a household that was
eligible but not sampled for the NHIS, who happened to have become a member of a
MEPS reporting unit by the time of the MEPS Round 1 interview. MEPS data, (e.g.,
utilization and income) were collected for the period of time a non-key person
was part of the sampled unit to permit family level analyses. However, non-key
persons who leave a sample household would not be recontacted for subsequent
interviews. Non-key individuals are not part of the target sample used to obtain
person-level national estimates.
It should be pointed out that a person may
be key even though not part of the civilian, non-institutionalized portion of
the U.S population. For example, a person in the military may be living with his
or her civilian spouse and children in a household sampled for the NHIS. The
person in the military would be considered a key person for MEPS. However, such
a person would not receive a person-level sample weight so long as he or she was
in the military. All key persons who participated in the first round of a MEPS
panel received a person-level sample weight except those who were in the
military. The variable indicating "keyness" is KEYNESS. This variable
can be found on MEPS person-level files.
Eligibility - The
eligibility of a person for MEPS pertains to whether or not data were to be
collected for that person. All key, in-scope persons of a sampled RU were
eligible for data collection. The only non-key persons eligible for data
collection were those who happened to be living in the same RU as one or more
key persons, and their eligibility continued only for the time that they were
living with a key person. The only out-of-scope persons eligible for data
collection were those who were living with key in-scope persons, again only for
the time they were living with a key person. Only military persons meet this
description. A person was considered eligible if they were eligible at any time
during Round 1. The variable indicating "eligibility" is ELIGRND1,
where 1 is coded for persons eligible for data collection for at least a portion
of the Round 1 reference period, and 2 is coded for persons not eligible for
data collection at any time during the first round reference period. This
variable can be found on MEPS person-level files.
Pre-imputed - This means that only a series of logical edits were applied to the HC data to
correct for several problems including outliers, co-payments or charges reported
as total payments, and reimbursed amounts counted as out-of-pocket payments.
Missing data remains.
Unimputed -
This means that only a series of logical edits were applied to the MPC data to
correct for several problems including outliers, co-payments or charges reported
as total payments, and reimbursed amounts counted as out-of-pocket payments.
These data were used as the imputation source to account for missing HC data.
Imputation -
A method of estimating values for cases with missing data. Hot-deck imputation
creates a data set with complete data for all nonrespondent cases, by
substituting the data from a respondent case that resembles the nonrespondent on
certain known variables.
Return To Table Of Contents
D. Variable-Source
Crosswalk
MEPS HC-033B: 1999 Dental Visits
Survey Administration Variables
Variable |
Description |
Source |
DUID |
Dwelling unit ID |
Assigned in sampling |
PID |
Person number |
Assigned in sampling |
DUPERSID |
Sample person ID (DUID + PID) |
Assigned in sampling |
EVNTIDX |
Event ID |
Assigned in Sampling |
EVENTRN |
Event round number |
CAPI derived |
DVR2FLAG |
Indicates whether or not a Panel 3
Round 2 event occurred in 1999 |
Constructed |
FFEEIDX |
Flat fee ID |
Constructed |
Return To Table Of Contents
Dental Events Variables
Variable |
Description |
Source |
DVDATEYR |
Event start date year |
CAPI derived |
DVDATEMM |
Event start date month |
CAPI derived |
DVDATEDD |
Event start date day |
CAPI derived |
GENDENT |
General dentist seen |
DN03 |
DENTHYG |
Dental hygienist seen |
DN03 |
DENTTECH |
Dental technician seen |
DN03 |
DENTSURG |
Dental surgeon seen |
DN03 |
ORTHODNT |
Orthodontist seen |
DN03 |
ENDODENT |
Endodontist seen |
DN03 |
PERIODNT |
Periodontist seen |
DN03 |
DENTYPE |
Other dental specialist seen |
DN03 |
EXAMINE |
General exam or consultation |
DN04 |
CLENTETX |
Edited CLENTETH |
DN04 (Edited) |
CLENTETH |
Cleaning, prophylaxis, or polishing |
DN04 |
JUSTXRAY |
X-rays, radiographs or bitewings |
DN04 |
FLUORIDE |
Fluoride treatment |
DN04 |
SEALANT |
Sealant application |
DN04 |
FILLINGX |
Edited FILLING |
DN04 (Edited) |
FILLING |
Fillings |
DN04 |
INLAY |
Inlays |
DN04 |
CROWNSX |
Edited CROWNS |
DN04 (Edited) |
CROWNS |
Crowns or caps |
DN04 |
ROOTCANX |
Edited ROOTCANL |
DN04 (Edited) |
ROOTCANL |
Root canal |
DN04 |
GUMSURGX |
Edited GUMSURG |
DN04 (Edited) |
GUMSURG |
Periodontal scaling/root planing or gum |
DN04 |
RECLVISX |
Edited RECLIVIS |
DN04 (Edited) |
RECLIVIS |
Periodontal recall visit |
DN04 |
EXTRACT |
Extraction, tooth pulled |
DN04 |
IMPLANT |
Implants |
DN04 |
ABSCESS |
Abscess or infection treatment |
DN04 |
ORALSURX |
Edited ORALSURG |
|
ORALSURG |
Oral surgery |
DN04 |
BRIDGESX |
Edited BRIDGES |
DN04 (Edited) |
BRIDGES |
Bridges |
DN04 |
DENTUREX |
Edited DENTURES |
DN04 (Edited) |
DENTURES |
Dentures or partial dentures |
DN04 |
REPAIR |
Repair bridges/dentures or relining |
DN04 |
ORTHDONX |
Edited ORTHDONT |
DN04 (Edited) |
ORTHDONT |
Orthodontia, braces or retainers |
DN04 |
WHITEN |
Bonding, whitening or bleaching |
DN04 |
TMDTMJ |
Treatment for TMD or TMJ |
DN04 |
DENTPROX |
Edited DENTPOC |
DN04OV |
DENTPROC |
Other dental procedures |
DN04OV |
DENTOTHX |
Edited DENTOTHR |
DN04 (Edited) |
DENTOTHR |
Other specified dental procedures |
DN04 |
DENTINJ |
Visit because of accident or injury |
DN01 |
DENTMED |
Receive medicine including free sample |
DN05 |
Return To Table Of Contents
Flat Fee Variables
Variable |
Description |
Source |
FFDVTYPE |
Flat fee bundle |
Constructed |
FFBEF99 |
Total # of visits in flat fee before
1999 |
FF05 |
FFTOT00 |
Total # of visits in flat fee after
1999 |
FF02 |
Return To Table Of Contents
Imputed Expenditure Variables
Variable |
Description |
Source |
DVSF99X |
Amount paid, family ( Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVMR99X |
Amount paid, Medicare (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVMD99X |
Amount paid, Medicaid (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVPV99X |
Amount paid, private insurance (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVVA99X |
Amount paid, Veterans (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVCH99X |
Amount paid, CHAMPUS/CHAMPVA (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVOF99X |
Amount paid, other federal (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVSL99X |
Amount paid, state and local govt
(Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVWC99X |
Amount paid, workers comp (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVOR99X |
Amount paid, other private (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVOU99X |
Amount paid, other public (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVOT99X |
Amount paid, other insurance (Imputed) |
CP07,CP09A, CP11-CP34OV2 (Edited) |
DVXP99X |
Sum of DVSF99X DVOT99X |
Constructed |
DVTC99X |
Household reported total charge (
Imputed) |
CP09A,CP09OV (Edited) |
IMPFLAG |
Imputation Status |
Constructed |
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Weights
Variable |
Description |
Source |
PERWT99F |
Final person level weight, 1999 |
Constructed |
VARPSU99 |
Variance estimation PSU,1999 |
Constructed |
VARSTR99 |
Variance estimation stratum, 1999 |
Constructed |
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