AHRQ 2011 Annual Conference AHRQ Data Resources to Inform Health Policy Research: The Medical Expenditures Panel Surve

1. AHRQ 2011 Annual ConferenceAHRQ Data Resources to Inform Health Policy Research: The Medical Expenditures Panel Survey (MEPS) Anita Soni, Ph.D.

2. Medical Expenditure Panel Survey MEPS OVERVIEW

3. MEPS Overview • History & Purpose • Survey Components & Design • Sample • Core Content • Supplemental CAPI sections & Questionnaires • Public Use Files • Dissemination of Data

4. MEPS History • 1977 National Medical Care Expenditure Survey • 1987 National Medical Expenditure Survey • 1996 Medical Expenditure Panel Survey

5. MEPS-HC Purpose & Uses • Estimates and tracks annual health care use, expenditures and insurance coverage • Provides estimates of expenditures and sources of payment by selected demographic variables • Used for policy-related and behavioral research on the determinants of health care use, spending, and insurance coverage • Used in microsimulation models to analyze alternative health care delivery proposals

6. MEPS Survey Components • MEPS-HC -- Household Component • MEPS-MPC -- Medical Provider Component • MEPS-IC -- Insurance Component

7. MEPS-HC Survey Design • Sub-sample of respondents from the previous year’s National Health Interview Survey (NHIS) • Representative of the civilian non-institutionalized population of the US • Five in-person interviews over 2 ½ year period using Computer Assisted Personal Interview (CAPI) • Interviews average 90 minutes with a range of one to four hours

8. Oversampling in MEPS Panels 7-15 (2002-2010) • Carryover from NHIS • Blacks • Hispanics • Asians (panels 12-15 after 2006 NHIS redesign) • Additional MEPS Oversampling • Asians • Low income (panels 7-13) • Blacks (panels 9-11, 13-15) • Hispanics (panels 13-15)

9. MEPS Panel Design: Data Reference Periods N is equal to the number of people with a positive person weight on the file.

10. MEPS-HC Sample Sizes Year Families Persons 1996 8,655 21,571 1997 13,087 32,636 1998 9,023 22,953 1999 9,345 23,565 2000 9,515 23,839 2001 12,852 32,122 2002 14,828 37,418 2003 12,860 32,681 2004 13,018 32,737 2005 12,810 32,320 2006 12,811 32,577 2007 11,615 29,370 2008 12,316 31,262 2009 13,875 34,920

11. MEPS-HC Core Interview Content • Demographics • Charges and Payments • Health Status • Conditions • Utilization • Employment • Health Insurance

12. MEPS- HC Supplemental CAPI Sections Sections asked in rounds 2 and 4: • Access to care • Child preventive health • Satisfaction with health plans & providers Sections asked in rounds 3 and 5: • Assets (round 5 only) • Income • Preventive Care

13. MEPS-HC Supplemental Paper Questionnaires • Diabetes Care Survey (DCS) • Given once a year to each person identified as having diabetes • Includes questions about diabetes related tests and managing diabetes • Adult Self-Administered Questionnaire (SAQ) • Given once a year to each adult 18 years old and older • Focuses on self-reported information such as opinions about health care issues and quality of care measures, assessment of own health, and height /weight.

14. MEPS-HC Caveats and Limitations • Sample size limitations preclude some analyses • Typically, one respondent provides data for the entire household • Household respondents may not be able to report accurately certain types of information • type of health plan • detailed event information • diagnoses

15. MedicalExpenditure Panel Survey MEDICAL CONDITIONS DATA

16. Medical Conditions File Medical Conditions File contains • Household reported data • Data on Conditions • Data on Procedures

17. Medical Conditions File Structure • Each record represents unique condition or procedure for a person • Persons may be represented on file once, several times or not at all • Can be linked to person and event files for analysis

18. MEPS Condition Roster One roster per person Cumulates medical conditions reported across MEPS interviews Interviewer records verbatim responses to questions in the following 4 sections: Condition Enumeration Priority Conditions (yes/no) Medical Events Disability

19. Condition Enumeration We're interested in learning about health problems that may have bothered (PERSON) {since (START DATE)/between (START DATE) and (END DATE)}. Health problems include physical conditions, accidents, or injuries that affect any part of the body as well as mental or emotional health conditions, such as feeling sad, blue, or anxious about something.

20. Condition Enumeration Asked in every round Has a time frame (since last interview until today) Responses recorded verbatim and coded into 5 digit ICD9 codes Responses directly linked to conditions roster Chronic/priority conditions appear only once on the roaster Acute conditions can have many records Responses aggregated across rounds for the annual responses

21. Priority Conditions New section since Panel 12 Separate section of questionnaire Series of questions asking if “ever” had condition “yes/no” responses, no ICD9 coding responses of yes with a current utilization record will appear on person’s condition roster Factors used in determining priority conditions Prevalence Expenditures Policy relevance

22. Priority Conditions List Heart disease Heart attack Angina High cholesterol Cancer Stroke High blood pressure Diabetes Asthma Arthritis/Joint pain Emphysema Chronic bronchitis Attention deficit disorder

23. Medical Events What conditions were discovered or led (PERSON) to make this visit? PROBE: Any other condition? IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before? Types of visits Inpatient Outpatient Emergency Room Office Based Home Health Conditions associated with Prescribed Medicine purchases: What health problem is (MEDICINE) prescribed for? PROBE: Any other health problems?

24. Event Count Variables Indicates number of events associated with condition for person: Home Health (HHNUM) Inpatient stays (IPNUM) Hospital outpatient (OPNUM) Office-based (OBNUM) Emergency room (ERNUM) Prescription Medicine purchases (RXNUM)

25. Disability Days Condition Questions Missed school or work What are the health problems that caused (PERSON) to miss work/school on those days? PROBE: Any other health problems? Bed days What are the health problems that caused (PERSON) to spend half day or more in bed on those days? PROBE: Any other health problems?

26. Reporting and Recording Conditions • Respondents may report having the same condition more than once • Interviewer probes whether occurrence of condition already reported • Each unique episode of a condition recorded only once • person may have multiple colds in year • each cold has separate record

27. Reporting and Recording Conditions • Respondents may report having the same condition more than once • Interviewer verifies that these are different occurrences of the condition • Each unique episode of a condition is recorded only once • person may have more than one cold in a year • each cold has a separate record

28. Accidents and Injury Questions • Following items asked if relevant to reported condition: • date of accident • place (work, home, school, etc.) • cause (gun, vehicle, fall, fire, etc.) • whether or not the person has recovered from the injury

29. Condition Coding and Editing • Fully specified ICD-9 CM codes (up to 5 digits) • ICD-9 condition codes collapsed to 3 digits to maintain confidentiality • Approximately 10% of condition codes are collapsed further by combining 2 or more 3-digit codes

30. Procedure Coding and Editing Only obtained from Medical Events Questions Fully specified ICD-9 CM codes (up to 4 digits) Collapsed to 2-digit codes Approximately 3% collapsed further by combining 2 or more 2-digit codes

31. Clinical Classification Codes (CCC) • ICD-9 codes aggregated into broad clinically meaningful categories • Edited to preserve confidentiality • Crosswalk included in documentation • Formerly Clinical Classification for Health Policy Research (CCHPR)

32. Condition-Event Link Files • Used to link conditions to: • Persons on person files • all reported conditions or just those associated with events • Events on event files • most conditions associated with events already included on event files • Separate link file for prescribed medicines

33. National Estimates of Conditions • Most appropriate to estimate “treated prevalence” • MEPS website summary data tables on Expenditures by Medical Condition • Condition more likely to be underreported if: • respondent/person not aware • not salient or bothersome • no medical care received

34. Condition Data Limitations/Caveats • Household-reported • One respondent usually providing information for all household members • Many recorded text strings not easily classifiable into ICD-9 codes • Limited information on procedures • Not suitable for prevalence estimates • More salient conditions tend to be better reported

35. Medical Expenditure Panel Survey Health Care Utilization and Expenditures

36. Health Care Utilization • MEPS household respondents asked to report all health care use for family members during reference period • Utilization is called an “event” in MEPS • Event type categories: • Office-Based Medical Provider Visits (OB) • Hospital Inpatient Stays (IP) • Outpatient Department Visits (OP) • Emergency Room Visits (ER) • Dental Visits (DN) • Prescription Medicine Purchases (RX) • Home Health Care (HH) • Other Medical Expenses (OM)

37. Health Care Expenditures • Collected at the event level • Represent payments to providers of the health care • Payments are reported by source (e.g., out-of-pocket, private insurance, public program) • Total expenditure is sum of payments across all sources of payment

38. Self or family Medicare Medicaid/SCHIP Private insurance VA TRICARE Other federal gov’t State or local gov’t Worker’s comp Other insurance Source of Payment Categories

39. Sources of Expenditure Data • Expenditures derived from two survey components: • Medical Provider Component (MPC) • Household Component (HC) • MPC data used when available • HC data used when no MPC data available • Events with no MPC or HC data on expenditures are imputed • results in no missing values

40. Sources of Expenditure Data by Event Type

41. Annual Utilization and Expenditure Data • Annual data cumulated across approx 2 ½ rounds of data collection • Event level files • Separate by type of service • Unique record for each reported event • Some persons have no events • Some persons have multiple events • Person-level file (full year consolidated) • Variables derived from event level

42. Event Level File Record Units

43. Event File Expenditure Variables:OB, DN and OM • 12 expenditure by source of payment variables • A total expenditure variable • sum of 12 source of payment variables • A total charge variable • provider’s charge before adjustment or discount

44. Hospital Event Files Expenditure Variables: IP, OP, and ER • Facility Expenditure Variables • 12 expenditure by source of payment variables • A total facility expenditure variable • A total facility charge variable • Separately Billing Doctor Expenditure (SBD) Variables • 12 SBD expenditure by source of payment variables • A total SBD expenditure variable • A total SBD charge variable • Total Expenditures for the event • Sum of facility and SBD expenditures • Total charges for the event • Sum of facility and SBD charges

45. Person/event ID Date(s) of care (not RX) Services/procedures Type of provider (not RX,ER,IP) Expenditure variables Full year person weight Variance estimation variables Imputation flag Common Variables in Event Files

46. Event Files: Medical Conditions • IP • Up to 4 per event • OB, OP, ER & RX • Up to 3 per event • HH • Need to obtain from condition file • DN & OME • No medical conditions

47. IP variables • Have operation? • Stay begin with ER visit? • Number of nights in hospital • Reason for stay (5 broad reasons) • Stay related to specific condition (yes or no); if yes, provide condition(s) • VA facility?

48. Laboratory tests Sonogram/ Ultrasound X-ray Mammogram MRI/CAT SCAN EKG/ECG EEG Vaccination Surgery Anesthesia Other tests or exams Diagnostic Tests/Services Received During OB, OP, or ER Visit

49. Main Medical ProviderOB and OP Visits • Specialty if a physician • 33 specialties plus “other” • Type of provider if not a physician • 17 types plus “other”

50. Physical therapy Occupational therapy Speech therapy Chemotherapy Radiation therapy Kidney dialysis IV therapy Treatment for drug or alcohol Received allergy shot Psychotherapy or counseling Treatments During an OB or OP Visit