MEPS HC-17: Household Component - Health Insurance Plan Abstraction Linked Data, 1996 RESEARCH FILE (non-nationally representative data)
February 2001
Agency for Healthcare Research and Quality
Center for Cost and Financing Studies
2101 East Jefferson Street, Suite 501
Rockville, MD 20852
(301) 594-1406
User Note
This file contains data from the 1996 Medical Expenditure Panel Survey that is being released for research purposes only. Significant nonresponse prevents these data from being used to make nationally representative estimates. There is no sampling weight included in this file and users are warned to exercise caution in generalizing their results beyond the sample of persons included in the file. This file is being made available to the research community to provide insights into insurance coverage which are comparable to case studies. The data on this file are being provided as a MEPS Research File, and as such are intended for sophisticated users who are familiar with the MEPS public use files and have experience analyzing complex survey data.
TABLE OF CONTENTS
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Insurance Component
3.0 Medical Provider Component
4.0 Nursing Home Component
5.0 Survey Management
C. Technical and Programming Information
1.0 General Information
2.0 Data File Description
2.1 Imputations in the MEPS - HC - HIPA Linked Data
2.2 Codebook Structure
2.3 Reserved Codes
2.4 Codebook Format
3.0 Data File Contents
3.1 ID Variables
3.2 Demographic Variables from the Household Component
3.3 Overview of the Health Insurance Plan Abstraction Data
3.4 Constructed Flags and Count Variables
D. Codebook
E. 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
This documentation describes one in a series of public use files from the Medical Expenditure
Panel Survey (MEPS). The survey provides a new and extensive data set on the use of health
services and health care in the United States.
MEPS is conducted to provide nationally representative estimates of health care use,
expenditures, sources of payment, and insurance coverage for the U.S. civilian
noninstitutionalized population. MEPS also includes a nationally representative survey of nursing
homes and their residents. MEPS is cosponsored by the Agency for Healthcare Research and
Quality (AHRQ) (formerly the Agency for Health Care Policy and Research (AHCPR)) and the
National Center for Health Statistics (NCHS).
MEPS comprises four component surveys: the Household Component (HC), the Medical
Provider Component (MPC), the Insurance Component (IC), and the Nursing Home Component
(NHC). The HC is the core survey, and it forms the basis for the MPC sample and part of the IC
sample. The separate NHC sample supplements the other MEPS components. 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. This file contains data from the Health Insurance Plan
Abstraction (HIPA) survey which is part of the MEPS Household Component.
MEPS is the third in a series of national probability surveys conducted by AHRQ on the
financing and use of medical care in the United States. The National Medical Care Expenditure
Survey (NMCES, also known as NMES-1) was conducted in 1977, the National Medical
Expenditure Survey (NMES-2) in 1987. Beginning in 1996, MEPS continues this series with
design enhancements and efficiencies that provide a more current data resource to capture the
changing dynamics of the health care delivery and insurance 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 accommodate these goals, new MEPS design features
include linkage with the National Health Interview Survey (NHIS), from which the sampling
frame for the MEPS HC is drawn, and continuous 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 two
calendar years are collected from each household. This series of data collection rounds is
launched each subsequent year on a new sample of households to provide overlapping panels of
survey data and, when combined with other ongoing panels, will provide continuous and current
estimates of health care expenditures.
The sampling frame for the MEPS HC is drawn from respondents to NHIS, conducted by NCHS.
NHIS provides a nationally representative sample of the U.S. civilian noninstitutionalized
population, with oversampling of Hispanics and blacks.
Health Insurance Plan Abstraction, 1996
The Health Insurance Plan Abstraction (HIPA) survey collects data on the private health
insurance plans held by MEPS household respondents and was conducted in 1996 as a periodic
part of the MEPS HC. The HIPA contains health insurance plan abstracts with descriptive
information on benefits such as deductibles, coinsurance rates, out of pocket maximums, and
plan maximums. The HIPA provides detailed information on coverage for hospital room and
board, inpatient and outpatient surgery, physician office visits, well baby visits, home health care,
inpatient and outpatient mental health services, alcohol and drug detoxification and
rehabilitation, outpatient prescription drugs, dental benefits, vision benefits and Medigap
policies. In addition, the HIPA contains information on other plan features including cost
containment provisions and reimbursement for preventive care, inpatient physician services, non-physician provider services and non-hospital health care facilities. For most covered services the
HIPA contains information on both in-network and out-of-network coverage.
Health insurance plan booklets in the HIPA survey are collected from households in the MEPS -HC, from employers in the MEPS - IC, and from Federal Employee Health Benefit plans
sponsored by the Federal government. Health benefits information in the HIPA is abstracted for
each policyholder. In cases where a plan booklet describes multiple health plans, only the plan(s)
that were held by the policyholder are abstracted. HIPA data is linked with data from the HC to
provide the final file. The potential population for the 1996 MEPS - Household Component -
Health Insurance Plan Abstraction Data (MEPS - HC - HIPA) consists of policyholders and
linked dependents who were covered by private health insurance at the time of their Round 1
interview for the 1996 MEPS and who are included in the full-year population in MEPS HC-008.
The 1996 MEPS - HC - HIPA contains information on health plan provisions for approximately
54 percent of the potential population. This yields a non-conditional response rate of 42 percent
when it is multiplied by the Round 1 response rate of 78 percent. Significant sample
nonresponse in the 1996 HIPA survey prevents these data from supporting national estimates.
For this reason there is no sampling weight included in this file and users are warned to exercise
caution in generalizing their results beyond the sample of persons included in the file. This file is
being made available to the research community to provide insights into insurance coverage
which are comparable to case studies.
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2.0 Insurance Component
The MEPS - IC collects data on health insurance plans obtained through employers, unions, and
other sources of private health insurance. Data obtained in the IC include the number and types
of private insurance plans offered, benefits associated with these plans, premiums, contributions
by employers and employees, eligibility requirements, and employer characteristics.
The sample for the 1996 MEPS - IC is made up of two parts, the household sample and the list
sample. Similar information is collected for each sample although the sources of the samples and
their purposes and uses are very different. Because of the similarity in data to be collected the
parts are combined for collection purposes only. They are not combined for analytic purposes.
Household Sample
The household sample consists of employers of respondents to the HC, as well as unions and
insurance companies which provide insurance to persons who are respondents of the HC. For the
household sample, the employers, unions and insurance companies which belong to the IC
sample, serve as proxy respondents for persons in the HC sample. Data from the household
sample can be linked with other person level information from the HC. Note that significant
sample nonresponse in the 1996 household sample prevents these data from supporting national
estimates. Furthermore, confidentiality concerns require that the MEPS - IC Household Sample
be used at the AHRQ Data Center.
List Sample
The list sample is a nationally representative random sample of private-sector establishments and
governments. In 1996 only the MEPS - IC List included a sample of self-employed persons with
no employees (SENE). Each of these three groups was selected independent of the others and
the household sample. Each was selected from a list frame. Private-sector establishments were
selected from the most recent Bureau of the Census' Standard Statistical Establishment List, a
list of private sector establishments maintained by the Census. Governments were selected from
the 1992 Census of Governments, maintained by the Census Governments Division. The
SENE's were selected from a list of persons who filed taxes with the Internal Revenue Service as
self employed persons.
The list sample is designed to contain a large enough sample of private-sector establishments and
governments for 40 states that it can support estimates of totals for employees working in these
40 states and the nation as a whole. Further details concerning strata used, sample and sample
allocations can be found in Sommers, (1999). Tables from the MEPS - IC list sample can be
found on the MEPS web site http://www.meps.ahrq.gov
The MEPS IC is an annual survey. Data are collected from the selected organizations through a
prescreening telephone interview, a mailed questionnaire, and a telephone followup for
nonrespondents.
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3.0 Medical Provider Component
The MEPS MPC supplements and validates 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 hospitals, hospital physicians, home health agencies, and
pharmacies reported in the HC. Also included in the MPC are all office-based physicians:
- Providing care for HC respondents receiving Medicaid.
- Associated with a 75-percent sample of HC households receiving care through an
HMO (health maintenance organization) or managed care plan.
- Associated with a 25-percent sample of the remaining HC households.
Data are collected on medical and financial characteristics of medical and pharmacy events
reported by HC respondents, including:
- Diagnoses coded according to ICD-9-CM (9th Revision, International
Classification of Diseases) and DSM-IV (Fourth Edition, Diagnostic and
Statistical Manual of Mental Disorders).
- Physician procedure codes classified by CPT-4 (Common Procedure
Terminology, Version 4).
- Inpatient stay codes classified by DRGs (diagnosis-related groups).
- Prescriptions coded by national drug code (NDC), medication name, strength, and
quantity dispensed.
- Charges, payments, and the reasons for any difference between charges and
payments.
The MPC is conducted through telephone interviews and mailed survey materials.
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4.0 Nursing Home Component
The 1996 MEPS NHC was a survey of nursing homes and persons residing in or admitted to
nursing homes at any time during calendar year 1996. The NHC gathered information on the
demographic characteristics, residence history, health and functional status, use of services, use
of prescription medicines, and health care expenditures of nursing home residents. Nursing
home administrators and designated staff also provided information on facility size, ownership,
certification status, services provided, revenues and expenses, and other facility characteristics.
Data on the income, assets, family relationships, and care-giving services for sampled nursing
home residents were obtained from next-of-kin or other knowledgeable persons in the
community.
The 1996 MEPS NHC sample was selected using a two-stage stratified probability design. In the
first stage, facilities were selected; in the second stage, facility residents were sampled, selecting
both persons in residence on January 1, 1996, and those admitted during the period January 1
through December 31.
The sample frame for facilities was derived from the National Health Provider Inventory, which
is updated periodically by NCHS. The MEPS NHC data were collected in person in three rounds
of data collection over a 1½-year period using the CAPI system. Community data were collected
by telephone using computer-assisted telephone interviewing (CATI) technology. At the end of
three rounds of data collection, the sample consisted of approximately 815 responding facilities,
3,209 residents in the facility on January 1, and 2,690 eligible residents admitted during 1996.
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5.0 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 and microdata files. Summary reports are released
as printed documents and electronic files. Microdata files are released on CD-ROM and/or as
electronic files.
Printed documents and 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 from 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, 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 the 1996 MEPS Household Component - Health Insurance Plan
Abstraction (HIPA) Data from the Medical Expenditure Panel Survey. Released as an ASCII
data file and SAS transport file, this research file contains information collected from the HIPA
survey. The HIPA collects and abstracts health insurance plan booklets for all MEPS household
respondents who were covered by a private insurance policy at the time of their Round 1
interview for the 1996 MEPS. Health insurance plan abstracts with detailed information on
benefits such as deductibles, coinsurance rates, out of pocket maximums, plan maximums,
covered services and other plan features are included in this file.
The following documentation offers a brief overview of the types and levels of data provided, the
content and structure of the files and the codebook, and programming information. It contains
the following sections:
Data File Description
Data File Contents
Codebook
Crosswalk of Variables to Variable Source
HIPA Abstraction Screens
For more information on MEPS HC survey design see S. Cohen, 1997; J.Cohen, 1997; and S.
Cohen, 1996. For information on the MEPS - HC - HIPA and for copies of the HIPA
instruments see the MEPS web site at the following address: http://www.meps.ahrq.gov
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2.0 Data File Description
The potential population for the 1996 MEPS - HC - HIPA Linked Data is all persons in the HC
who were covered by a private insurance policy at the time of their interview in Round 1 of the
1996 MEPS and who are included in the full-year population in MEPS HC-008. This definition
includes all policyholders and dependents. The MEPS - HC - HIPA contains detailed
information on health plan provisions for 54 percent of the potential population. This yields a
non-conditional response rate of 42 percent when it is multiplied by the Round 1 response rate of
78 percent.
The MEPS - HC - HIPA is a person establishment level file. There is one record on the file for
each unique combination of establishment (source of insurance), policyholder, and covered
person (policyholder or dependent). There are 8,181 records on the file that have HIPA data.
These records are comprised of 3,754 policyholders and 3,645 dependents who obtained
insurance from 3,736 establishments. Each record on the file contains the following ID
variables.
DUPERSID is the person identifier (either a dependent or a policyholder).
PHOLDER indicates whether the person is the policyholder for the insurance coverage
identified on the record.
DEPNDNT indicates whether the person is a dependent covered under the insurance
coverage identified on the record.
ESTBID is an ID number for the establishment--employer, union, insurance company--
that is the source of the insurance coverage on the record.
EPRSID is a combination of ESTBID and the policyholder's DUPERSID and uniquely
identifies each health plan--where health plan is defined as the insurance coverage that a
policyholder obtains from an individual establishment.
COVCOUNT is the number of policies that cover each individual as a policyholder or as
a dependent.
A person (DUPERSID) can be listed more than once on this file if they are covered--as a
policyholder or a dependent-- by insurance policies from more than one establishment.
Establishment-policyholder pairs (EPRSIDs) can be listed more than once if the health plan a
policyholder obtains from a given establishment also covers his/her dependents. As noted above
there is a record on the MEPS - HC - HIPA for each unique combination of establishment--
policyholder (EPRSID) and covered person (DUPERSID). The following table presents a
hypothetical example that illustrates the relationship between the ID variables on this file.
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| Establishment ID |
Person
ID |
Establishment
ID +
Policyholder
ID |
PHOLDER |
DEPNDNT |
COVCOUNT |
|---|
| 11 |
44 |
1144 |
1 |
0 |
2 |
| 22 |
44 |
2244 |
1 |
0 |
2 |
| 33 |
51 |
3351 |
1 |
0 |
1 |
| 33 |
52 |
3351 |
0 |
1 |
1 |
| 33 |
53 |
3351 |
0 |
1 |
1 |
The first two rows of the table represent a situation where a person (DUPERSID = 44) is listed
two times (COVCOUNT = 2) in the MEPS - HC -HIPA file because she obtains insurance from
more than one establishment. Since the person is a policyholder (PHOLDER = 1) her
DUPERSID is repeated in her EPRSID. The last three rows of the table represent a situation
where a health plan (i.e., a unique establishment-policyholder pair, EPRSID = 3351) covers a
policyholder and two dependents. Note that the policyholder's DUPERSID appears in the
EPRSID for all three covered persons and that a combination of EPRSID and DUPERSID is
required to uniquely identify each record on the file.
In order to conduct person-level analyses it is necessary to identify all policies that cover each
individual either as a policyholder or as a dependent. Since each person in the MEPS - HC -
HIPA is uniquely identified by the variable DUPERSID, person-level analyses can be conducted
by examining all health plans that are linked to each DUPERSID. The variable COVCOUNT
was constructed to facilitate person-level analyses.
It is also important to note that some health plans in the MEPS - HC - HIPA do not have a record
for a policyholder. Specifically, 397 unique EPRSIDs do not have a record where PHOLDER =
1. A total of 514 dependents are covered by these health plans. Health plans that only have
records for dependents occur in the MEPS - HC - HIPA in cases where the policyholder is
deceased, the policyholder is not in the dependents' reporting unit, or the policyholder is not
included in the full-year population in MEPS HC-008. Return
To Table Of Contents
2.1 Imputations in the MEPS - HC - HIPA Linked Data
As noted above the MEPS - HC - HIPA contains detailed data on health plan provisions for
approximately 54 percent of persons who held private insurance at Round 1 of the 1996 MEPS
and who are included in the full-year population in MEPS HC-008.(1) Most nonresponse occurred
because health plan booklets were not collected. In addition some plan booklets were collected
and subsequently rejected for abstraction. The most frequent reasons for rejecting a plan booklet
for abstraction were that insufficient details were provided of plan provisions or that the plan
booklet described several "offered" health plans and it was not possible to determine which plan
the MEPS respondent actually held. Entire HIPA records were imputed in cases where the
policyholder had IC benefits information from the MEPS followback but did not have a HIPA
record. The IC benefits were used to aid the imputation of HIPA records for these cases. These
MEPS - HC - HIPA records are identified by an imputation flag (ICIMP = 1).
The values of some constructed variables were also imputed. All constructed variables for which
some values were imputed have an imputation flag. These flags have the same (or similar name)
as the constructed variable preceded by an "I". For example IOVDEDI is the imputation flag for
OVDEDI.
In constructing variables, imputations were done to replace values for variables that were missing
in the original, unedited HIPA data. Missing values in the original HIPA data occurred when
abstractors could not determine some aspect of a health plan's benefits from the plan booklet.
One reason for missing values is that some health plan booklets describe policies that cover
outpatient prescription drugs but the booklets do not provide details of the drug coverage.(2) Entire
sets of constructed drug coverage variables were imputed for these policies. Logical edits were
used in cases where the initial construction of overall out of pocket limits and hospital room and
board maximums resulted in implausible values. Some health plans, for example, had
implausibly low per confinement/year maximums for hospital room and board. In constructing
hospital maximum variables for these health plans, we treated the maximum given in the original
HIPA data as a "per day", rather than a "per confinement/year" maximum. In cases, such as this,
where the value of a variable was changed by a logical edit the variable was flagged as imputed. Return
To Table Of Contents
2.2 Codebook Structure
Frequencies are provided for each variable on the file. The codebook and data file sequence list
variables in the following order:
Unique person and establishment identifiers from the Household Component
Demographic variables from the Household Component
Constructed HIPA variables that summarize insurance provisions
Imputation flags for constructed HIPA variables
All variables from the HIPA instrument
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2.3 Reserved Codes
The following reserved code values are used:
VALUE DEFINITION
-1
NOT APPLICABLE Question was not asked due to skip pattern.
-9
NOT SPECIFIED Interviewer did not record the data or abstractor
could not
determine the benefit.
9,999,999 The variable has an unlimited value. (For example, for a
policy which
has no lifetime dollar maximum OVMAXIL =
9,999,999.)
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2.4 Codebook Format
This codebook describes an ASCII data set and provides the following information 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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3.0 Data File Contents
3.1 ID Variables
Identifiers from the Household Component
In the MEPS Household Component the definitions of Dwelling Units (DUs) and Group
Quarters 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.
The MEPS - HC - HIPA can be linked to other person-level public use files such as MEPS
HC001: 1996 Panel Round 1 Population Characteristics by using the DUPERSID.
ESTBID is an ID number assigned to places of employment and to sources of insurance during
the household interview.
EPRSID is a combination of ESTBID and the policyholder's DUPERSID.
PHOLDER indicates whether the person represented by DUPERSID is the policyholder for the
insurance coverage identified on the record.
DEPNDNT indicates whether the person represented by DUPERSID is a dependent covered
under the insurance coverage identified on this record.
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3.2 Demographic Variables from the Household Component
Age as of Round 1, race/ethnicity, and sex are added to this file for the convenience of
researchers. This information was collected in the household interview. For more information
on these variables refer to the documentation for MEPS HC001: 1996 Panel Round 1 Population
Characteristics.
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3.3 Overview of the Health Insurance Plan Abstraction Data
In the positional listing of variables, which begins on page 14 of the codebook, the
original, unedited HIPA variables begin with five coverage variables--MEDICAL, MEDIGAP,
DRUGS, DENTAL, and VISION-- that indicate whether a health plan provides each type of
benefits. All medical policies (MEDICAL = 1) provide insurance coverage for hospital room
and board and most provide coverage for other medical services such as physician office visits
and surgery. Medigap policies (MEDIGAP = 1) are supplemental health plans purchased by
Medicare beneficiaries to cover the deductibles, coinsurance, and other uncovered benefits of the
Medicare program. A health plan cannot be both a medical policy and a Medigap policy (i.e., if
MEDICAL = 1 then MEDIGAP = 2 and vice versa). In most cases coverage for outpatient
prescription drugs (DRUGS = 1) and dental and vision benefits (DENTAL = 1, VISION = 1) is
provided as part of a medical policy or a Medigap policy. The HIPA data, however, also contains
information on single service plans that do not cover medical services (MEDICAL = 2) and are
not Medigap policies (MEDIGAP = 2). These single service plans cover different combinations
of drug, dental, and vision benefits.
Health plan provisions in the HIPA data are recorded in terms of plan internal limits and
overall limits. Internal limits refer to plan provisions that are specific to a particular covered
service. Overall limits refer to plan provisions that apply over many services, but not necessarily
to all services. The overall limit variables in the HIPA database provide information on the
deductibles, coinsurance rates, out of pocket maximums, and plan maximums that apply across a
number of services in medical policies. Most health plan provisions in the HIPA data are also
recorded as they apply within the plan's provider network (in-plan) and outside the plan's
provider network (out of plan). Many HIPA variables end with the suffix "I" or "O" to indicate
whether the variable refers to in-plan or out of plan provisions.
The HIPA data contain detailed information on coverage for a number of medical
services (see list below). For each medical service an initial summary of medical services
variable characterizes a health plan's coverage of the service. The variable HSCOVI, for
example, classifies each health plan's in-plan coverage of hospital room and board as:
1 = Covered in Full
4 = Internal Limits Only
5 = Overall Limits Only
6 = Internal and Overall Limits
-1 = Not Applicable
If a health plan has internal limits only (HSCOVI = 4) then the in-plan deductible, coinsurance
rate and other limits for hospital room and board are recorded in a set of hospital specific
variables that begin with "HS" and end with "I." If a health plan has overall limits only
(HSCOVI = 5) then the in-plan overall limits are the only relevant limits for hospital room and
board. Each medical service in the HIPA database has a coverage type variable and a set of
service-specific limit variables for both the in-plan and out of plan coverage of the service.
Variables for each service are identified by a prefix as follows:
| HS = hospital room and board |
MI = inpatient mental health |
| IS = inpatient surgery |
MO = outpatient mental health |
| OS = outpatient surgery |
AD = inpatient alcohol/drug detox |
| OF = physician office visits |
AR = inpatient alcohol/drug rehabilitation |
| WB = well baby |
AO = outpatient alcohol/drug rehabilitation |
| HH = home health care |
|
The HIPA data also contains information on Medigap policies. All Medigap variables
begin with the prefix "GAP." The variable GAPTYPE indicates whether a policy is a one of the
ten standard Medigap policies (GAPTYPE = A, ..J) or another type of plan (GAPTYPE = 11)(3).
Following GAPTYPE is a series of
variables that indicate which deductibles, coinsurance rates
and other uncovered benefits of the Medicare program are covered by the Medigap policy. For
example, GAPA = 1 indicates that the policy covers Part A benefits.
Finally, the variables for drug, dental, and vision benefits are each identified by a prefix
as follows:
DR = drug
DN = dental
VS = vision
As noted above drug, dental, and vision benefits may be included as part of a medical policy or a
Medigap policy, or they may be provided in different combinations in single service policies.
Drug, dental and vision benefits that are part of medical policies may be subject to overall and/or
internal limits. Drug, dental and vision benefits that are provided in Medigap policies or single
service policies, on the other hand, are only subject to internal limits. It is also important to note
that separate drug coverage variables are provided for brand and generic drugs.
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3.4 Constructed Flags and Count Variables
General Description of Constructed Variables
The rest of the documentation describes variables that were constructed to assist
researchers in using the MEPS - HC - HIPA data. (Users who want more information on the
original, unedited HIPA variables should refer to the HIPA Abstraction Screens in the technical
appendix in section F of the documentation.) Variables were constructed which summarize the
overall policy limits and the coverage for hospital room and board, physician office visits, and
outpatient prescription drugs for each health plan. Constructed variables incorporate both overall
and internal limits and flags are provided which indicate whether a particular plan provision
results from an overall limit, an internal limit, or both.
In constructing variables we assumed that covered individuals would use the most
generous benefits available to them. For this reason only in-plan provisions were used to
construct variables since they are more generous than out of plan provisions. In constructing
drug variables brand or generic information was used according to the following criterion. If a
health plan had information for both types of drugs, we used brand name information if the brand
name coinsurance rate(4) was greater than, or equal to, the generic coinsurance rate. If a health
plan had information for only one type of drugs then the available information was used to
construct the drug variables.(5)
Health plan provisions that increase benefits for using participating
pharmacies or for using mail order drugs may also affect the generosity of drug benefits. Both
unedited and constructed drug benefit variables in this file are coded as they apply to a covered
person using a local participating pharmacy.
In the positional listing of variables, which begins on page 14 of the codebook, the
constructed variables begin with OVLIMIT and end with DRGINOOP. The prefix of each
constructed variable indicates whether the variable applies to overall limits, to hospital room and
board, to physician office visits, or to outpatient prescription drugs. Following the constructed
variables in the positional listing of variables are imputation flags. These flags begin with
IOVDEDI and end with IDRGMAXL. Not all constructed variables have an imputation flag. If
a constructed variable does not have an imputation flag this indicates that no values were
imputed for this variable. The prefix of the imputation flags are the same, or are similar to, the
prefixes of the constructed variables with an "I" preceding them. The prefixes for constructed
variables and imputation flags are as follows:
OV = overall variables
HOSP = hospital room and board variables
DRV = physician office visit variables
DRG = outpatient prescription drug variables
IOV = imputation flag for overall variables
IHSP = imputation flag for hospital room and board variables
IDRV = imputation flag for physician office visit variables
IDRG = imputation flag for outpatient prescription drug variables
Coverage Variables
The coverage variables--OVLIMIT, HOSPCOV, DRVCOV, and DRGCOV--indicate
whether a health plan has overall limits and whether the plan provides benefits in each of the
service categories. Users should note that all three types of health plans described
above--medical, Medigap, and single-service--potentially include drug coverage. Only medical
policies, however, may have overall limits or coverage for hospital room and board and physician
office visits. OVLIMIT, HOSPCOV, and DRVCOV, therefore, are set equal to "-1 Not
Applicable" for Medigap and single service policies. The unedited HIPA variables used to
construct each coverage variable are given below.
| Constructed Variable
|
Unedited HIPA Variables
|
| OVLIMIT
|
medical, overlimi
|
| HOSPCOV
|
medical, hscovi
|
| DRVCOV
|
medical, ofcovi
|
| DRUGCOV
|
drugs, drugcovb, drugcovg
|
Coinsurance Rates and Payment Type Variables
The coinsurance rate variables summarize the percent of total costs that are covered by
the insurance plan after any deductibles have been met and before any maximums take effect.
The rate variables have values expressed in terms of percentages that range from 0 to 100. There
is one rate variable for overall limits and one for each of the three service categories. The letters
"RATE" are used as the last four letters of the variable name for this group of variables. For
each rate variable there is a corresponding payment type variable, with a variable name ending
with the four letters "PAYT." Payment type variables indicate how the health plan pays for the
covered service. The payment type variables were constructed so that analysts can reconstruct
the original benefit. They are coded as follows:
(_PAYT = 1) plan pays a specified percentage of the charges
(_PAYT = 2) plan pays the remainder after a copayment by the covered person
(_PAYT = 3) plan pays a specified percentage after a copayment by the covered
person
(_PAYT = 4) plan has a maximum allowable payment for a covered service
(_PAYT = 5) plan has "Negotiated Discounts Only"--only applies to drug
coverage
As a first example consider a health plan where the payment type for physician office
visits is a percentage (DRVPAYT = 1) and the corresponding rate variable has a value of 80
(DRVRATE = 80). In this case the interpretation is straightforward: the plan is written in terms
of the percentage of covered charges paid by the insurer and pays 80 percent of all covered
charges for physician office visits. In other health plans payments for physician office visits
involve a copayment (_PAYT = 2 or 3) or a maximum allowable payment for a service (_PAYT
= 4). In constructing the "RATE" variables, copayments and maximum allowable payments
were converted into percentages by using the assumption that each covered person faces the
average cost of each covered service. Since health plan booklets were collected for the HIPA
survey in 1996, average costs were calculated for each covered service using MEPS HC - 011:
The 1996 Full Year Use and Expenditure Data. The average costs for each service are as follows:
Hospital room and board: $1147/day
Physician office visits: $91/visit
Prescriptions: $33.60/prescription
Overall: (Uses the average cost for physician office visits.)
For an example of how coinsurance rates were calculated for health plans that had
copayments (_PAYT = 2), consider a health plan that describes the coverage for physician office
visits as fully covered after a $10 copay. We assume that the covered person faces the average
cost of a physician office visit for MEPS households in 1996, which was $91. If the covered
person pays $10 for every visit then the plan pays $81 for every visit. We calculate the percent
paid by the plan by dividing 81 by 91 and code the answer (.89) as a percent in the rate variable
(DRVRATE = 89). We also set DRVPAYT = 2 (copayment) so that the original benefit can be
reconstructed by analysts using the file. Users should note that the unedited HIPA data records
hospital room and board deductibles for some health plans in terms of an amount per day. In
constructing the coinsurance rate for hospital room and board (HOSPRATE) "per day"
deductibles are treated as though they were copays.
In a small percentage of cases the coinsurance rates for physician office visits, hospital
room and board, and prescription drugs are determined by both a copayment and a coinsurance
rate (_PAYT = 3). As an example suppose that a health plan describes the coverage for
physician office visits as paying 90 percent of the cost of each visit after a copay of $10. To
calculate the coinsurance rate we assume that the covered person is charged $91 for the physician
office visit. The covered person pays a $10 copay and then the plan pays 90 percent of the
remaining $81. We calculate the percent paid by the plan by multiplying 81 by (.9) and then
dividing by 91. Then we code the answer (.80) as a percent in the rate variable (DRVRATE =
.80) and set DRVPAYT = 3.(6)
Another example is given for the small number of cases in which the coinsurance rate for
physician office visits and hospital room and board are determined by maximum allowable
payments (_PAYT = 4). Some policies have limits expressed in terms of a dollar maximum per
visit for physician office visits or maximum dollars per day for hospital room and board. These
limits are incorporated into the coinsurance rates of the respective services. As an example
consider a heath plan that specifies that it will pay a maximum of $60 per physician office visit.
In this case we calculate the percent of the visit paid by the plan by dividing 60 by 91. We code
the answer (.66) as a percent in the rate variable (DRVRATE = 66) and set DRVPAYT = 4. If a
health plan had specified a dollar maximum per visit that was greater than 91 then the limit was
not used to calculate DRVRATE. Values for maximum allowable costs for each service that
were greater than the average cost of the service were not used so that constructed _RATE
variables always have values that are less than, or equal to 100.
Finally, in some drug policies, the covered person receives "Negotiated Discounts Only"
(DRGPAYT = 5). These policies negotiate price discounts on behalf of covered persons but do
not have provisions for cost sharing. Because they do not share costs, DRGRATE (and all other
drug variables) for these policies is set equal to -1.
Return To Table Of Contents
Deductibles
Individual deductible variables were constructed for hospital room and board, physician
office visits and prescription drugs and individual and family deductibles were constructed for
overall limits. Deductibles for specific services may result from internal limits, from overall
limits, or from a combination of the two. In health plans where both an internal and an overall
deductible applied to a service the deductibles were summed.(7) The constructed deductible
variables included in this file represent the deductible faced by a person for that service who has
not used any other service or met any other deductible. Analysts who want to study the
generosity of insurance coverage as it applies to a single service, therefore, can use the
constructed deductible variables as they are recorded in the file. Some analysts may want to
study the generosity of insurance coverage as it applies to more than one service. To facilitate
studies of this kind, flag variables (FDEDIO_) were constructed that indicate whether each
service-specific deductible results from an internal limit (FDEDIO_ = 1), an overall limit
(FDEDIO_ = 2), or a sum of the two (FDEDIO_ = 3).
An example is now given of how the deductible flag variables (FDEDIO_) can be used to
study insurance coverage as it applies to utilization of more than one health service. Consider a
health plan that has FDEDIO_H = 2 and FDEDIO_P = 2 so that the deductible for hospital room
and board (HOSPDEDI) and physician office visits (DRVDEDI) are both equal to the overall
deductible (OVDEDI). The deductible that the covered person faces for the total costs of both
types of services in this case is OVDEDI. It is not OVDEDI multiplied by two because covered
persons are only required to meet their overall deductible once. For a second example consider a
health plan that has FDEDIO_H = 1 and FDEDIO_P = 2 so that the deductible for hospital room
and board (HOSPDEDI) results from a limit that is specific to hospital room and board and the
deductible for physician office visits (DRVDEDI) is equal to the overall deductible. In this case
the covered person faces separate deductibles for the costs of hospital room and board
(HOSPDEDI) and for the costs of physician office visits (DRVDEDI = OVDEDI).
Users should note that internal hospital deductibles in the HIPA file are recorded in one
of three ways: a dollar amount per confinement/year, a number of days per confinement/year, or a
dollar amount per day. The constructed hospital deductible variable (HOSPDEDI) is recorded in
terms of a dollar amount per confinement/year. For cases where the deductible is expressed as
the number of days per confinement/year we converted the deductible into an amount per
confinement/year using assumptions about the average cost per day for hospital room and board.
These cost assumptions are discussed above in the description of the constructed coinsurance rate
variables. For cases where the deductible is expressed as an amount per day we treat the
deductible as a copay and incorporate it into the hospital coinsurance rate (HOSPRATE).
Maximums
Annual and lifetime plan maximum variables were constructed for overall limits, hospital
room and board, physician office visits and prescription drug coverage. In order to use the
maximum variables it is necessary to understand how the lifetime and annual variables relate to
each other. As an example consider the lifetime and annual maximums for physician office visits
(DRVMAXIL and DRVMAXIY). The following table presents all of the different combinations
of values for these two variables.
| DRVCOV |
DRVMAXIL |
DRVMAXIY |
|---|
| -1:NA |
-1 |
-1 |
| 2:No |
-1 |
-1 |
| 1:Yes |
>0 |
-1 |
| 1:Yes |
-1 |
>0 |
| 1:Yes |
>0 |
>0 |
Lifetime and annual maximum variables are both coded as "-1 Not Applicable" for health
plans that do not cover physician office visits. This includes Medigap and single-service plans
(DRVCOV = -1) and medical plans that do not cover physician office visits (DRVCOV = 2).
Health plans that have coverage for physician office visits (DRVCOV = 1) may have maximums
expressed in terms of lifetime and/or annual limits. The third row of the table represents health
plans where the physician office visit maximum is expressed in terms of a lifetime limit
(DRVMAXIL >0) but is not expressed in terms of an annual limit (DRVMAXIY = -1). The
fourth row represents the opposite situation. It is important to note--as the third and fourth row
of the table demonstrate--that both the lifetime and annual maximum variables must be used to
ensure that relevant maximums are obtained for all health plans. Finally, the health plans
represented by the fifth row of the table have maximums expressed in terms of both lifetime and
annual limits. Many of these health plans have no plan maximum (DRVMAXIL = 9,999,999
and DRVMAXIY = 9,999,999).
The constructed maximum variables included on this file represent the maximum amount
that a health plan will pay for a service for a person who has not used any other service. Analysts
who want to study the generosity of insurance coverage for a single service, therefore, can use the
constructed maximums as they are recorded in the file. Analysts may also want to study the
generosity of insurance coverage as it applies to more than one service. To facilitate studies of
this kind, flag variables (FMAXIO_) were constructed that indicate whether each service-specific annual maximum results from an internal limit (FMAXIO_ = 1), or an overall limit
(FMAXIO_ = 2). No flag variable was constructed for lifetime maximums because all lifetime
maximums result from overall limits.(8)
Return To Table Of Contents
Users should note that annual hospital room and board maximums in the HIPA file are
recorded in one of three ways: a dollar amount per confinement/year, a number of days per
confinement/year, or a dollar amount per day. The constructed annual hospital maximum
variable (HOSPMAXY) is recorded in terms of a dollar amount per confinement/year. For cases
where the maximum is expressed as the number of days per confinement/year we converted the
maximum into an amount per confinement/year using assumptions about the average cost per day
for hospital room and board. These cost assumptions are discussed above in the description of
the constructed coinsurance rate variables. We also constructed a separate variable
(HOSPMAXNT) for the maximum number of days in the hospital per confinement / year. For
cases where the maximum is expressed as a dollar amount per day the maximum is incorporated
into the hospital coinsurance rate (HOSPRATE).(9) (See the discussion on coinsurance rates for
health plans that have _PAYT = 4 for a description of how these maximums are incorporated
into the coinsurance rate.)
Users should also note that annual physician office visit maximums in the HIPA file are
also recorded in one of three ways: a dollar amount per year, a maximum number of visits per
year, or a maximum dollar amount per visit. The constructed annual physician office visits
maximum variable (DRVMAXY) is recorded in terms of a dollar amount per year. For cases
where the maximum is expressed as the number of visits per year we converted the maximum
into an amount per year using assumptions about the average cost of a physician office visit. We
also constructed a separate variable (DRVMAXVS) for the maximum number of physician office
visits per year. For cases where the maximum is expressed as an amount per visit the maximum
is incorporated into the physician office visit coinsurance rate. (See the discussion on
coinsurance rates for health plans that have _PAYT = 4 for a description of how these maximums
are incorporated into the coinsurance rate.)
Out of Pocket Limits
Out of pocket (OOP) limit variables are constructed for overall individual OOP limits
(OVMOOPI) and for overall family OOP limits (OVMOOPF). A flag variable (OOPDEDFL)
indicates whether or not the individual (family) overall deductible counts toward the individual
(family) OOP limit. For health plans that do include the deductible in the OOP limit OVMOOPI
and OVMOOPF are constructed by subtracting the individual or family overall deductible from
the stated OOP amount. For example, if OOPDEDFL = 1 then OVMOOPI = OOP Amount -
OVDEDI. The total overall out of pocket expenses faced by a covered who has not previously
had any medical expenditures, therefore, is the overall individual deductible plus the constructed
OOP limit (OVDEDI + OVMOOPI).(10) This is true whether or not the deductible is included in
the OOP limit. The total overall out of pocket expenses faced by a family that has not previously
had any medical expenditures is the overall family deductible plus the constructed family OOP
limit (OVDEDF + OVMOOPF).
In addition to the overall OOP limits a variable (HOSPMOOP) is constructed for internal
individual hospital room and board OOP limits. If a health plan specifies an individual OOP
limit that is specific to hospital room and board then HOSPMOOP 0. For all other health plans
HOSPMOOP is coded as "-1 NOT APPLICABLE." For health plans that have an internal
hospital room and board OOP limit a flag variable (FOOP_H) indicates whether or not the
overall individual OOP limit also applies. If FOOP_H = 1 then HOSPMOOP is the only OOP
limit that applies to hospital room and board. If FHOOP = 2 then both HOSPOOP and
OVMOOPI apply.
There are no OOP limits that are specific to prescription drugs but a flag variable
(DRGINOOP) indicates whether a covered person or covered family's prescription drug
expenditures apply to their overall OOP limit.
Return To Table Of Contents
D. Codebook
E. Variable-Source Crosswalk
HC-HIPA Linked Data Research File
Crosswalk of Variables to Variable Source
OVERALL LIMIT VARIABLES - PUBLIC USE
| VARIABLE |
LABEL |
SOURCE (HIPA VARIABLES |
| OVLIMIT |
OVERALL LIMIT INDICATOR |
MEDICAL, OVERLIMI |
| OVDEDI |
OVERALL INDIVIDUAL
DEDUCTIBLE |
MEDICAL, OVERLIMI, DEDI,
DEDIDI, DEDIPCTI |
| OVDEDF |
OVERALL FAMILY DEDUCTIBLE |
MEDICAL, OVERLIMI, DEDI,
DEDFDI, |
| OVRATE |
OVERALL COINSURANCE RATE |
MEDICAL, OVERLIMI, COICOPI,
COICOPPI, COICOPDI, DRVEXP |
| OVPAYT |
OVERALL PAYMENT TYPE |
MEDICAL, OVERLIMI, COICOPI |
| OVMAXIY |
OVERALL ANNUAL MAXIMUM |
MEDICAL, OVERLIMI, MAXNONEI,
MAXNSI, MAXCYI, MAXCYDI, |
| OVMAXIL |
OVERALL LIFETIME MAXIMUM |
MEDICAL, OVERLIMI, MAXNONEI,
MAXNSI, MAXLIFI, MAXLIFDI |
| OVMOOPI |
OVERALL INDIVIDUAL OUT OF
POCKET MAXIMUM |
MEDICAL, OVERLIMI, OOPI, OOPII,
OOPIDI, OVRATE, OOPDEDFL,
OVDEDI |
| OVMOOPF |
OVERALL FAMILY OUT OF
POCKET MAXIMUM |
MEDICAL. OVERLIMI, OOPI,
OOPFI, OOPFDI, OVRATE,
ODEDFL, OVDEDF |
| OOPDEDFL |
FLAG: DEDUCTIBLE INCLUDED IN
OOP LIMIT? |
OOPDEDI |
Return To Table Of Contents
HOSPITAL ROOM AND BOARD VARIABLES - PUBLIC USE
| VARIABLE |
LABEL |
SOURCE (HIPA VARIABLES) |
| HOSPCOV |
HOSPITAL R / B COVERAGE
INDICATOR |
MEDICAL, HSCOVI |
| HOSPDEDI |
HOSPITAL R / B INDIVIDUAL
DEDUCTIBLE |
MEDICAL, HSCOVI, HSDEDII,
HSDEDCYI, HSDEDDYI,
HSDECYDI, HSDEDYNI, HOSPEXP,
HSDEDOI, OVDEDI |
| FDEDIO_H |
FLAG: HOSP. DED. INTERNAL /
OVERALL |
MEDICAL, HSCOVI, HSDEDII,
HSDEDCYI, HSDEDDYI, HSDEDOI |
| HOSPRATE |
HOSPITAL R / B COINSURANCE
RATE |
MEDICAL, HSCOVI, HSCOINII,
HSCOINPI, HSDEDDFI, HSDEDDVI,
HSDEDFDI, HOSPEXP, HSCOINOI,
COICOPI, COICOPPI, COICOPDI,
HSMXDYDI, HSMXDYDI,
HSMXCYI, HSMXCYDI |
| HOSPPAYT |
HOSPITAL R / B PAYMENT TYPE |
MEDICAL, HSCOVI, HSCOINII,
HSCOINPI, HSDEDDFI, HSDEDDVI,
HSCOINOI, COICOPI |
| HOSPMAXY |
HOSPITAL R / B ANNUAL
MAXIMUM |
MEDICAL, HSCOVI, HSMAXDII,
HSMXCYDI, HSMAXNII,
HSMXCYNI, HSMAXOI, MAXCYI,
MAXCYDI, OVMAXIY, OVMAXIL |
| FMAXIO_H |
FLAG: HOSP. ANN. MAX INTERNAL
/ OVERALL |
MEDICAL, HSCOVI, HSMAXDII,
HSMAXNII, HSMAXOI, MAXCYI |
| HOSPMAXL |
HOSPITAL R / B LIFETIME
MAXIMUM |
MEDICAL, HSCOVI, HSMAXOI,
MAXLIFI, MAXLIFDI, OVMAXIL |
| HOSPMOOP |
HOSPITAL R / B INTERNAL OOP
MAXIMUM |
MEDICAL, HSCOVI, HSOOPII,
HSOOPDI, HSOOPOI |
| FOOP_H |
FLAG: HOSP OOP INTERNAL /
OVERALL |
MEDICAL, HSCOVI, HSOOPII,
HSOOPOI |
| HSPMAXNT |
HOSPITAL R / B MAX NIGHTS /
YEAR |
MEDICAL, HSCOVI, HSMAXNII,
HSMXCYNI |
Return To Table Of Contents
PHYSICIAN OFFICE VISIT VARIABLES - PUBLIC USE
| VARIABLE |
LABEL |
SOURCE |
| DRVCOV |
PHYSICIAN OFF. VIS. COVERAGE
INDICATOR |
MEDICAL, OFCOVI |
| DRVDEDI |
PHYSICIAN OFF. VIS. IND.
DEDUCTIBLE |
MEDICAL, OFCOVI, OFDEDII,
OFDEDDI, OFDEDOI, OVDEDI |
| FDEDIO_P |
FLAG: PHYS. DED. INTERNAL /
OVERALL |
MEDICAL, OFCOVI, OFDEDII, ,
OFDEDOI |
| DRVRATE |
PHYSICIAN OFF. VIS.
COINSURANCE RATE |
MEDICAL, OFCOVI, OFCOIFII,
OFCOPFII, OFCOPVII, OFCOINPI,
OFCOPDI, DRVEXP, OFCOINOI,
COICOPI, COICOPPI, COICOPDI |
| DRVPAYT |
PHYSICIAN OFF. VIS. PAYMENT
TYPE |
MEDICAL, OFCOVI, OFCOIFII,
OFCOPFII, OFCOPVII, OFCOINOI,
COICOPI |
| DRVMAXIY |
PHYSICIAN OFF. VIS. ANNUAL
MAXIMUM |
MEDICAL, OFCOVI, OFMXYRII,
OFMXYRDI, OFMXNVII,
OFMXNVNI, DRVEXP, OFMAXOI,
MAXCYI, MAXCYDI, OVMAXIY,
OVMAXIL |
| FMAXIO_P |
FLAG: PHYS. ANN. MAX INTERNAL
/ OVERALL |
MEDICAL, OFCOVI, OFMXYRII,
OFMXNVII, OFMAXOI |
| DRVMAXIL |
PHYSICIAN OFF. VIS. LIFETTIME
MAXIMUM |
MEDICAL, OFCOVI, OFMAXOI,
MAXLIFI, MAXLIFDI, OVMAXIL |
| DRVMAXVS |
PHYSICIAN OFF. VIS. MAX VISITS /
YEAR |
MEDICAL, OFCOVI, OFMSNVII,
OFMXNVNI |
Return To Table Of Contents
OUTPATIENT PRESCRIPTION DRUG COVERAGE VARIABLES - PUBLIC USE
| VARIABLE |
LABEL |
SOURCE |
| DRGCOV |
DRUG COVERAGE INDICATOR |
DRUGS, DRUGCOVB, DRUGCOVG |
| DRGDEDI |
DRUG INDIVIDUAL DEDUCTIBLE |
DRUGS, DRUGCOVB, DRDEDIB,
DRDEDIDB, DRDEDOB,
DRUGCOVG, DRDEDIG,
DRDEDIDG, DRDEDOG, DEDI,
OVDEDI |
| FDEDIO_D |
FLAG: DRUG. DED. INTERNAL /
OVERALL |
DRUGS, DRUGCOVB, DRDEDIB,
DRDEDOB, DRUGCOVG,
DRDEDIG, DRDEDOG |
| DRGRATE |
DRUG COINSURANCE RATE |
DRUGS, DRUGCOVB, DRUGCOVG,
DRCOINOB, DRCOINIB DRCOPIB,
DRCOPDB, DRCOINPB,
DRCOINOG, DRCOINIG, DRCOIPIG,
DRCOPDG, DRCOINPG, COICOPI,
COICOPPI, COICOPDI, |
| DRGPAYT |
DRUG PAYMENT TYPE |
DRUGS, DRUGCOVB, DRUGCOVG,
DRCOINOB, DRCOINIB DRCOPIB,
DRCOINOG, DRCOINIG, DRCOIPIG,
COICOPI |
| DRGMAXIY |
DRUG ANNUAL MAXIMUM |
DRUGS, DRUGCOVB, DRMAXIB,
DRMAXDB, DRMAXOB,
DRUGCOVG, DRMAXIG,
DRMAXDG, DRMAXOG, MAXCYI,
MAXCYDI, OVMAXIY, OVMAXIL |
| FMAXIO_D |
FLAG: DRUG. ANN. MAX
INTERNAL / OVERALL |
DRUGS, DRUGCOVB, DRMAXIB,
DRMAXOB, DRUGCOVG,
DRMAXIG, DRMAXOG, MAXCYI,
MAXCYDI, |
| DRGMAXIL |
DRUG LIFETIME MAXIMUM |
DRUGS, DRUGCOVB, DRMAXOB,
DRUGCOVG, DRMAXOG MAXLIFI,
MAXLIFDI, OVMAXIL |
| DRGINOOP |
FLAG: DRUGS INCLUDED IN OOP
LIMIT? |
MEDICAL, OVERLIMI, OOPI,
OOPAPPI, OOPDRUGI |
1. This yields a non-conditional response rate of 42 percent when it is multiplied by the Round 1 response
rate of 78 percent.
2. In order to be accepted for abstraction, a health plan was required to have details on both hospital room
and board and physician office visit coverage. Details on prescription drug coverage, however, were not required.
3. Some of these "other" plans are grandfathered plans sold prior to the establishment of the ten A-J plans,
while others seem to fall into one of the ten categories.
4. The coinsurance rate is defined as the percent of total costs that are covered by the insurance plan after
any deductibles have been met and before any maximums take effect.
5. If a plan booklet did not distinguish between generic and brand name drugs the HIPA abstractors assumed
that both were covered. Drug benefits for these cases were coded as brand name drug coverage, and generic drug
coverage was coded as "not specified."
6. For health plans with _PAYT = 3 or 4 the original benefits can only be reconstructed by using the
unedited HIPA variables.
7. There are also a small number of cases where two different types of internal deductibles apply. Again, in
these cases, the two types of deductibles are summed.
8. Some values for service-specific lifetime maximum variables were coded from internal limits, but in every
case in which this was done the health plan provides unlimited coverage of the service (_MAXL = 9,999,999).
9. Some health plans in the HIPA data had a maximum dollar amount per confinement/year for hospital
room and board that was less than or equal to $1000--many were well below $1000. In editing the data we treated
cases that had per confinement/year maximums that were less then or equal to $1000 as per day, rather than per
confinement/year maximums. We chose $1000 as the cutoff point both because it is the largest dollar value in the
HIPA data that would make sense as a daily maximum and because inspection of the health plans revealed that there
was a qualitative difference between the policies that were coded with per confinement/year maximums less than
$1000 and those with per confinement/year maximums greater than $1000. (Health plans with per confinement/year
maximums greater than $1000 tended to have either no overall limits (internal limits only) or very low overall
maximums.
10. The unedited OOP limit variables in the HIPA file are expressed in one of three ways: as an OOP
amount, as a covered expense, or as benefits paid. When an OOP variable is expressed in terms of a covered
expense it is converted to an OOP amount by multiplying the covered expense by [1 - OVRATE], where OVRATE
is the overall coinsurance rate for the policy. When an OOP variable is expressed in terms of benefits paid it is
converted to an OOP amount by multiplying the benefits paid by [1 - OVRATE] /
OVRATE.
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