MEPS HC-102H: 2006 Home Health Visits
August 2008
Agency for Healthcare Research and Quality
Center for Financing, Access and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406
Table of Contents
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Survey Management and Data Collection
C. Technical And Programming Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Source and Naming Conventions
2.4.1 Variable-Source Crosswalk
2.4.2 Expenditure and Source of Payment Variables
2.5 File Contents
2.5.1 Survey Administration Variables
2.5.1.1 Person Identifiers (DUID, PID, DUPERSID)
2.5.1.2 Record Identifier (EVNTIDX)
2.5.1.3 Round Indicator (EVENTRN)
2.5.1.4 Panel Indicator (PANEL)
2.5.2 Home Health Event Variables
2.5.2.1 Date of Event (HHDATEYR, HHDATEMM)
2.5.2.2 Characteristics of Event (MPCELIG-OTHCWOS)
2.5.2.3 Treatments, Therapies, and Services (HOSPITAL-OTHSVCOS)
2.5.2.4 Frequency of Event (FREQCY-HHDAYS)
2.5.3 Flat Fee Variables
2.5.4 Condition, Procedure, and Clinical Classification Codes
2.5.5 Expenditure Data
2.5.5.1 Definition of Expenditures
2.5.5.2 Data Editing and Imputation Methodologies of Expenditure Variables
2.5.5.2.1 General Data Editing Methodology
2.5.5.2.2 General Hot-Deck Imputation
2.5.5.2.3 Home Health Data Editing and Imputation
2.5.5.3 Imputation Flag Variable (IMPFLAG)
2.5.5.4 Flat Fee Expenditures
2.5.5.5 Zero Expenditures
2.5.5.6 Sources of Payment
2.5.5.7 Home Health Expenditure Variables (HHSF06X - HHXP06X)
2.5.5.8 Rounding
3.0 Sample Weight (PERWT06F)
3.1 Overview
3.2 Details on Person Weight Construction
3.2.1 MEPS Panel 10 Weight
3.2.2 MEPS Panel 11 Weight
3.2.3 The Final Weight for 2006
3.2.4 Coverage
3.3 Using MEPS Data for Trend Analysis
4.0 Strategies for Estimation
4.1 Developing Event-Level Estimates
4.2 Person-Based Estimates for Home Health Care
4.3 Variables with Missing Values
4.4 Variance Estimation (VARPSU, VARSTR)
5.0 Merging/Linking MEPS Data Files
5.1 Linking to the Person-Level File
5.2 Linking to the Prescribed Medicines File
5.3 Linking to the Medical Conditions File
5.4 Pooling Annual Files
5.5 Longitudinal Analysis
_._ References
D. Variable - Source Crosswalk
A. Data Use Agreement
Individual identifiers have been removed from the
micro-data contained in these files. Nevertheless, under sections 308 (d) and
903 (c) of the Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1),
data collected by the Agency for Healthcare Research and Quality (AHRQ) and/or
the National Center for Health Statistics (NCHS) may not be used for any purpose
other than for the purpose for which they were supplied; any effort to determine
the identity of any reported cases is prohibited by law.
Therefore in accordance with the above referenced Federal
Statute, it is understood that:
No one is to use the data in this data set in
any way except for statistical reporting and analysis; and
If the identity of any person or establishment
should be discovered inadvertently, then (a) no use will be made of
this knowledge, (b) the Director Office of Management AHRQ will be
advised of this incident, (c) the information that would identify any
individual or establishment will be safeguarded or destroyed, as
requested by AHRQ, and (d) no one else will be informed of the
discovered identity; and
No one will attempt to link this data set with
individually identifiable records from any data sets other than the
Medical Expenditure Panel Survey or the National Health Interview
Survey.
By using these data you signify your agreement to comply
with the above stated statutorily based requirements with the knowledge that
deliberately making a false statement in any matter within the jurisdiction of
any department or agency of the Federal Government violates Title 18 part 1
Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5
years in prison.
The Agency for Healthcare Research and Quality requests
that users cite AHRQ and the Medical Expenditure Panel Survey as the data source
in any publications or research based upon these data.
Return To Table Of Contents
B. Background
1.0 Household Component
The Medical Expenditure Panel Survey (MEPS) provides
nationally representative estimates of health care use, expenditures, sources of
payment, and health insurance coverage for the U.S. civilian
non-institutionalized population. The MEPS Household Component (HC) also
provides estimates of respondents' health status, demographic and socio-economic
characteristics, employment, access to care, and satisfaction with health care.
Estimates can be produced for individuals, families, and selected population
subgroups. The panel design of the survey, which includes 5 Rounds of interviews
covering 2 full calendar years, provides data for examining person level changes
in selected variables such as expenditures, health insurance coverage, and
health status. Using computer assisted personal interviewing (CAPI) technology,
information about each household member is collected, and the survey builds on
this information from interview to interview. All data for a sampled
household are reported by a single household respondent.
The MEPS-HC was initiated in 1996. Each year a new panel
of sample households is selected. Because the data collected are
comparable to those from earlier medical expenditure surveys conducted in 1977
and 1987, it is possible to analyze long-term trends. Each annual MEPS-HC sample
size is about 15,000 households. Data can be analyzed at either the person
or event level. Data must be weighted to produce national
estimates.
The set of households selected for each panel of the MEPS
HC is a subsample of households participating in the previous year's National
Health Interview Survey (NHIS) conducted by the National Center for Health
Statistics. The NHIS sampling frame provides a nationally representative sample
of the U.S. civilian non-institutionalized population and reflects an oversample
of blacks and Hispanics. MEPS oversamples additional policy relevant sub-groups
such as Asians and low income households. The linkage of the MEPS to the
previous year's NHIS provides additional data for longitudinal analytic
purposes.
Return To Table Of Contents
2.0 Medical Provider Component
Upon completion of the household CAPI interview and
obtaining permission from the household survey respondents, a sample of medical
providers are contacted by telephone to obtain information that household
respondents can not accurately provide. This part of the MEPS is called the
Medical Provider Component (MPC) and information is collected on dates of visit,
diagnosis and procedure codes, charges and payments. The Pharmacy Component
(PC), a subcomponent of the MPC, does not collect charges or diagnosis and
procedure codes but does collect drug detail information, including National
Drug Code (NDC) and medicine name, as well as date filled and sources and
amounts of payment. The MPC is not designed to yield national estimates. It is
primarily used as an imputation source to supplement/replace household reported
expenditure information.
Return To Table Of Contents
3.0
Survey Management and Data Collection
MEPS HC and MPC data are collected under the authority of
the Public Health Service Act. Data are collected under contract with Westat,
Inc. Data sets and summary statistics are edited and published in accordance
with the confidentiality provisions of the Public Health Service Act and the
Privacy Act. The National Center for Health statistics (NCHS) provides
consultation and technical assistance.
As soon as data collection and editing are completed, the
MEPS survey data are released to the public in staged releases of summary
reports, micro data files, and tables via the MEPS Web site:
www.meps.ahrq.gov. Selected data can be analyzed through MEPSnet, an on-line
interactive tool designed to give data users the capability to statistically
analyze MEPS data in a menu-driven environment.
Additional information on MEPS is available from the MEPS
project manager or the MEPS public use data manager at the Center for Financing
Access and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither
Road, Rockville, MD 20850 (301-427-1406).
Return To Table Of Contents
C. Technical and Programming Information
1.0 General Information
This documentation describes one in a series of public use
event files from the 2006 Medical Expenditure Panel Survey (MEPS) Household
Component (HC) and Medical Provider Component (MPC). Released as an ASCII data
file (with related SAS and SPSS programming statements) and a SAS transport
file, the 2006 Home Health public use file provides detailed information on home
health events for a nationally representative sample of the civilian
noninstitutionalized population of the United States. Data from the Home Health
event file can be used to make estimates of home health event utilization and
expenditures for calendar year 2006. The file contains 68 variables and has a
logical record length of 297 with an additional 2-byte carriage return/line feed
at the end of each record. As illustrated below, this file consists of MEPS
survey data obtained in the 2006 portion of Round 3, and Rounds 4 and 5 for
Panel 10, as well as Rounds 1, 2, and the 2006 portion of Round 3 for Panel 11
(i.e., the rounds for the MEPS panels covering calendar year 2006).
301 Moved Permanently
301 Moved Permanently
Counts of home health utilization are based entirely on
household reports. Agency home health providers were sampled into the MEPS MPC
(see Section B. 2.0). Only those providers for whom the respondent signed a
permission form were included in MPC. Information from MPC was used to
supplement expenditure and payment data reported by the household, and does not
affect use estimates.
Data from this event file can be merged with other 2006
MEPS HC data files for the purposes of appending person-level data such as
demographic characteristics or health insurance coverage to each home health
record.
This file can also be used to construct summary variables
for expenditures, sources of payment, and related aspects of home health events
for calendar year 2006. Aggregate annual person-level information on the use of
home health providers and other health services use is provided on the 2006
Population Characteristics File, where each record represents a MEPS sampled
person.
The following documentation offers a brief overview of the
types and levels of data provided, and the content and structure of the file and
the codebook. It contains the following sections:
Data File Information
Sample Weight
Strategies for Estimation
Merging/Linking MEPS Data Files
References
Variable - Source Crosswalk
For more information on MEPS HC survey design see S.
Cohen, 1997; J. Cohen, 1997; and S. Cohen, 1996. For information on the MEPS MPC
design, see S. Cohen, 1999. A copy of the survey instruments used to
collect the information on this file is available on the MEPS Web site at the
following address: www.meps.ahrq.gov.
Return To Table Of Contents
2.0 Data File Information
The 2006 Home Health public use data set consists of one
event-level data file. The file contains characteristics associated with the
home health event and imputed expenditure data.
The Home Health use data set contains characteristics
associated with the home health event and imputed expenditure data. The home
health services represented on this file are provided by three kinds of home
health providers: formal (paid) home health agency providers, paid independent
providers (self-employed), and informal providers who do not reside in the same
household as the MEPS sampled person (care from informal providers who live in
the same household as the sampled person are not represented on this file).
Each record on this file represents a household-reported
home health event. A home health event is a MONTH of similar services provided
to a sampled person by the same PROVIDER (i.e., an employer in the case of
formal agency care and an individual in the case of paid independent and
informal care providers). For example, if a person received, from Provider
Agency A, four visits events from a nurse, ten visits events from a homemaker,
and four visits events from a physical therapist each from the same provider one
for each month every month during the months of January, February, and March,
and also received, from Provider B, a physician visit in the month of January
and February, there would be five event records on the file (NOT 56 records).
There would be one event record representing all the visits from Provider A for
the month of January, another record for Provider A's February visits, a third
Provider A record for the March visits, a fourth record representing the
Provider B physician visit in January and a fifth representing the Provider B
physician visit in February. Data were collected (and represented on this file)
in this manner because agencies, hospitals, and nursing homes provide MEPS
expenditure data in this manner. In order to be consistent with the definition
of what is considered a home health event on this file, this same definition
(i.e., a month of similar services) was applied to all types of home health
providers.
This public use data set contains 5,457 home health
records; of the records, 5,381 are associated with persons having a positive
person-level weight (PERWT06F). It includes all records related to home health
events for all household survey respondents who resided in eligible responding
households and reported at least one home health event. Each record represents
one household-reported home health event that occurred during calendar year
2006. Some household respondents may have multiple events and thus will be
represented in multiple records on the file. Other household respondents may
have reported no events and thus will have no records on this file. These data
were collected during the 2006 portion of Round 3, and Rounds 4 and 5 for Panel
10, as well as Rounds 1, 2, and the 2006 portion of Round 3 for Panel 11 of the
MEPS HC. The persons represented on this file had to meet either (a) or (b):
Be classified as a key in-scope person who
responded for his or her entire period of 2006 eligibility (i.e.,
persons with a positive 2006 full-year person-level weight (PERWT06F >
0)), or
Be an eligible member of a family all of whose
key in-scope members have a positive person-level weight (PERWT06F >
0). (Such a family consists of all persons with the same value for FAMIDYR.) That is, the person must have a positive full-year
family-level weight (FAMWT06F > 0). Note that FAMIDYR and FAMWT06F are
variables on the 2006 Population Characteristics file.
Persons with no home health events for 2006 are not
included on this event-level HH file but are represented on the person-level
2006 Full Year Population Characteristics file.
Home health providers include formal or paid, and informal
or unpaid providers. Formal or paid providers include: home health agency and
other independent paid providers. Informal or unpaid providers include family
and friends that reside outside of the sampled person’s household.
For home health agencies it is important to distinguish
between the provider and the home health worker. In these cases, the provider is
the agency or the facility that employs the workers. The home health workers are
the people who administer the care. Examples of home health care workers are the
following: nurses, physical therapists, home health aides, homemakers, and
hospice workers, among others. These examples are generally the types of workers
associated with agencies. Paid independent providers generally include
companions, nursing assistants, physicians, etc. For each record on this file,
one or more types of workers can be reported. The respondent is asked to mention
all of the types of home health workers who provided home health care (since
records represent a month of service, there can be more than one type of worker
on a single record). For example, an agency that provides two types of aides
that provide home health care to the same person during a specific month is
represented as one event on the file even though two workers employed at the
same agency provided care. When using this file, analysts must keep in mind that
a record on the file corresponds to a provider entity, not an individual or
particular worker.
Expenditure data for home health agency events are
collected exclusively in the MPC. Expenditure data for other paid independent
home health care events are collected from the household, since these types of
events are not included in the MPC. Friends, family and volunteers providing
home health care to a person are considered unpaid and are not included in the
MPC. No expenditure information is available for them.
Each home health record also includes the following: the
month the provider visited the household; type of provider; types of services
provided and if this was a repeat event; whether or not care was received due to
hospitalization; whether or not a person was taught how to use medical
equipment; imputed sources of payment, total payment and total charge for the
home health event expenditure; and a full-year person-level weight.
Data from this file can be merged with previously released
2006 MEPS HC person-level data, such as the MEPS 2006 Full-Year Population
Characteristics file, using the person identifier, DUPERSID, to append
person-level information, such as demographic or health insurance coverage, to
each record. Home Health events can also be linked to the MEPS 2006 Medical
Conditions File. Please see Section 5.0 or the MEPS 2006 Appendix File, HC-102I,
for details on how to link MEPS data files.
Return To Table Of Contents
2.1 Codebook Structure
For each variable on the Home Health event file, both
weighted and unweighted frequencies are provided in the accompanying codebook.
The codebook and data file sequence list variables in the following order:
Unique person identifier
Unique home health event identifier
Home health characteristic variables
Imputed expenditure variables
Weight and variance estimation variables
Note that the person identifier is unique within this data
year. See the section on pooling annual files, 5.4, for details.
Return To Table Of Contents
2.2 Reserved Codes
The following reserved code values are used:
Value |
Definition |
-1 INAPPLICABLE |
Question was not asked due to skip pattern. |
-7 REFUSED |
Question was asked and respondent refused to answer question. |
-8 DK |
Question was asked and respondent did not know answer. |
-9 NOT ASCERTAINED |
Interviewer did not record the data. |
Generally, values of -1, -7, -8, and -9 for
non-expenditure variables have not been edited on this file. The values of -1
and -9 can be edited by the data users/analysts by following the skip patterns
in the HC survey questionnaire (located on the MEPS Web site:
www.meps.ahrq.gov/survey_comp/survey_questionnaires.jsp).
Return To Table Of Contents
2.3 Codebook Format
The codebook describes an ASCII data set (although the
data are also being provided in a SAS transport file). The following codebook
items are provided for each variable:
Identifier |
Description |
Name |
Variable name (maximum of 8 characters) |
Description |
Variable descriptor (maximum of 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 |
Return To Table Of Contents
2.4 Variable Source and Naming Conventions
In general, variable names reflect the content of the
variable, with an eight-character limitation. Generally, imputed/edited
variables end with an "X".
Return To Table Of Contents
2.4.1 Variable-Source Crosswalk
Variables were derived either from the HC questionnaire
itself, the MPC data collection instrument, or from the CAPI. The source of each
variable is identified in Section D "Variable - Source Crosswalk" in one of four
ways:
- Variables derived from CAPI or assigned in sampling
are so indicated as "CAPI derived" or "Assigned in sampling,"
respectively;
- Variables which come from one or more specific questions have those
questionnaire sections and question numbers indicated in the "Source"
column; questionnaire sections are identified as:
- EV – Event Roster section
- HH – Home Health Event section
- CP – Charge Payment section
- Variables constructed from multiple questions using
complex algorithms are labeled "Constructed" in the "Source" column; and
- Variables that have been edited or imputed are so indicated.
Return To Table Of Contents
2.4.2 Expenditure and Source of Payment Variables
The names of the expenditure and source of payment
variables follow a standard convention, are seven characters in length, and end
in an "X" indicating edited/imputed. Please note that imputed means that a
series of logical edits, as well as an imputation process to account for missing
data, have been performed on the variable.
The total sum of payments and the 12 source of payment
variables are named in the following way:
The first two characters indicate the type of event:
IP - inpatient stay |
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 source of payment variables, the third and
fourth characters indicate:
SF - self or family |
OF - other Federal Government |
MR - Medicare |
SL - State/local government |
MD - Medicaid |
WC - Workers’ Compensation |
PV - private insurance |
OT - other insurance |
VA - Veterans Administration |
OR - other private |
TR - TRICARE/CHAMPVA |
OU - other public |
|
XP - sum of payments |
In addition, the total charge variable is indicated by TC
in the variable name.
The fifth and sixth characters indicate the year (06). The
seventh character, "X", indicates the variable is edited/imputed.
For example, HHSF06X is the edited/imputed amount paid by
self or family for 2006 home health expenditures.
Return To Table Of Contents
2.5 File Contents
2.5.1 Survey Administration
Variables
2.5.1.1 Person Identifiers (DUID,
PID, DUPERSID)
The dwelling unit ID (DUID) is a five-digit random number
assigned after the case was sampled for MEPS. The three-digit person number (PID)
uniquely identifies each person within the dwelling unit. The eight-character
variable DUPERSID uniquely identifies each person represented on the file and is
the combination of the variables DUID and PID. For detailed information on
dwelling units and families, please refer to the documentation for the 2006 Full
Year Population Characteristics file.
Return To Table Of Contents
2.5.1.2 Record Identifier (EVNTIDX)
EVNTIDX uniquely identifies each event (i.e., each record
on the home health file) and is the variable required to link home health events
to data files containing details on conditions (MEPS 2006 Medical Conditions
File). For details on linking see Section 5.0 or the MEPS 2006 Appendix File,
HC-102I.
Return To Table Of Contents
2.5.1.3 Round Indicator (EVENTRN)
EVENTRN indicates the round in which the home health event
was reported. Please note: Rounds 3, 4, and 5 are associated with MEPS survey
data collected from Panel 10. Likewise, Rounds 1, 2, and 3 are associated with
data collected from Panel 11.
Return To Table Of Contents
2.5.1.4 Panel Indicator (PANEL)
PANEL is a constructed variable used
to specify the panel number for the person. PANEL will indicate either Panel 10
or Panel 11 for each person on the file. Panel 10 is the panel that started in
2005, and Panel 11 is the panel that started in 2006.
Return To Table Of Contents
2.5.2 Home Health Event Variables
This file contains variables describing home health events
reported by household respondents in the Home Health Section of the MEPS HC
survey questionnaire.
Return To Table Of Contents
2.5.2.1 Date of Event (HHDATEYR, HHDATEMM)
The date variables (HHDATEYR and HHDATEMM) indicate the
year and month that the household respondent reported as the year and month of
occurrence for this type of home health event. An artifact of the data
collection for the variable HHDATEYR is that a person may have started receiving
that type of home health care from that provider prior to 2006. These variables
should not be interpreted as "true" start dates.
Return To Table Of Contents
2.5.2.2 Characteristics of Event (MPCELIG-OTHCWOS)
The HC questionnaire asked the respondent to
indicate whether the home health provider event(s) for each month’s services
were provided through an agency or an independent paid provider (SELFAGEN). The
response to the SELFAGEN question dictated the skip pattern CAPI followed
regarding the questions in the home health section of the HC questionnaire. The
questionnaire also asked respondents if the provider was paid or whether a
friend, relative, or volunteer (HHTYPE) provided the home health services. The
constructed variable MPCELIG indicates whether the home health provider event
was eligible for MPC data collection and the type of imputation process the
event went through. MPCELIG is a more accurate variable for determining whether
the event was an agency, a paid independent or an informal care event. However,
SELFAGEN is a more accurate variable for determining the home health questions
asked of the respondent. All respondents receiving care from an agency, hospital
or nursing home were asked to identify the type of home health worker (CNA-SPEECTHP)
they saw – for example, certified nursing assistant, home health aide,
registered nurse, etc.
Analysts should keep in mind that these identifications by
household respondents are subjective in nature, are not mutually exclusive or
collectively exhaustive, and should not be used to make certain estimates. For
example, a person on one type of insurance may identify an individual providing
home health care services to them as a personal care attendant while an
individual having a different type of insurance coverage may identify that same
worker as a home care aide. Making estimates of personal care attendants or home
care aides based on their identification by household respondents and treating
these types of workers as mutually exclusive groups will result in inaccurate
estimates. Respondents may also have indicated that they were seen by more than
one home health care worker during a single event. For example, since an event
is a month of services, a respondent may have reported being seen by a nurse, a
physical therapist, and/or a home health aide during a single event. Respondents
were also asked to identify other non-skilled, skilled, and other workers seen
during that month of care (NONSKILL-OTHCWOS). However, "other specify" variables
(SKILLWOS and OTHCWOS) were not reconciled with the type of health care worker
variable (CNA-SPEECTHP). In addition, the type of health care worker variables
(CNA-SPEECTHP) were not reconciled with MPCELIG, SELFAGEN and HHTYPE, so
inconsistencies between these variables are possible.
Return To Table Of Contents
2.5.2.3 Treatments, Therapies, and Services (HOSPITAL-OTHSVCOS)
Regardless of the type of provider, all respondents were
asked if the home health services received were due to a hospitalization
(HOSPITAL), whether services were due to a medical condition (VSTRELCN), if the
person was helped with daily activities (DAILYACT), if the person received
companionship services (COMPANY), and whether or not the person received any
other type of services (OTHSVCE and OTHSVCOS). Only persons receiving care from
a formal provider were asked if they were taught how to use medical equipment (MEDEQUIP)
and whether or not they received a medical treatment (TREATMT).
Return To Table Of Contents
2.5.2.4 Frequency of Event (FREQCY-HHDAYS)
Several variables identify the frequency and length of
home health events (FREQCY-MINLONG) and whether or not the same services were
received during each month (SAMESVCE). Frequency of event variables (FREQCY-
TMSPDAY) were used as building blocks to construct HHDAYS. HHDAYS indicates the
number of days the person received care during that event (i.e., month of care).
Frequency variables can be combined to get a measure of the intensity of care.
For example, HHDAYS can be used in conjunction with HRSLONG and TMSPDAY to form
a measure of intensity of care, that is, how many hours of care were provided in
one month.
Return To Table Of Contents
2.5.3 Flat Fee Variables
A flat fee is the fixed dollar amount a person is charged
for a package of health care services provided during a defined period of time.
Because MEPS does not collect flat fee information about home health events, no
flat fee variables are included in this file.
Return To Table Of Contents
2.5.4 Condition, Procedure, and Clinical Classification Codes
Information on household reported medical conditions and
procedures (including condition codes, procedure codes, and clinical
classification codes) associated with each home health event are NOT provided on
this file. To obtain complete condition information associated with an event,
the analyst must link to the 2006 Medical Conditions File. Details on how to
link to the MEPS 2006 Medical Conditions File are provided in the MEPS 2006
Appendix File, HC-102I.
Return To Table Of Contents
2.5.5 Expenditure Data
2.5.5.1 Definition of Expenditures
Expenditures on this file refer to what is paid for health
care services. More specifically, expenditures in MEPS are defined as the sum of
payments for care received, including out-of-pocket payments and payments made
by private insurance, Medicaid, Medicare and other sources. The definition of
expenditures used in MEPS differs slightly from its predecessors, the 1987 NMES
and 1977 NMCES surveys, where "charges" rather than sum of payments were used to
measure expenditures. This change was adopted because charges became a less
appropriate proxy for medical expenditures during the 1990s due to the
increasingly common practice of discounting. Although measuring expenditures as
the sum of payments incorporates discounts in the MEPS expenditure estimates,
these estimates do not incorporate any payment not directly tied to specific
medical care events, such as bonuses or retrospective payment adjustments paid
by third party payers. Another general change from the two prior surveys is that
charges associated with uncollected liability, bad debt, and charitable care
(unless provided by a public clinic or hospital) are not counted as expenditures
because there are no payments associated with those classifications. While
charge data are provided on this file, data users/analysts should use caution
when working with this data because a charge does not typically represent actual
dollars exchanged for services or the resource costs of those services, nor are
they directly comparable to the expenditures defined in the 1987 NMES (for
details on expenditure definitions, see Monheit et al, 1999). For details on
expenditure definitions, please refer to the following, "Informing American
Health Care Policy" (Monheit et al., 2000). AHRQ has developed factors to apply
to the 1987 NMES expenditure data to facilitate longitudinal analysis. These
factors can be accessed via the CFACT Data Center. For more information, see the
Data Center section of the MEPS Web site at
www.meps.ahrq.gov/data_stats/onsite_datacenter.jsp. If examining
trends in MEPS expenditures or performing longitudinal analysis on MEPS
expenditures, please refer to section C, sub-section 3.3 for more information.
Return To Table Of Contents
2.5.5.2 Data Editing and Imputation Methodologies of Expenditure Variables
The general methodology used for editing and imputing
expenditure data is described below. However, please note, the MPC included home
health events provided by an agency and did not include home health care
provided by paid independent providers. Although the general procedures remain
the same for all home health events, there were some differences in the editing
and imputation methodologies applied to those events followed in the MPC and
those events not followed in the MPC. Analysts should note that home health care
provided by friends, family, or volunteers was assumed to be free and was not
included in any imputation process. Please see below for details on the
differences between these editing/imputation methodologies.
Home health expenditure data for agency, hospital, and
nursing home providers were collected exclusively from the MPC (i.e., household
respondents were not asked to report home health expenditures from these types
of providers). The MPC contacted 100 percent of the agency, hospital, and
nursing home health providers identified by household respondents. Since paid
independent home health providers were not included in the MPC, all expenditure
data from these providers were collected from household respondents.
Return To Table Of Contents
2.5.5.2.1 General Data Editing Methodology
Logical edits were used to resolve internal
inconsistencies and other problems in the HC and MPC survey-reported data. The
edits were designed to preserve partial payment data from households and
providers, and to identify actual and potential sources of payment for each
household-reported event. In general, these edits accounted for outliers,
co-payments or charges reported as total payments, and reimbursed amounts that
were reported as out-of-pocket payments. In addition, edits were implemented to
correct for mis-classifications between Medicare and Medicaid and between
Medicare HMOs and private HMOs as payment sources. These edits produced a
complete vector of expenditures for some events, and provided the starting point
for imputing missing expenditures in the remaining events.
Return To Table Of Contents
2.5.5.2.2 General Hot-Deck Imputation
A weighted sequential hot-deck procedure was used to
impute for missing expenditures, as well as total charge. This procedure uses
survey data from respondents to replace missing data, while taking into account
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. Within this file, simple events were
imputed separately. 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.
Return To Table Of Contents
2.5.5.2.3 Home Health Data Editing and Imputation
Expenditures for home health events were developed in a
sequence of logical edits and imputations. (Analysts should note that home
health care provided by friends, family, or volunteers was assumed not to have
associated expenditures and was not included in any imputation process. All
expenditures for home health care provided by informal care providers were
assigned "–1" (INAPPLICABLE) because those types of events were skipped out
(never asked) of the questions regarding expenditures.) "Household" edits were
applied to sources and amounts of payment for all household-reported events for
paid independent providers and unmatched agency providers. "MPC" edits were
applied to provider-reported sources and amounts of payment for records matched
to household-reported events for all agency home health providers. Both sets of
edits were used to correct obvious errors in the reporting of expenditures.
Imputations for independent paid providers and for agencies were conducted
separately. Within this file, separate imputations were performed for simple
events.
Logical edits were used to sort each event into a specific
category for the imputations. Events with complete expenditures were flagged as
potential donors for the hot-deck imputations while events with missing
expenditure data were assigned to various recipient categories. Each event with
missing expenditure data was assigned to a recipient category based on the
extent of its missing charge and expenditure data. For example, an event with a
known total charge but no expenditure information was assigned to one category,
while an event with a known total charge and partial expenditure information was
assigned to a different category. Similarly, events without a known total charge
and no or partial expenditure information were assigned to various recipient
categories.
The logical edits produced eight recipient categories for
HHP and eight recipient categories for HHA for events with missing data.
Expenditures were imputed through separate hot-deck imputations for each of the
eight recipient categories. The donor pool in these imputations includes events
with complete expenditures from the HC for HHP or the MPC for HHA.
The donor pool included "free events" because, in some
instances, providers are not paid for their services. These events represent
charity care, bad debt, provider failure to bill, and third party payer
restrictions on reimbursement in certain circumstances. (This does not include
MPCELIG=3 (informal) events. As stated previously, home health care provided by
friends, family, or volunteers (informal, MPCELIG=3) was assumed not to have
expenditures associated with it and was not included in any imputation process.)
Return To Table Of Contents
2.5.5.3 Imputation Flag Variable (IMPFLAG)
IMPFLAG is a six-category variable that indicates if the
event contains complete Household Component (HC) or Medical Provider Component (MPC)
data, was fully or partially imputed, or was imputed in the capitated imputation
process. The following list identifies how the imputation flag is coded; the
categories are mutually exclusive.
IMPFLAG=0 not eligible for imputation (includes zeroed out events)
IMPFLAG=1 complete HC data
IMPFLAG=2 complete MPC data
IMPFLAG=3 fully imputed
IMPFLAG=4 partially imputed
IMPFLAG=5 complete MPC data through capitation imputation (not applicable to HH)
Return To Table Of Contents
2.5.5.4 Flat Fee Expenditures
A flat fee is the fixed dollar amount a person is charged
for a package of health care services provided during a defined period of time.
Because MEPS does not collect flat fee information about home health events,
there are no flat fee expenditure data included in this file.
Return To Table Of Contents
2.5.5.5 Zero Expenditures
There are some medical events reported by respondents
where the payments were zero. This could occur for several reasons including (1)
free care was provided, (2) bad debt was incurred, (3) follow-up events were
provided without a separate charge (e.g., after a surgical procedure), or (4)
the event was paid for through government or privately-funded research or
clinical trials. If all of the medical events for a person fell into one of
these categories, then the total annual expenditures for that person would be
zero. All expenditures for home health care provided by informal care providers
(family, friends, or volunteers, MPCELIG=3) were assigned –1 "INAPPLICABLE"
because those types of events were skipped out (never asked) of the questions
regarding expenditures.
Return To Table Of Contents
2.5.5.6 Sources of Payment
In addition to total expenditures, variables are provided
which itemize expenditures according to major source of payment categories.
These categories are:
- Out-of-pocket by user or family,
- Medicare,
- Medicaid,
- Private Insurance,
- Veterans Administration, excluding TRICARE/CHAMPVA,
- TRICARE/CHAMPVA,
- Other Federal sources - includes Indian Health
Service, Military Treatment Facilities, and other care by the Federal
government,
- Other State and Local sources - includes community
and neighborhood clinics, State and local health departments, and State
programs other than Medicaid,
- Workers’ Compensation, and
- Other Unclassified sources - includes sources such
as automobile, homeowner’s, and liability insurance, and other
miscellaneous or unknown sources.
Two additional source of payment variables were created to
classify payments for events with apparent inconsistencies between insurance
coverage and sources of payment based on data collected in the survey. These
variables include:
- Other Private - any type of private insurance
payments reported for persons not reported to have any private health
insurance coverage during the year as defined in MEPS, and
- Other Public - Medicare/Medicaid payments reported
for persons who were not reported to be enrolled in the Medicare/Medicaid
program at any time during the year.
Though relatively small in magnitude, data users/analysts
should exercise caution when interpreting the expenditures associated with these
two additional sources of payment. While these payments stem from apparent
inconsistent responses to health insurance and source of payment questions in
the survey, some of these inconsistencies may have logical explanations. For
example, private insurance coverage in MEPS is defined as having a major medical
plan covering hospital and physician services. If a MEPS sampled person did not
have such coverage but had a single service type insurance plan (e.g., dental
insurance) that paid for a particular episode of care, those payments may be
classified as "other private." Some of the "other public" payments may stem from
confusion between Medicaid and other state and local programs or may be from
persons who were not enrolled in Medicaid, but were presumed eligible by a
provider who ultimately received payments from the public payer.
Return To Table Of Contents
2.5.5.7 Home Health Expenditure Variables (HHSF06X - HHXP06X)
Home health agency, hospital, and nursing home events are
sampled at a rate of 100% for the MPC. Households were not asked any
expenditure-related questions in regards to these types of events; therefore,
there are no household reported expenditure data for these events. Conversely,
paid independent providers are not included in the MPC. Household reported
responses are the only data available for these types of events. All expenditure
data for paid independent providers are fully imputed from household reported
expenditures. There are no expenditure data for informal care providers.
Informal care (MPCELIG=3, unpaid care provided by family, friends, or
volunteers) was assigned -1, "INAPPLICABLE", in all expenditure categories.
The constructed variable MPCELIG is provided on this file.
MPCELIG indicates whether the home health provider event was eligible for MPC
data collection, and MPCELIG determines the imputation process applied to that
event.
All of these expenditures have gone through an editing and
imputation process and have been rounded to the nearest penny. HHSF06X - HHOT06X
are the 12 sources of payment. HHTC06X is the total charge, and HHXP06X is the
sum of the 12 sources of payment for the home health expenditures. The 12
sources of payment are: self/family (HHSF06X), Medicare (HHMR06X), Medicaid
(HHMD06X), private insurance (HHPV06X), Veterans Administration (HHVA06X),
TRICARE/CHAMPVA (HHTR06X), other Federal sources (HHOF06X), State and Local
(non-federal) government sources (HHSL06X), Workers’ Compensation (HHWC06X),
other private insurance (HHOR06X), other public insurance (HHOU06X), and other
insurance (HHOT06X). Analysts can determine if a home health event was provided
by an agency or by some other paid independent provider by subsetting the
variable MPCELIG to the appropriate and desired value.
Return To Table Of Contents
2.5.5.8 Rounding
Expenditure variables on the 2006 home health event file
have been rounded to the nearest penny. Person-level expenditure information
released on the 2006 Person-Level Expenditure File was rounded to the nearest
dollar. It should be noted that using the 2006 MEPS event files to create
person-level totals will yield slightly different totals than those on the
person-level expenditure file. These differences are due to rounding only.
Moreover, in some instances, the number of persons having expenditures on the
event files for a particular source of payment may differ from the number of
persons with expenditures on the person-level expenditure file for that source
of payment. This difference is also an artifact of rounding only. Please see the
MEPS 2006 Appendix File, HC-102I, for details on such rounding differences.
Return To Table Of Contents
3.0 Sample Weight (PERWT06F)
3.1 Overview
There is a single full year person-level weight (PERWT06F)
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 2006. A key person
either was a member of an NHIS household at the time of the NHIS interview, or
became a member of a family associated with such a household after being
out-of-scope at the time of the NHIS (the latter circumstance includes newborns
as well as 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.
Return To Table Of Contents
3.2 Details on Person Weight Construction
The person-level weight PERWT06F was developed in several
stages. Person-level weights for Panels 10 and 11 were created separately. The
weighting process for each panel included an adjustment for nonresponse over
time and calibration to independent population figures. The calibration was
initially accomplished separately for each panel by raking the corresponding
sample weights to Current Population Survey (CPS) population estimates based on
five variables. The five variables used in the establishment of the initial
person-level control figures were: census region (Northeast, Midwest, South,
West); MSA status (MSA, non-MSA); race/ethnicity (Hispanic, non-Hispanic with
black as sole reported race, non-Hispanic with Asian as sole reported race, and
other); sex; and age. A 2006 composite weight was then formed by multiplying
each weight from Panel 10 by the factor .47 and each weight from Panel 11 by the
factor .53. The choice of factors reflected the relative sample sizes of the two
panels, helping to limit the variance of estimates obtained from pooling the two
samples. The composite weight was again raked to the same set of CPS-based
control totals. When poverty status information derived from income variables
became available, a final raking was undertaken on the previously established
weight variable. Control totals were established using poverty status (five
categories: below poverty, from 100 to 125 percent of poverty, from 125 to 200
percent of poverty, from 200 to 400 percent of poverty, at least 400 percent of
poverty) as well as the original five variables used in the previous
calibrations.
Return To Table Of Contents
3.2.1 MEPS Panel 10 Weight
The person-level weight for MEPS Panel 10 was developed
using the 2005 full year weight for an individual as a "base" weight for survey
participants present in 2005. For key, in-scope respondents who joined an RU
some time in 2006 after being out-of-scope in 2005, the 2005 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 raking to population control figures for December 2006. These control
figures were derived by scaling back the population totals obtained from the
March 2007 CPS to correspond to a national estimate for the civilian
noninstitutionalized population provided by the Census Bureau for December 2006.
Variables used in the establishment of person-level control figures included:
census region (Northeast, Midwest, South, West); MSA status (MSA, non-MSA);
race/ethnicity (Hispanic, black but non-Hispanic, Asian but non-Hispanic, and
other); sex; and age. Overall, the weighted population estimate for the civilian
noninstitutionalized population on December 31, 2006 is 295,668,762. Key,
responding persons not in-scope on December 31, 2006 but in-scope earlier in the
year retained, as their final Panel 10 weight, the weight after the nonresponse
adjustment.
Return To Table Of Contents
3.2.2 MEPS Panel 11 Weight
The person-level weight for MEPS Panel 11 was developed
using the MEPS Round 1 person-level weight as a "base" weight. For key, in-scope
respondents who joined an RU after Round 1, the Round 1 family weight served as
a "base" weight. The weighting process included an adjustment for nonresponse
over Round 2 and the 2006 portion of Round 3 as well as raking to the same
population control figures for December 2006 used for the MEPS Panel 10 weights.
The same five variables employed for Panel 10 raking (census region, MSA status,
race/ethnicity, sex, and age) were used for Panel 11 raking. Similarly, for
Panel 11, key, responding persons not in-scope on December 31, 2006 but in-scope
earlier in the year retained, as their final Panel 11 weight, the weight after
the nonresponse adjustment.
Note that the MEPS Round 1 weights incorporated the
following components: the original household probability of selection for the
NHIS; ratio-adjustment to NHIS-based national population estimates at the
household (occupied dwelling unit) level; adjustment for nonresponse at the
dwelling unit level for Round 1; and poststratification to figures at the family
and person level obtained from the March CPS data base of the corresponding year
(i.e., 2005 for Panel 10 and 2006 for Panel 11).
Return To Table Of Contents
3.2.3 The Final Weight for 2006
Variables used in the establishment of person-level
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, non-Hispanic
with black as sole reported race, non-Hispanic with Asian as sole reported race,
and other); sex; and age. Overall, the weighted population estimate for the
civilian noninstitutionalized population for December 31, 2006 is 295,668,762
(PERWT06F>0 and INSC1231=1). In addition, the weights of two groups of persons
who were out-of-scope on December 31, 2006 were poststratified.
Specifically, the weights of those who were in-scope some time during the year,
out-of-scope on December 31, and entered a nursing home during the year were
poststratified to a corresponding control total obtained from the 1996 MEPS
Nursing Home Component. Those who died while in-scope during 2006 were
poststratified to corresponding estimates derived using data obtained from the
Medicare Current Beneficiary Survey (MCBS) and Vital Statistics information
provided by the National Center for Health Statistics (NCHS). Separate
control totals were developed for the "65 and older" and "under 65" civilian
noninstitutionalized populations. The sum of the person-level weights across all
persons assigned a positive person level weight is 299,267,035.
Return To Table Of Contents
3.2.4 Coverage
The target population for MEPS in this file is the 2006
U.S. civilian noninstitutionalized population. However, the MEPS sampled
households are a subsample of the NHIS households interviewed in 2004 (Panel 10)
and 2005 (Panel 11). New households created after the NHIS interviews for the
respective Panels and consisting exclusively of persons who entered the target
population after 2004 (Panel 10) or after 2005 (Panel 11) are not covered by
MEPS. Neither are previously out-of-scope persons who join an existing household
but are unrelated to the current household residents. Persons not covered by a
given MEPS panel thus include some members of the following groups: immigrants;
persons leaving the military; U.S. citizens returning from residence in another
country; and persons leaving institutions. The set of uncovered persons
constitutes only a small segment of the MEPS target population.
Return To Table Of Contents
3.3 Using MEPS Data for Trend Analysis
MEPS began in 1996, and the utility of the survey for
analyzing health care trends expands with each additional year of data. However,
it is important to consider a variety of factors when examining trends over time
using MEPS. Statistical significance tests should be conducted to assess the
likelihood that observed trends may be attributable to sampling variation. The
length of time being analyzed should also be considered. In particular, large
shifts in survey estimates over short periods of time (e.g. from one year to the
next) that are statistically significant should be interpreted with caution,
unless they are attributable to known factors such as changes in public policy,
economic conditions, or MEPS survey methodology. Looking at changes over longer
periods of time can provide a more complete picture of underlying trends.
Analysts may wish to consider using techniques to smooth or stabilize analyses
of trends using MEPS data such as comparing pooled time periods (e.g. 1996-97
versus 2004-05), working with moving averages, or using modeling techniques with
several consecutive years of MEPS data to test the fit of specified patterns
over time. Finally, researchers should be aware of the impact of multiple
comparisons on Type I error. Without making appropriate allowance for multiple
comparisons, undertaking numerous statistical significance tests of trends
increases the likelihood of inappropriately concluding that a change has taken
place.
Return To Table Of Contents
4.0 Strategies for Estimation
4.1 Developing Event-Level Estimates
The data in this file can be used to develop national 2006
event level (i.e., monthly) estimates for the U.S. civilian noninstitutionalized
population on expenditures and sources of payment for home health care medical
provider visits. The weight assigned to each home health care medical provider
event reported is the person-level weight of the person who was visited. If a
person had several events reported, each event is assigned that individual’s
person-level weight. Estimates must be weighted by PERWT06F to be nationally
representative. For example, the appropriate estimate for the overall mean
out-of-pocket payment per month of care is computed as follows (the subscript
‘j’ identifies each event and represents a numbering of events from 1 through
the total number of events in the file):
, where
= PERWT06Fj (full year person
weight for the person
associated with event j) and
= HHSF06Xj (amount paid by self/family for event j)
Estimates and corresponding standard errors (SE) can be
derived using an appropriate computer software package for complex survey
analysis such as SAS, Stata, SUDAAN or SPSS (www.meps.ahrq.gov/survey_comp/standard_errors.jsp).
The tables below contain the correct event-level estimates
for several key variables on this file. Informal care (MPCELIG = 3) is not
included in the tables because, by definition, there are no payments for those
events and, therefore, no expenditure data are collected.
Selected Event-Level Estimates
Expenditures: Home Health Agency & Paid Independents (MPCELIG
= 1, 2):
Estimate of Interest |
Variable |
Estimate (SE) |
Estimate (SE) Excluding 0s |
Proportion of events with expenditures>0* |
hhxp06X |
0.976 (0.0058) |
----- |
Mean total payments per month of care |
hhxp06X |
$1,001 (61.1000) |
$1,026 (61.4000) |
Mean proportion of total monthly expenditures paid out of pocket |
hhsf06X/
hhxp06X |
----- |
0.189 (0.0216) |
Mean total payments per month where any services provided due to hospitalization (HOSPITAL=1) |
hhxp06X |
$1,114 (60.5000) |
$1,149 (59.4000) |
Expenditures: Home Health Agency Providers only (MPCELIG=1)
Estimate of Interest |
Variable |
Estimate (SE) |
Estimate (SE) Excluding 0s |
Proportion of events with expenditures>0* |
hhxp06X |
0.979 (0.0066) |
----- |
Mean total payments per month |
hhxp06X |
$1,088 (67.7000) |
$1,111 (68.3000) |
Mean proportion of total monthly expenditures paid out of pocket |
hhsf06X/
/hhxp06X |
----- |
0.085 (0.0139) |
Mean total payments per month where any services provided due to hospitalization (HOSPITAL=1) |
hhxp06X |
$1,165 (64.2000) |
$1,190 (63.0000) |
Expenditures: Paid Independent Providers only (MPCELIG=2)
Estimate of Interest |
Variable |
Estimate (SE) |
Estimate (SE) Excluding 0s |
Proportion of events with expenditures>0* |
hhxp06X |
0.958 (0.0175) |
----- |
Mean total payments per month |
hhxp06X |
$543 (70.6000) |
$566 (74.3000) |
Mean out-of-pocket payments per month of care |
hhsf06X |
$384 (66.8000) |
$400(69.8000) |
Mean proportion of total monthly expenditures paid out of pocket |
hhsf06X/
/hhxp06X |
---- |
0.753 (0.0516) |
Mean total payments per month where any services provided due to hospitalization (HOSPITAL=1) |
hhxp06X |
$654 (129.8000) |
$734 (139.5000) |
*Zero payment events can occur in MEPS for the following
reasons: (1) there was no charge for a follow-up event, (2) the provider was
never paid by an individual, insurance plan, or other source for services
provided, (3) charges were included in another bill, or (4) the event was paid
for through government or privately-funded research or clinical trials.
Return To Table Of Contents
4.2 Person-Based Estimates for Home Health Care
To enhance analyses of home health care, analysts may link
information about the home health care received by sample persons in this file
to the annual full year consolidated file (which has data for all MEPS sample
persons), or conversely, link person-level information from the full year
consolidated file to this event level file. Both this file and the full year
consolidated file may be used to derive estimates relative to persons with home
health care and annual estimates of total expenditures. However, if the estimate
relates to the entire population, this file cannot be used to calculate the
denominator, as only those persons with at least one month in which home health
care was provided are represented on this data file. Therefore, the full year
consolidated file must be used for person-level analyses that include both those
with and without home health care.
Return To Table Of Contents
4.3 Variables with Missing Values
It is essential that the analyst examine all variables for
the presence of negative values used to represent missing values. For continuous
or discrete variables, where means or totals may be taken, it may be necessary
to set negative values to values appropriate to the analytic needs. That is, the
analyst should either impute a value or set the value to one that will be
interpreted as missing by the computing language used. For categorical and
dichotomous variables, the analyst may want to consider whether to recode or
impute a value for cases with negative values or whether to exclude or include
such cases in the numerator and/or denominator when calculating proportions.
Methodologies used for the editing/imputation of expenditure variables (e.g.,
sources of payment and zero expenditures) are described in Section 2.5.5.2.
Return To Table Of Contents
4.4 Variance Estimation (VARPSU, VARSTR)
MEPS has a complex sample design.
To obtain estimates of variability (such as the standard error of sample
estimates or corresponding confidence intervals) for MEPS estimates, analysts
need to take into account the complex sample design of MEPS for both
person-level and family-level analyses. Several methodologies have been
developed for estimating standard errors for surveys with a complex sample
design, including the Taylor-series linearization method, balanced repeated
replication, and jackknife replication. Various software packages provide
analysts with the capability of implementing these methodologies. Replicate
weights have not been developed for the MEPS data. Instead, the variables needed
to calculate appropriate standard errors based on the Taylor-series
linearization method are included on this file as well as all other MEPS public
use files. Software packages that permit the use of the Taylor-series
linearization method include SUDAAN, Stata, SAS (version 8.2 and higher), and
SPSS (version 12.0 and higher). For complete information on the capabilities of
each package, analysts should refer to the corresponding software user
documentation.
Using the Taylor-series linearization method, variance
estimation strata and the variance estimation PSUs within these strata must be
specified. The variance strata variable is named VARSTR, while the variance PSU
variable is named VARPSU. Specifying a "with replacement" design in a computer
software package, such as SUDAAN, provides standard errors appropriate for
assessing the variability of MEPS survey estimates. It should be noted that the
number of degrees of freedom associated with estimates of variability indicated
by such a package may not appropriately reflect the actual number available. For
MEPS sample estimates for characteristics generally distributed throughout the
country (and thus the sample PSUs), one can expect at least 100 degrees of
freedom for the 2006 full year data associated with the corresponding estimates
of variance.
Prior to 2002, MEPS variance strata and PSUs were
developed independently from year to year, and the last two characters of the
strata and PSU variable names denoted the year. However, beginning with the 2002
Point-in-Time PUF, the variance strata and PSUs were developed to be compatible
with MEPS data associated with the NHIS sample design used through 2006. Such
data can be pooled and the variance strata and PSU variables provided can be
used without modification for variance estimation purposes for estimates
covering multiple years of data. There are 203 variance estimation strata, each
stratum with either two or three variance estimation PSUs.
Note: A new NHIS sample design is being implemented
beginning in 2006. As a result, the MEPS variance estimation structure will be
modified for MEPS data collected in 2007 and beyond.
Return To Table Of Contents
5.0 Merging/Linking MEPS Data Files
Data from this file can be used alone or in conjunction
with other files for different analytic purposes. This section provides
instructions, or the details on where to find the instructions, for linking the
2006 home health provider events with other 2006 MEPS public use files,
including the 2006 person-level and conditions files. Each MEPS panel can also
be linked back to the previous years’ National Health Interview Survey public
use data files. For information on obtaining MEPS/NHIS link files please see
www.meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.
Return To Table Of Contents
5.1 Linking to the Person-Level File
Merging characteristics of interest from other 2006 MEPS
files (e.g., the 2006 Full Year Population Characteristics File or the 2006
Prescribed Medicines File) expands the scope of potential estimates. For
example, to estimate the total number of home health provider events of persons
with specific characteristics (e.g., age, race, and sex), population
characteristics from a person-level file need to be merged onto the home health
provider file. This procedure is illustrated below. The MEPS 2006 Appendix File,
HC-102I, provides additional details on how to merge 2006 MEPS data files.
- Create data set PERSX by sorting the 2006 Full
Year Population Characteristics File by the person identifier, DUPERSID.
Keep only variables to be merged on to the home health provider event
file and DUPERSID.
- Create data set HVIS by sorting the home health
provider event file by person identifier, DUPERSID.
- Create final data set NEWHVIS by merging these two
files by DUPERSID, keeping only records on the home health provider
event file.
The following is an example of SAS code, which completes these steps:
PROC SORT DATA=HCXXX (KEEP=DUPERSID AGE31X AGE42X AGE53X SEX RACEX EDUCYR) OUT=PERSX;
BY DUPERSID;
RUN;
PROC SORT DATA=HVIS;
BY DUPERSID;
RUN;
DATA NEWHVIS;
MERGE HVIS (IN=A) PERSX (IN=B);
BY DUPERSID;
IF A;
RUN;
Return To Table Of Contents
5.2 Linking to the Prescribed Medicines File
The RXLK provides a link from 2006 MEPS event files to the
2006 Prescribed Medicines File. Because prescribed medicines data are not
collected for home health events, this Home Health File cannot be linked to the
2006 Prescribed Medicines File.
Return To Table Of Contents
5.3 Linking to the Medical Conditions File
The CLNK provides a link from 2006 MEPS event files to the
2006 Medical Conditions File. When using the CLNK, data users/analysts should
keep in mind that (1) conditions are self-reported and (2) there may be multiple
conditions associated with a home health provider event. Data users/analysts
should also note that not all home health provider events link to the condition
file. For detailed linking examples, including SAS code, data users/analysts
should refer to the MEPS 2006 Appendix File, HC-102I.
Return To Table Of Contents
5.4 Pooling Annual Files
To facilitate analysis of subpopulations and/or low
prevalence events, it may be desirable to pool together more than one year of
data to yield sample sizes large enough to generate reliable estimates. For more
details on pooling MEPS data files see
www.meps.ahrq.gov/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-036.
Starting in Panel 9, values for DUPERSID from previous
panels will occasionally be re-used. Therefore, it is necessary to use the panel
variable (PANEL) in combination with DUPERSID to ensure unique person-level
identifiers across panels. Creating unique records in this manner is advised
when pooling MEPS data across multiple annual files that have one or more
identical values for DUPERSID.
Return To Table Of Contents
5.5 Longitudinal Analysis
MEPS Panel Longitudinal Weight files containing estimation
variables to facilitate longitudinal analysis are available for downloading in
the data section of the MEPS Web site.
Return To Table Of Contents
References
Cohen, S.B. (1999). Sample Design of the 1996 Medical
Expenditure Panel Survey Medical Provider Component. Journal of
Economic and Social Measurement. Vol 24, 25-53.
Cohen, S.B. (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.
Cox, B.G. and Cohen, S.B. (1985). Chapter 8: Imputation
Procedures to Compensate for Missing Responses to Data Items. In
Methodological Issues for Health Care Surveys. Marcel Dekker, New York.
Monheit, A.C., Wilson, R., and Arnett, III, R.H. (Editors)
(1999). Informing American Health Care Policy. Jossey-Bass Inc, San Francisco.
Shah, B.V., Barnwell, B.G., Bieler, G.S., Boyle, K.E.,
Folsom, R.E., Lavange, L., Wheeless, S.C., and Williams, R. (1996). Technical
Manual: Statistical Methods and Algorithms Used in SUDAAN Release 7.0,
Research Triangle Park, NC: Research Triangle Institute.
Return To Table Of Contents
D. Variable-Source
Crosswalk
VARIABLE-SOURCE CROSSWALK
FOR MEPS HC-102H: 2006
HOME HEALTH VISITS
Survey Administration Variables
Variable |
Description |
Source |
DUID |
Dwelling unit ID |
Assigned in sampling |
PID |
Person number |
Assigned in sampling |
DUPERSID |
Person ID (DUID + PID) |
Assigned in sampling |
EVNTIDX |
Event ID |
Assigned in sampling |
EVENTRN |
Event round number |
CAPI derived |
PANEL |
Panel Number |
Constructed |
Return To Table Of Contents
Home Health Events Variables
Variable |
Description |
Source |
HHDATEYR |
Event date – year |
CAPI derived |
HHDATEMM |
Event date – month |
CAPI derived |
MPCELIG |
MPC eligibility flag |
Constructed |
SELFAGEN |
Does provider work for agency or self |
EV06A |
HHTYPE |
Home health event type |
EV06 |
CNA |
Type of hlth care wrkr – cert nurse asst |
HH01 |
COMPANN |
Type of hlth care wrkr – companion |
HH01 |
DIETICN |
Type of hlth care wrkr – dietitian/nutrt |
HH01 |
HHAIDE |
Type of hlth care wrkr – home care aide |
HH01 |
HOSPICE |
Type of hlth care wrkr – hospice worker |
HH01 |
HMEMAKER |
Type of hlth care wrkr - homemaker |
HH01 |
IVTHP |
Type of hlth care wrkr – IV therapist |
HH01 |
MEDLDOC |
Type of hlth care wrkr – medical doctor |
HH01 |
NURPRACT |
Type of hlth care wrkr – nurse/practr |
HH01 |
NURAIDE |
Type of hlth care wrkr – nurse’s aide |
HH01 |
OCCUPTHP |
Type of hlth care wrkr – occup therap |
HH01 |
PERSONAL |
Type of hlth care wrkr – pers care attdt |
HH01 |
PHYSLTHP |
Type of hlth care wrkr – physicl therapy |
HH01 |
RESPTHP |
Type of hlth care wrkr – respira therapy |
HH01 |
SOCIALW |
Type of hlth care wrkr – social worker |
HH01 |
SPEECTHP |
Type of hlth care wrkr – speech therapy |
HH01 |
OTHRHCW |
Type of hlth care wrkr – other |
HH01 |
NONSKILL |
Type of hlth care wrkr – non-skilled |
HH02 |
SKILLED |
Type of hlth care wrkr – skilled |
HH02 |
SKILLWOS |
Specify type of skilled worker |
HH02OV1 |
OTHCW |
Type of hlth care wrkr – some other |
HH02 |
OTHCWOS |
Specify other type health care worker |
HH02OV2 |
HOSPITAL |
Any hh care svce due to hospitalization |
HH04 |
VSTRELCN |
Any hh care svce Related to Hlth Cond |
HH04 |
TREATMT |
Person received medical treatment |
HH06 |
MEDEQUIP |
Person was taught use of med equipment |
HH07 |
DAILYACT |
Person was helped with daily activities |
HH08 |
COMPANY |
Person received companionship services |
HH09 |
OTHSVCE |
Person received oth home care services |
HH10 |
OTHSVCOS |
Specify other home care srvce received |
HH10OV |
FREQCY |
Provider helped every week/some weeks |
HH11 |
DAYSPWK |
# days / week provider came |
HH12 |
DAYSPMO |
# days / month provider came |
HH13 |
HOWOFTEN |
Prov came once per day/more than once |
HH14 |
TMSPDAY |
Times/day provider came to home to help |
HH15 |
HRSLONG |
Hours each visit lasted |
HH16_01 |
MINLONG |
Minutes each visit lasted |
HH16_02 |
SAMESVCE |
Any oth mons per received same services |
HH17 |
HHDAYS |
Days per month in home health, 2006 |
Constructed |
Return To Table Of Contents
Imputed Expenditure Variables
Variable |
Description |
Source |
HHSF06X |
Amount paid, family (Imputed) |
CP Section (Edited) |
HHMR06X |
Amount paid, Medicare (Imputed) |
CP Section (Edited) |
HHMD06X |
Amount paid, Medicaid (Imputed) |
CP Section (Edited) |
HHPV06X |
Amount paid, private insurance (Imputed) |
CP Section (Edited) |
HHVA06X |
Amount paid, Veterans (Imputed) |
CP Section (Edited) |
HHTR06X |
Amount paid, TRICARE/CHAMPVA (Imputed) |
CP Section (Edited) |
HHOF06X |
Amount paid, other federal (Imputed) |
CP Section (Edited) |
HHSL06X |
Amount paid, state & local gov (Imputed) |
CP Section (Edited) |
HHWC06X |
Amount paid, workers comp (Imputed) |
CP Section (Edited) |
HHOR06X |
Amount paid, other private (Imputed) |
Constructed |
HHOU06X |
Amount paid, other public (Imputed) |
Constructed |
HHOT06X |
Amount paid, other insurance (Imputed) |
CP Section (Edited) |
HHXP06X |
Sum of HHSF06X – HHOT06X (Imputed) |
Constructed |
HHTC06X |
Hhld reported total charge (Imputed) |
CP Section (Edited) |
IMPFLAG |
Imputation status |
Constructed |
Return To Table Of Contents
Weights
Variable |
Description |
Source |
PERWT06F |
Expenditure file person weight, 2006 |
Constructed |
VARSTR |
Variance estimation stratum, 2006 |
Constructed |
VARPSU |
Variance estimation PSU, 2006 |
Constructed |
Return To Table Of Contents |