MEPS-HC-229I: Appendix to MEPS 2021 Event Files HC-229A - HC-229H
August 2023
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
5600 Fishers Lane
Rockville, MD 20857
(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 Format
2.2 Variable Naming and Source
2.3 Contents of Condition-Event Link File (CLNK)
2.4 ICD-10-CM, CCSR1X, CCSR2X, and CCSR3X
3.0 Merging/Linking MEPS Data Files
3.1 Limitations/Caveats of the CLNK File
3.2 National Health Interview Survey
3.3 Using MEPS Data for Trend Analysis
3.4 Longitudinal Analysis
References
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. Furthermore, linkage of the Medical Expenditure Panel
Survey and the National Health Interview Survey may not occur
outside the AHRQ Data Center, NCHS Research Data Center (RDC) or
the U.S. Census RDC network.
By using these data you signify your agreement to
comply with the above stated statutorily based requirements with the knowledge
that deliberately making a false statement in any matter within the jurisdiction
of any department or agency of the Federal Government violates Title 18 part 1
Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5
years in prison.
The Agency for Healthcare Research and Quality
requests that users cite AHRQ and the Medical Expenditure Panel Survey as the
data source in any publications or research based upon these data.
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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
noninstitutionalized 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 includes five rounds of interviews
covering two full calendar years. Additional rounds were added in 2020 and 2021,
covering third and fourth years respectively, to compensate for the smaller
number of completed interviews in later panels. These extra rounds provide 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 noninstitutionalized population. In 2006, the NHIS
implemented a new sample design, which included Asian persons in addition to
households with Black and Hispanic persons in the oversampling of minority
populations. NHIS introduced a new sample design in 2016 that discontinued
oversampling of these minority groups.
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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 cannot accurately provide. This part of the MEPS is called the
Medical Provider Component (MPC) and information is collected on dates of
visits, 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 amounts of payment. The MPC is not
designed to yield national estimates. It is primarily used as an imputation
source to supplement/replace household reported expenditure information.
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MEPS HC and MPC data are collected under the authority
of the Public Health Service Act. Data are collected under contract with Westat,
Inc. (MEPS HC) and Research Triangle Institute (MEPS MPC). Data sets and summary
statistics are edited and published in accordance with the confidentiality
provisions of the Public Health Service Act and the Privacy Act. The National
Center for Health Statistics (NCHS) provides consultation and technical
assistance.
As soon as data collection and editing are completed,
the MEPS survey data are released to the public in staged releases, micro data
files, and tables via the
MEPS website and
datatools.ahrq.gov.
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,
5600 Fishers Lane, Rockville, MD 20857 (301-427-1406).
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This documentation describes the MEPS Public Use
Release HC-229I, which is the Appendix to MEPS releases HC-229A through HC-229H.
This release contains the condition-event link file (CLNK), provided in ASCII
(with related SAS, SPSS, R, and Stata programming statements and data
user information) and SAS data set, SAS transport file, Stata data set, and
Excel file versions.
This documentation offers a brief overview of the
content and structure of the files and the accompanying codebook. It contains
the following sections:
- Data File Information
- Merging/Linking MEPS Data Files
For more information on MEPS HC sample design see
Chowdhury et al. (2019). For information on the MEPS MPC design, see RTI
International (2019). A copy of the survey instruments used to collect the
information on this file, are available on the
MEPS website.
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This public use data set consists of a data file
containing variables for linkage of the MEPS 2021 event-level data files. The
H229IF1 or CLNK file, is used for linking the MEPS Conditions file with the MEPS
event files. The CLNK file contains 6 variables and has a logical record length
of 71 with an additional 2-byte carriage return/line feed at the end of each
record.
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The codebook describes an ASCII data set (although the
data are also being provided in a SAS data set, SAS transport file, Stata data
set, and Excel file), and provides the following programming identifiers for
each variable:
| Identifier |
Description |
| Name |
Variable name |
| Description |
Variable descriptor |
| 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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In general, variable names reflect the content of the
variable. All variables contained on the file were derived from the CAPI.
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The CLNK file contains the variables needed to link
each record on the MEPS 2021 Conditions file, HC-231, with one or more records
on the MEPS 2021 event files, HC-229D through HC-229H. Section 3.0 contains
additional information on completing this linkage.
The ten-character variable DUPERSID uniquely
identifies each person represented on the file. The variable DUPERSID is the
combination of the variables DUID and PID. All ID variables begin with the 2
digit panel number. There may be more than one record on the CLNK file for a
specific DUPERSID value.
CONDIDX is the 13-digit ID that uniquely identifies
each condition for a person and corresponds to a unique record on the MEPS 2021
Conditions file, HC-231. The variable CONDIDX is the combination of the
variables DUPERSID and CONDN (see HC-231 for a description of CONDN). The
2-digit panel number is added in the beginning of CONDIDX. There may be more
than one record on the CLNK file for a specific CONDIDX value.
EVNTIDX is the 16-digit number that uniquely
identifies each event for a person and corresponds to a unique record on one of
the MEPS 2021 event files, HC-229B through HC-229H. (EVNTIDX is not included on the 2021 Prescribed Medicines event file, HC-229A; rather, on this file the variable for linking with EVNTIDX on the CLNK file is LINKIDX.) There may be more than one
record on the CLNK file for a specific EVNTIDX value. The 2-digit panel number
is added in the beginning of EVNTIDX, and a 2-digit event type number is added
to the end. The event type number indicates the type of event record and has
been rolled up into the following values:
01 = MVIS - office-based medical provider visit event on MEPS release HC-229G or
OPAT - outpatient department visit event on MEPS release HC-229F or
EROM - emergency room visit event on MEPS release HC-229E or
STAZ - inpatient hospital stay event on MEPS release HC-229D or
HVIS - home health visit event on MEPS release HC-229H
03 = PMED - prescribed medicine event on MEPS release HC-229A
CLNKIDX is the 29-digit number that uniquely
identifies each record on the CLNK file and is the combination of CONDIDX +
EVNTIDX. There is just one record on this file for each value of CLNKIDX, i.e.,
each unique combination of CONDIDX + EVNTIDX.
The variable EVENTYPE indicates the type of event record, and has the following values:
1 = MVIS - office-based medical provider visit event contained on MEPS release HC-229G
2 = OPAT - outpatient department visit event contained on MEPS release HC-229F
3 = EROM - emergency room visit event contained on MEPS release HC-229E
4 = STAZ - inpatient hospital stay event contained on MEPS release HC-229D
7 = HVIS - home health visit event contained on MEPS release HC-229H
8 = PMED - prescribed medicines event contained on MEPS release HC-229A
PANEL is a constructed variable used to specify the
panel number for the interview in which the condition was reported. PANEL will
indicate either Panel 23, Panel 24, Panel 25, or Panel 26. Panel 23 is the panel
that started in 2018, Panel 24 is the panel that started in 2019, Panel 25 is
the panel that started in 2020, and Panel 26 is the panel that started in 2021.
The panel number is included as the first two digits of the DUID and DUPERSID.
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ICD-10-CM diagnosis codes and Clinical Classification
Software Refined (CCSR) codes are both used to group medical conditions into
clinically meaningful categories. For the purposes of MEPS, one ICD-10-CM
diagnosis code may map to up to three CCSR categories (CCSR1X, CCSR2X, CCSR3X)
using the v2022.2 release of the CCSR for ICD-10-CM diagnoses. For more
information on CCSR, visit the
user guide for CCSR.
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3.0 Merging/Linking MEPS Data Files
This file is intended to be used in conjunction with
other files. Specifically, the Conditions file (HC-231), the Prescribed Medicines event file (HC-229A), and event files HC-229B
through HC-229H.
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When using the CLNK file, analysts should keep in mind
that (1) conditions are self-reported and (2) there may be multiple conditions
associated with an event. Users should also note that not all events link to the
Conditions file.
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Data from this file can be used alone or in
conjunction with other files for different analytic purposes. 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 the
MEPS website.
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First, of course, we note that there are uncertainties
associated with 2020 and 2021 data quality as discussed in the Survey Sample
Information section of the Consolidated PUF document (HC-233). Preliminary
evaluations of a set of MEPS estimates of particular importance suggest that
they are of reasonable quality. Nevertheless, analysts are advised to exercise
caution in interpreting these estimates, particularly in terms of trend analyses
since access to health care was substantially affected by the COVID-19 pandemic
as were related factors such as health insurance and employment status for many
people.
MEPS began in 1996, and the utility of the survey for
analyzing health care trends expands with each additional year of data; however,
when examining trends over time using MEPS. The length of time being analyzed
should 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.
With respect to methodological considerations, in 2013
MEPS introduced an effort focused on field procedure changes such as interviewer
training to obtain more complete information about health care utilization from
MEPS respondents with full implementation in 2014. This effort likely resulted
in improved data quality and a reduction in underreporting starting in the
second half of 2013 and throughout 2014 full year files and has had some impact
on analyses involving trends in utilization across years. The changes in the
NHIS sample design in 2016 and 2018 could also potentially affect trend
analyses. The new NHIS sample design is based on more up-to-date information
related to the distribution of housing units across the U.S. As a result, it can
be expected to better cover the full U.S. civilian, noninstitutionalized
population, the target population for MEPS, as well as many of its
subpopulations. Better coverage of the target population helps to reduce the
potential for bias in both NHIS and MEPS estimates.
Another change with the potential to affect trend
analyses involved major modifications to the MEPS instrument design and data
collection process, particularly in the events sections of the instrument. These
were introduced in the Spring of 2018 and thus affected data beginning with
Round 1 of Panel 23, Round 3 of Panel 22, and Round 5 of Panel 21. Since the
Full Year 2017 PUFs were established from data collected in Rounds 1-3 of Panel
22 and Rounds 3-5 of Panel 21, they reflected two different instrument designs.
In order to mitigate the effect of such differences within the same full year
file, the Panel 22 Round 3 data and the Panel 21 Round 5 data were transformed
to make them as consistent as possible with data collected under the previous
design. The changes in the instrument were designed to make the data collection
effort more efficient and easy to administer. In addition, expectations were
that data on some items, such as those related to health care events, would be
more complete with the potential for identifying more events. Increases in
service use reported since the implementation of these changes are consistent
with these expectations. Data users should be aware of possible impacts
on the data and especially trend analyses for these data years due to the design
transition.
Process changes, such as data editing and imputation,
may also affect trend analyses. For example, users should refer to the Section
2.5.11 in the 2021 Full Year Consolidated file (HC-233) and, for more detail,
the documentation for the prescription drug file (HC-229A) when analyzing
prescription drug spending over time.
As always, it is recommended that data users review
relevant sections of the documentation for descriptions of these types of
changes that might affect the interpretation of changes over time before
undertaking trend analyses.
Analysts may also wish to consider using statistical
techniques to smooth or stabilize analyses of trends using MEPS data such as
comparing pooled time periods (e.g. 1996-1997 versus 2011-2012), 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, statistical significance tests should be
conducted to assess the likelihood that observed trends are not attributable to
sampling variation. In addition, 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 concluding that a change has taken place when
one has not.
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Panel-specific longitudinal files are available for
downloading in the data section of the MEPS website. For all four panels (Panel
23, Panel 24, Panel 25, and Panel 26), the longitudinal file comprises MEPS
survey data obtained in all rounds of the panel and can be used to analyze
changes over the entire length of the panel. For Panel 24, a file representing a
three-year period will also be established and updated to cover four years with
the release of 2022 data. For Panel 23, a file representing a four-year period
will be established. Variables in the file pertaining to survey administration,
demographics, employment, health status, disability days, quality of care,
patient satisfaction, health insurance, and medical care use and expenditures
were obtained from the MEPS full-year Consolidated files from the years covered
by each panel.
For more details or to download the data files, please
see Longitudinal Weight files at the
AHRQ website.
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Chowdhury, S.R., Machlin, S.R., Gwet, K.L.
Sample Designs of the Medical Expenditure Panel Survey Household
Component, 1996-2006 and 2007-2016. Methodology
Report #33. January 2019. Agency for Healthcare Research and Quality, Rockville,
MD.
RTI International (2019). Medical Provider
Component (MEPS-MPC) Methodology Report 2017 Data Collection. Rockville, MD.
Agency for Healthcare Research and Quality.
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