Medical Expenditure Panel Survey (MEPS)
Purpose and Method of Operation
The objectives of AHCPR's Medical Expenditure Panel Survey are
to provide public and private sector decision makers with the
ability to:
- Obtain timely national estimates of health care use and
expenditures, private and public health insurance coverage,
and the availability, costs, and scope of private health
insurance benefits among the U.S. population.
- Analyze changes in behavior as a result of market forces or
policy changes (and the interaction of both) on health care
use, expenditures, and insurance coverage.
- Develop cost/savings estimates of proposed changes in policy.
- Identify the impact of changes in policy for key subgroups
of the population (i.e., who benefits and who pays more).
These objectives are accomplished through the fielding of the Medical
Expenditure Panel Survey (MEPS). MEPS is an interrelated series of
surveys that replaces the National Medical Expenditure Survey (NMES).
MEPS not only updates information that was last collected a decade ago
in FY 1987 but it will also provide more timely data, at a lower cost per
year of data, through the move to an ongoing data collection effort.
Overview
AHCPR's Medical Expenditure Panel Survey collects detailed
information regarding the use and payment for health care
services from a nationally representative sample of Americans.
No other surveys supported by the Federal Government or the
private sector provide this level of detail regarding: the health
care services used by Americans at the household level and their
associated expenditures (for families and individuals); the cost,
scope, and breadth of private health insurance coverage held by
and available to the U.S. population; and the specific services
that are purchased through out-of-pocket and/or third-party
payments.
This level of detail enables public and private-sector economic
models to develop national and regional estimates of the impact
of changes in financing, coverage, and reimbursement policy and
estimates of who benefits and who bears the cost of a change in
policy. No other survey provides the foundation for estimating
the impact of changes on different economic groups or special
populations of interest, such as the poor, elderly, veterans, the
uninsured, or racial/ethnic groups. That is why these surveys
have always been seen as a critical national resource by the
private sector (e.g., RAND, Heritage Foundation, Lewin-VHI, and
the Urban Institute) as well as the public sector (e.g., Office
of Management and Budget (OMB), Congressional Budget Office
(CBO), Physician Payment Review Commission (PPRC), Prospective
Payment Assessment Commission (ProPAC), and Treasury Department).
Within the past few years, the Department has initiated a Survey
Integration Plan. The major goal of the Plan is to improve the
effectiveness and efficiency of the major HHS surveys. MEPS is
the result of that effort. Unlike NMES, which developed its own
large sampling frame of families to interview, MEPS relies upon
an existing nationally representative sampling frame that was
developed by the National Center for Health Statistics (NCHS).
The linkage between the MEPS household survey and NCHS' National
Health Interview Survey (NHIS) has achieved significant savings
in sample frame development and enhancements in analytical
capacity.
MEPS builds upon the strengths of the 1977 and 1987 NMES and
streamlines the Department's data collection efforts. This
integration will assure a better return on the Federal
Government's investment by moving from a periodic survey once
every ten years to a continuing longitudinal data collection
effort. Over time, MEPS will provide more comprehensive data for
public and private sector decision makers.
The first MEPS data (from 1996) became available in April 1997
and key findings are summarized in the table below. This rich data
source has become not only more comprehensive and timely, but
MEPS' new design has enhanced analytic capacities, allowed for
longitudinal analyses, and developed greater statistical power and
efficiency.
MEPS Data—Key Findings
Date |
Public Use Data
Release | Key Findings |
April 1997 | Round 1 1996
Medical Expenditure Panel Survey Component person-level demographics, employment, health status, and health insurance. | 17% of the U.S. populationwas uninsured throughout the first half of 1996.
19.6% of privately insured
children in single-parent
families get health insurance
coverage from a policyholder
not residing in their household.
Almost 53% of children covered
by Medicaid have at least one
parent that works.
A greater percentage of
workers are being offered
health insurance by their
employers in 1996 than in
1987; however, a smaller
proportion are accepting
insurance.
|
April 1997 | Round 1 1996
MEPS—Nursing Home Survey Component—person-level demographic and health status data and Round 1 facility characteristics data. | Almost 66% of U.S. nursing
homes in 1996 were operated
for-profit.
Over 80% of nursing home
residents needed help with 3
or more activities of daily
living.
Almost half of all nursing
home residents have some
form of dementia.
|
September 1997 | Release 2 1996
Household Survey Component—Round 1 parent identifiers and managed care data, and Round 2 health status and access to care data. | Nearly 19% of the population
had no usual source of health
care in 1996.
About 12% of all American
families experienced barriers
to receiving needed health
care services.
|
Summer 1998 | MEPS—Household Survey Component 1996—population characteristics and utilization data file. | Full-year demographics, health
insurance, employment, and
utilization.
|
Summer 1998 | MEPS—Nursing Home Survey Component 1996—population characteristics and residence history data
file. | Nursing home resident person
level demographics, residence
history, and insurance variables.
|
Winter 1998 | MEPS—Nursing Home Survey Component—use and expenditure data file. | Nursing home resident person
level health status; demographics; variables indicating
living spouse, siblings, children,
or parents; prior long-term care
use; veteran status; use of
health care services; use of
prescribed medicines; insurance;
income and assets; and health
care expenditures.
|
Winter 1998 | MEPS—Household Survey Component 1996—use and expenditure data file. | Person level use, source of
payment, expenditures, health
status, health insurance, and
income.
|
1999 | 1996-1997 Panel Household Component—conditions, events, and job data files. | Detailed condition, event, and
job information.
|
1999 | Linked Household Component Survey—Insurance Component Survey data file. | 1996 full-year use and
expenditure file linked with
1996 Insurance Component
file.
|
Funding History
Funding for The MEPS program prior to FY 1999 has been as
follows:
Year |
Amount | FTEs |
1994 | $10,000,000 | --- |
1995 | $15,000,000 | --- |
1996 | $15,100,000 | --- |
1997 | $38,886,000 | --- |
1998 | $36,300,000 | --- |
Sources of MEPS funding follow:
Year |
Budget Authority | 1% Evaluation | Total |
1994 Actual | $10,000,000 | --- | $10,000,000 |
1995 Actual | $9,918,000 | $5,082,000 | $15,000,000 |
1996 Actual | $10,000,000 | $5,000,000 | $15,000,000 |
1997 Actual | $224,000 | $38,662,000 | $38,886,000 |
1998 Appropriation | $0 | $36,300,000 | $36,300,000 |
Rationale for the Budget Estimate
The FY 1999 request for MEPS totals $27,800,000 in 1% evaluation
funds. The total reflects a decrease of $8,500,000 from the FY
1998 level of $36,300,000.
The decrease of $8,500,000 from the FY 1998 level is the net
effect of three factors: the conclusion of the Nursing Home
Component of MEPS, the end of the development and testing phase
of the survey, and the move to the lower sample size of a non-peak year in the sample (the Department's Survey Integration Plan
calls for five-year peaks in sample size for MEPS.
In FY 1999, data collection will be ongoing for the MEPS
Household Survey, the MEPS Medical Provider Survey, and the MEPS
Insurance Component (MEPS-IC), which consists of the MEPS Health
Insurance Plans Survey and the former National Employer Health
Insurance Survey (NEHIS). More specifically, in-person
interviews will be conducted with 9,000 families to obtain
calendar year 1998 health care data, and with 5,600 new families
sampled for the 1999 MEPS household survey. The Medical Provider
Survey conducted in 1999 will consist of interviews with
approximately 3,000 facilities, 12,000 office-based providers,
7,000 hospital-identified physicians, and over 500 home health
providers. In addition, the Insurance Component in 1999 will
consist of interviews with more than 40,000 employers and 1,000
insurance carriers.
All of the MEPS components will be heavily engaged in survey-related activities directed to the following tasks: data editing,
imputation, data preparation and data processing, development of
estimation weights and variance estimation capabilities for the
component surveys, preparation of public use tapes, and
development of analytical and methodological reports.
The design of the surveys under the ongoing HHS Survey
Integration Plan calls for a smaller panel in each of the four
years between the quinquennial peak sample size years, yielding
over time considerably more data for reduced fixed costs. The
implementation of the HHS Survey Integration Plan will provide
the Congress, OMB, the Department, the private sector, and the
research and policy community with continuous, up-to-date data on
health care, use, expenditures, and the employer health insurance
market. This plan greatly enhances the analytic capabilities
over the separate NHIS, NMES and NEHIS surveys. The Department,
in cooperation with OMB, is continuing the survey integration
initiative in order to achieve more efficiencies and savings.
Data collection for the Insurance Component (MEPS-IC)is now being
conducted by the Census Bureau rather than by the original
contractor. This move is cost efficient as a consequence of the
sample design capacities that the Census Bureau has made
available to the survey at marginal cost, and the opportunity to
use and make marginal changes to existing survey control systems
rather than having to redevelop them. AHCPR is continuing its
efforts to negotiate further efficiencies in all areas of the
MEPS.
A Critical Resource
Since 1977, AHCPR's expenditure surveys have been an important
and unique resource for public and private sector decision
makers. No other surveys effectively and efficiently link data
about persons, their families, employers, and providers with data
on health care use, expenditures, insurance coverage, and health
status.
The data from earlier surveys (1977 and 1987) have quickly become
a linchpin for the nation's economic models and their projections
of health care expenditures and utilization. In the public sector,
OMB, CBO, PPRC, ProPAC, and the Treasury Department among
others, rely upon these data to evaluate health reform policies,
the effect of tax code changes on health expenditures and tax
revenue, and proposed changes in government health programs such
as Medicare. In the private sector, these data are used by many
private businesses, foundations and academic institutions to
develop economic projections. These data represent a major
resource for the health services research community at large.
MEPS dramatically improves the value and cost-effectiveness of
AHCPR's data collection effort. Survey integration means that
MEPS will yield a broader array of data than NMES. The move from
a large survey every ten years to following a smaller cohort of
families on an ongoing basis has four primary benefits: it will
decrease the cost per year of data collected; it will provide
more timely data on a continuous basis; it will create for the
first time the ability to assess changes over time; and it will
permit the correlation of these data with the National Health
Accounts.
The timeliness of the data provided by MEPS will enhance the
accuracy of the economic models upon which the Administration,
and the private sector rely. MEPS will provide concrete and
current insights regarding the dynamics of insurance coverage,
job lock, the adequacy of insurance coverage, spousal coverage,
health insurance coverage from multiple sources, and the sites
and providers of specific health care services.
Major Components of MEPS
MEPS consists of a series of interrelated surveys. The
individual components of MEPS and the information each will
provide is outlined as follows.
- Household Survey—Six interviews will be conducted with
each new sample of households for MEPS over a 3-year period
to obtain health care use, and expenditure and insurance
coverage data for two consecutive calendar years. The 1996
MEPS sample included 10,800 families, the 1997 MEPS sample
included 6,300 families, the 1998 MEPS sample will include
5,200 families and the 5,600 new families. This is the only
survey that collects health care expenditures of American
families.
- Medical Provider Survey—Interviews will be conducted with
3,000 hospitals, 12,000 office-based physicians, 500 home
health providers, and 7,000 hospital-identified physicians
in 1999 to obtain health care information on MEPS Household
Survey participants. A separate interview will be conducted
to obtain information for each of the calendar years
associated with the MEPS Household Survey Panel. This
survey allows AHCPR to verify information collected at the
household and to get information from providers when it is
not known by the household (e.g., households receiving
Medicaid or that are in capitated plans will not know their
expenditures).
- MEPS Insurance Component—Health Insurance Plans Survey—Interviews will be conducted with 10,000 employers, 500
unions, and 500 insurers in 1999 to obtain detailed
information on the health insurance benefits and premiums
associated with health insurance coverage held by the MEPS
Household Survey participants. A separate interview will be
conducted to obtain information for each of the calendar
years associated with the MEPS Household Survey Panel. This
survey allows evaluation of insurance purchasing choices and
the impact of those choices on use and access to care.
- MEPS Insurance Component Establishment Level (formerly NEHIS)—Interviews will be conducted with 30,000 establishments to
obtain national and state-specific (40 states) estimates of
the availability of health insurance at the workplace, the
type of coverage provided by employers, and the associated
costs of coverage. For each establishment surveyed, the
MEPS-IC Establishment Level Survey will obtain information
on the number and characteristics of plans offered, the
scope and breadth of benefits included in each plan and the
corresponding copayment provisions, the number of current
workers and retirees enrolled in each plan, and whether each
plan is fully or self-insured. The MEPS-IC Establishment
Level Survey data will also include characteristics of each
establishment including its size, the type of workforce
employed, aggregate data on payroll and available fringe
benefits, industrial classification, and corporate status.
National Nursing Home Expenditure Study—This survey will
provide calendar year expenditure estimates for nursing home
care for persons residing in a nursing home anytime during
1996. In addition to making expenditure estimates by
sources of payment, the survey estimates changes in sources
of payment (e.g., Medicaid) over the year. The design of
the survey permits expenditure estimates by important
sub-populations including persons admitted or discharged during
the year; by functional health status, insurance coverage,
and income distributions; and by characteristics of the
nursing home residents' care-givers who reside in the
community. Also, the survey can provide estimated physician
use, prescribed medicine use, and hospital use by nursing
home residents. No other national nursing home survey has
the capability of uniformly measuring health status using
data collection materials based on HCFA's Resident
Assessment Instrument or collecting data from the nursing
home residents' next-of-kin who reside in the community.
The information derived from these surveys will enable the
Congress, the Administration, and other public and private sector
policy makers to evaluate the impact of:
- Growing enrollment in managed care.
- Enrollment in different types of managed care.
- Changes in how chronic care and disability are managed and
financed.
- Alternative approaches to provision of long-term care.
- Changes in employer-supported health insurance.
- Changes in Federal and State policy.
In addition to assessing broad trends such as these, MEPS will
address a host of specific, policy-relevant questions. Examples
of these questions are outlined in the section on significant
questions addressed by MEPS.
MEPS will make a significant contribution to improving the
accuracy of the nation's economic models in at least two ways.
First, with each passing year, attempts to extrapolate the 1987
data to the current year are increasingly subject to error;
current data are essential and MEPS will provide them. Second,
the fact that this survey will provide a third data series for
these sophisticated models will significantly improve their
ability to identify and assess trends that may not be obvious
with data from only two points in time (1977 and 1987). Thus,
the critical importance of collecting this third series of data
cannot be overemphasized.
The Future
Integrating many complex surveys while decreasing costs and
enhancing the Department's analytic capabilities is a continuing
effort. During 1997, AHCPR explored the possibility of using
the Census Bureau for collection of Household Survey data. This
proved to be unfeasible and AHCPR will publish a solicitation in
February 1998 for this purpose, with decisions expected by Summer
1998.
In FY 1999, the MEPS will support research on the health effects
of welfare reform. Particular attention will be given to research
that investigates the health consequences of welfare to work
programs. Specific areas of emphasis will include health
insurance coverage among former welfare recipients who became
employed, and health care access and utilization by former
welfare recipients who exhaust their traditional Medicaid
benefits.
Return to Budget Justification Statement
Current as of February 1998
Internet Citation:
Medical Expenditure Panel Survey (MEPS). Estimates for Appropriations from Justification of Budget Committees,
Fiscal Year 1999. February 1998. Agency for Health Care Policy and Research, Rockville, MD.
http://www.ahrq.gov/about/cj1999/meps99.htm