MEPS: A National Information Resource to Support Health Care Research and Inform Policy and Practice Steven B. Cohen PhD Joel W. Cohen PhD & Karen Beauregard MHA Presentation AHRQ new mission and emphasis on information and research efforts that translate into policy and practice MEPS overview and design enhancements Program outreach and impact Research Update MEPS Data Products and Dissemination New AHRQ Mission Statement To improve the quality, safety, efficiency, and effectiveness of health care for all Americans Center for Financing, Access and Cost Trends Conducts, supports and manages studies of the cost and financing of health care, the access to health care services and related trends. Develops data sets to support policy and behavioral research and analyses. These studies and data development activities are designed to provide health care leaders and policymakers with the information and tools they need to improve decisions on health care financing, access, coverage and cost. Medical Expenditure Panel Survey (MEPS) Annual Survey of 15,000 households: provides national estimates of health care use, expenditures, insurance coverage, sources of payment, access to care and health care quality Permits studies of: Distribution of expenditures and sources of payment Role of demographics, family structure, insurance Expenditures for specific conditions Trends over time MEPS Components Household Component (HC) Medical Provider Component (MPC) Insurance Component (IC) MEPS Household Component Sample Design Oversampling of policy relevant domains 1996 Minorities (Blacks & Hispanics) 1997 Minorities Low income Children with activity limitations Adults with functional limitations Predicted high expenditure cases Elderly 1998-2001 Minorities 2002+ Minorities, Asians, Low Income 15,000 households; ~35,000 persons HC - Purpose Estimates annual health care use and expenditures Provides distributional estimates Supports person and family level analysis Tracks changes in insurance coverage and employment Longitudinal design; linkage to NHIS MPC - Purpose Compensate for household nonresponse Accuracy and detail Imputation source Methodological studies MPC - Targeted Sample All hospitals and associated physicians All office-based physicians All home health agencies All pharmacies MEPS: Pharmacy Component 8000 pharmacies sampled – data on prescribed medicines purchased by households Data obtained: – Medication Name – National Drug Code (NDC) – Quantity Dispensed – Strength and Form – Sources of Payment – Amount Paid by Each Source IC - Purpose Availability of health insurance Access to health insurance Cost of health insurance Benefit and payment provisions of private health insurance IC - Sample 30,000 establishments: derived from Census Bureau frame Supports national and state estimates Employers linked to HC sample Data released in tabular form on MEPS website Recent MEPS Enhancements Supports state estimates: Direct state level estimates of cost, coverage and use for the largest states. Supports metro area estimates: Direct MSA level estimates of cost, coverage and use for the largest metropolitan areas. MEPS CAPI upgrade: Movement to Windows Based Computer Assisted Personal Interview System (CAPI). Recent Collaborations CDC, Chronic Disease Directors and Nat’l Pharmaceutical Council Effort focused on the burden and costs of chronic disease. Consortium recommended adoption of the MEPS to quantify medical costs for high prevalence chronic diseases. CMS National Health Care Expenditure Estimates and Sources of Payment Reconciliation: MEPS and the National Health Accounts DHHS Data Council AHRQ DHHS Data Council Co-Chair Options for improving Departmental data capacity for analyses for racial and ethnic minority populations Enhancements to the analytic capacity and policy relevance of national, state and local health insurance data Assessment of current HHS data capabilities for prescription drug information; plans for future MMA related enhancements for systematic data on prescription drug utilization, costs, expenditures and efficacy Recent Collaborations Fast turn-around estimates of expenditures for selected conditions for Report to Congress Technical assistance to Congressional Research Service on insurance issues Collaboration with Treasury Department on analyses of Health Savings Accounts Serve on HHS Research Coordinating Council work group on estimating the number of uninsured MEPS Impact Informs GDP Estimates: MEPS data on premium costs are used to produce estimates of the GDP for the nation. Medicare Modernization Act (MMA): MEPS used to estimate future costs of Rx benefit, detailed estimates of Rx use and expenses for near elderly CDC-NPC-CDD-AHRQ Collaboration: MEPS used to estimate the cost of specific chronic diseases. MEPS Impact State Reports on Coverage: MEPS has been used by numerous States in annual reports and evaluations of their population’s eligibility and enrollment decisions. HRSA state planning grant initiative program: Numerous states have participated in program, using MEPS data to provide reports to their legislatures and governors. Obesity Cost Calculator: Sponsored by NBGH. MEPS used for cost estimates and now includes a module for estimating return on investment to firms for providing bariatric surgery benefits. Maryland Health Care Commission Report using the MEPS IC MEPS Informs Consumers’ Checkbook Guide to Health Plans Annual Approximate Yearly Cost to You ($) publication Plan Yearly If Your Health If Your Health If Your Health Rates every plan Code Plan Name Premium ($) Care Usage Care Usage Care Usage were Low were Average were High available to federal employees and Local HMOs and Point of Service Kaiser Midretirees E32 1510 1650 2350 3890 Atlantic Compares likely JP2 M.D. IPA 1530 1690 2460 4160 cost of various Aetna HealthJN5 1070 1270 2620 5390 plan options to St employee Aetna HealthJN2 1570 1760 2880 5330 Hi Estimated 2004 cost Aetna to average family 222 Consumer 1290 1290 3450 7340 of 3 with head Driven under 55 2G2 CareFirst 2280 2480 3530 5850 Yearly Limit on Cost to You Excluding Dental($) 5480 7330 5530 6030 16950 9530 Knowledge Transfer Efforts: Statistical Methods Provide support for statistical and methodological research to improve the quality, efficiency, timeliness of health care surveys Sponsor of Conferences on Health Survey Research Methods OMB’s Statistical Policy Conference on Achieving Statistical Quality in a Diverse and Changing Environment OMB’s Federal Committee on Statistical Methodology Knowledge Transfer Efforts: Recent Enhancements Continued to speed up the production of estimates In process of redesigning MEPS web site. Expanded the content of the MEPS web site Enhanced MEPS outreach activities Research Uses of the Medical Expenditure Panel Survey Areas of Research Using MEPS Data Access, use, and quality Expenditures Private and public health insurance Health status and health behaviors Microsimulation modeling Statistics and methods Outline Descriptive data – Insurance and expenditures Illustrative research findings Current research Number of uninsured under age 65 1996–2004 Any time in year Number in millions 70 62.0 62.2 44.5 44.2 59.1 60 50 42.0 58.5 42.6 First half of year Full year 61.7 61.9 61.7 43.8 45.7 45.9 62.9 47.0 48.1 40 30 33.7 31.6 32.1 31.0 28.7 31.5 31.3 32.0 1996 1997 1998 1999 2000 2001 2002 20 10 0 2003 Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 1996–2003 Full-Year and 1996–2004 Point-in-Time Files 2004 Number of children under age 18, by all-year insurance status, 1996–2003 Number in millions Private 40 39.8 39.7 41.4 Public only 42.0 40.4 Uninsured 38.6 39.4 38.9 14.1 16.1 30 20 10.9 11.8 11.6 11.3 12.4 7.0 7.1 6.5 5.3 6.3 5.6 5.1 1996 1997 1998 1999 2000 2001 2002 16.5 10 0 Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 1996–200 Full-Year Files 4.6 2003 Percent uninsured by age, population under age 65, 2001 to 2002 Uninsured at least one month 60 Uninsured 24 months 56.7 51.8 50 Percent 40 33.8 31.9 30 27.0 26.7 21.1 20 16.8 15.8 11.4 9.9 10 10.3 5.4 8.2 0 Total Under 18 18-24 25-29 30-34 35-54 Rhoades, J. A. The Long-Term Uninsured in America, 2001 to 2002: Estimates for the U.S. Population under Age 65. Statistical Brief #67. January 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/papers/st67/stat67.pdf 55-64 Percent uninsured by race/ethnicity, population under age 65, 2001 to 2002 Uninsured at least one month Uninsured 24 months 60 52.6 50 Percent 40 30 34.7 34.4 27.6 27.2 23.8 20 13.5 9.4 10 6.9 8.1 0 Hispanic Non-Hispanic Black Non-Hispanic White Non-Hispanic Asian, Pacific Islanders Non-Hispanic Other Rhoades, J. A. The Long-Term Uninsured in America, 2001 to 2002: Estimates for the U.S. Population under Age 65. Statistical Brief #67. January 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/papers/st67/stat67.pdf Health Insurance Premiums Employee/Employer Contributions for Single Coverage 1996 - 2002 2002 $565 2001 $498 2000 $450 1999 $420 1998 $383 $2,624 $2,391 $2,205 $1,905 $1,791 1997 $320 $1,731 1996 $342 $1,650 $0 $1,000 Employee Contribution Employer Contribution $2,000 $3,000 $4,000 Premiums increased 10.4% & employee contributions increased 13.5% over 2001, continuing the trend from previous years. AHRQ MEPS Insurance Component Index to Tables www.meps.ahrq.gov/Data_Pub/IC_Tables.htm Health Insurance Premiums Employee/Employer Contributions for Family Coverage 1996 - 2002 2002 $1,987 $6,482 2001 $1,741 2000 $1,614 1999 $1,438 1998 $1,382 1997 $1,305 1996 $1,275 $0 $5,768 $5,158 $4,620 $4,208 Employee Contribution Employer Contribution $4,027 $3,679 $2,000 $4,000 $6,000 $8,000 $10,000 Premiums increased 12.8% and employee contributions increased 14.1% over 2001, continuing the trend from previous years. AHRQ MEPS Insurance Component Index to Tables www.meps.ahrq.gov/Data_Pub/IC_Tables.htm Distribution of Health Expenses by Source of Payment, 2002 Total = $810.7 Billion 8% 11% 40% 19% Private Medicare Out-of-pocket Medicaid Other 22% Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2002. Distribution of Health Expenses by Type of Service, 2002 4% 2% 8% 32% 19% Inpatient Ambulatory Prescribed Meds Dental Home Health Other 35% Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2002. Median and average medical expenses per person, 2002 $3,302 $3,500 $2,813 $3,000 $2,500 $2,000 $1,500 Median Average $960 $1,000 $663 $500 $0 Persons with expenditures Per capita expenditures Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2002 Concentration of Medical Expenditures 1987, 1996, and 2002 1% of the population 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1987 1996 2002 Top Top Top Top 1% 5% 10% 50% accounts for around 25% of expenses 50% of the population accounts for only 3% of expenses This degree of concentration has been consistent over time Source: Berk and Monheit, “Concentration of Expenditures Revisited,” Health Affairs, March/April 2001, and 2002 MEPS. Concentration of Expenditures, 2002 97 100 80 80 Percent of Total Expenditures 64 60 49 40 22 20 3 0 Top 1% (>=$35,543) Top 5% (>=$11,487) Top 10% (>=$6,444) Top 20% (>=$3,219) Top 50% (>=$664) Bottom 50% (<$664) Percent of Population Conwell, L. J. and Cohen, J. W. Characteristics of Persons with High Medical Expenditures in the U.S. Civilian Noninstitutionalized Population, 2002. Statistical Brief #73. March 2005. Agency for Healthcare Research and Quality, Rockville, Md. http://www.meps.ahrq.gov/papers/st73/stat73.pdf Conditional Distributions by Percentile for Persistence of Expenditures Persistence of Level of Health Care Expenditures: 1999-2000 60.0 55.0 50.0 45.0 40.0 35.0 Percent (%) 30.0 25.0 20.0 15.0 90-100% 80-90% 70-80% 60-70% 50-60% 40-50% Expenditure Group 30-40% 2000 20-30% 10-20% 0-10% 10.0 5.0 0- 10 % 0% -2 -3 0% 10 Expenditure Group 1999 20 30 -4 0% 0% -5 40 -6 0% 0% 50 -7 60 -8 0% 0% 70 -9 80 90 -1 00 % 0.0 Factors for Models Demographic characteristics: Age; sex; race/ethnicity; marital status; region; MSA classification Health status measures: health status; limitations in activity Health insurance coverage: full year insured; part year insured; uninsured Health conditions: Diagnosis of arthritis; cancer; cerebrovascular disease; diabetes; heart disease; high blood pressure Accidental events: poisoning; trauma Utilization measures: inpatient events; ambulatory visits; number of prescribed medicine purchases Expenditure measures: total health care spending Predictive Models Model 1: Logistic Model with prior year’s medical expenditures and precursor information (t-1). (Y=1 top 10% in $s; 0 otherwise) Model 2: Logistic Model with prior year’s medical expenditures (t-1) and precursor information (t-1 and t-2). Factors Associated With the Prediction of High Levels of Medical Expenditures Prior Year Characteristics High level of prior year medical expenditures Age (elderly) Family size (single) Health status (poor) Family income (high) Activity limitation High use of Rx and office based Dr. visits Presence of either COPD or infectious disease Sensitivity and Specificity of Model 1 Actual High Expenditure Classification in 2001 High Expenditure in 2001-top decile Not High Expenditure in 2001 Total Predicted as High Expenditure2000 Top Decile Not Predicted as High Total ExpenditureNot in Top Decile 49.9% True + 50.1% False -- 1,013 (10.0 %) 5.6% False + 94.4% True -- 9,116 (90.0 %) 10,129 Sensitivity and Specificity of Model 2 Total Actual High Expenditure Classification in 2001 Predicted as High Expenditure2000 Top Decile Not Predicted as High ExpenditureNot in Top Decile High Expenditure in 2001-top decile Not High Expenditure in 2001 49.3% True + 50.7% False -- 1,013 (10.0 %) 5.6% False + 94.4% True -- 9,116 (90.0 %) Total 10,129 Out-of-pocket Expenses as a Percent of Family Income, 2002 35 34 30 Percent 25 18 20 Top 5% Bottom 50% 15 10 5 3 5 0 >10% >20% Conwell, L. J. and Cohen, J. W. Characteristics of Persons with High Medical Expenditures in the U.S. Civilian Noninstitutionalized Population, 2002. Statistical Brief #73. March 2005. Agency for Healthcare Research and Quality, Rockville, Md. http://www.meps.ahrq.gov/papers/st73/stat73.pdf Changes in Percent Uninsured for Children, 19772001 Percent Uninsured 25 20 15 10 5 0 1977 1987 First part of year 1997 Entire year 2001 Any time during year P. Cunningham and J. Kirby, “Children’s Health Coverage: A Quarter-Century Of Change,” Health Affairs, Sept/Oct 2004 Take-Up Rates among Children Eligible for Public Coverage, 1996-2002 100 80 60 40 20 0 80 80 77 61 60 44 Mcd-welfare elig Mcd-poverty expans 1996 (1998 SCHIP) SCHIP 2002 Between 1996 (1998 for SCHIP) and 2002, there was a dramatic increase in enrollment among children eligible for Medicaid and SCHIP. TSelden, JHudson, JBanthin, “Tracking Changes in Eligibility and Coverage among Children, 1996-2002,” Health Affairs 23(5):39-50, September/October 2004. Take Up of Dependent Coverage Logit analysis of take-up of any coverage and family coverage: – – – Cost of coverage matters. So does Medicaid eligibility of family members. Income also a factor, but not a large effect. Results suggest declining dependent coverage related to: – – Out-of-pocket premium costs for such coverage Medicaid eligibility of family members Source: Monheit and Vistness, The Demand for Dependent Health Insurance: How Important is the Cost of Family Coverage? Journal of Health Economics, forthcoming. Employer-Sponsored Health Insurance Offers 80 % of Estabs that Offer Health Insurance Percent of Establishments 70 % of Estabs with Health Insurance that Offer 1 Plan 60 % of Estabs with Health Insurance that Offer >1 Plan 50 40 30 20 10 0 1997 1998 1999 2000 2001 2002 Year Zawacki and Taylor, “Fully Paid Employer Provided Health Insurance: Trends in Benefits Over Time,” Agency for Healthcare Research and Quality, 2005. MEPS: Prescription Drugs Increase as Percent of Total Health Expenses, 1996 -2002 6% 3% 8% 8% 4% 2% 32% 38% 19% 13% 33% 1996 Inpatient Ambulatory Prescribed Meds Dental Home Health Other 35% 2002 Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 1996 and 2002 Recent Publications CFACT staff – More than 50 publications in 2004-05 – Dedicated journal issues External users – Identified more than 70 articles in 2004-05 – Prescription drug costs and use – Expenditures and obesity – Costs of covering the uninsured Knowledge Transfer Efforts: Health Services Research Forthcoming AHRQ Sponsored Medical Care Supplement on “Trends in Medical Care Costs, Coverage, Use and Access: Research Findings from the MEPS” What Happens When Workers Fail to Take up EmploymentRelated Health Insurance? What Drives Health Insurance Options at the Workplace? Evidence from 1997-2002 MEPS Employer Data Access to Care and Utilization among Children, the Effect of Public and Private Coverage Trends in Medicaid Prescription Drug Expenditures Children and Antibiotics: Analysis of Reduced Use Forthcoming AHRQ Sponsored Medical Care Supplement “Trends in Medical Care Costs, Coverage, Use and Access: Research Findings from the MEPS” The Utility of Extended Longitudinal Profiles in Predicting Future Health Care Expenditures Using the SF-12 Health Status Measure to Predict Medical Expenditures Explaining Racial and Ethnic Disparities in Health Care Reports of Fewer Activity Limitations: Recovery, Survey Fatigue, or Switching Respondent? AHRQ Working Paper Series Examples of Current InHouse Research Changes in treatment for mental health services The effects of direct to consumer advertising on prescription drug use and expenses Health status and persistence of expenditures Identifying factors accounting for disparities in access and use MEPS Data Products and Dissemination MEPS Public Use Data Methods of Dissemination MEPS web site – www.meps.ahrq.gov AHRQ clearinghouse – CD-ROM – 800-358-9295 Questions? – MEPSPD@ahrq.gov WWW.MEPS.AHRQ.GOV MEPS Mailing List/List Server Mailing List/List Server click on “Mail List/List Server” from Web site both receive e-mail notices of data and publications released on the Web List Server allows for interactive exchange of ideas and information MEPS Data Product Information Types of Products Upcoming Data Releases MEPS Data Center MEPS Data Products Publications (Findings, Methods, Chartbooks) Stat Briefs On-line tables MEPS-NET Micro-data files – Public use – Data Center Recent Statistical Briefs Access to Urgent Medical Care Among Adults 18 and Older 2000-2002, Janet Greenblatt and Michelle Roberts Antidepressant Use Trends 1997-2002, Marie Stagnitti Five Most Costly Medical Conditions 1997-2002, Gary Olin and Jeffrey Rhoades Percentage of adults age 18 and older receiving urgent care when needed, 2000–2002 always usually sometimes/never 100% 16.7 14.9 15.4 29.2 28.0 27.1 54.1 57.1 57.5 2000 2001 2002 80% 60% 40% 20% 0% Percent of U.S. civilian noninstitutionalized population with at least one antidepressant prescribed medicine purchase, by sex, 1997 and 2002 1997 2002 15 Percent 11.4 10 7.4 5.4 5 3.8 0 Male Female Expenditures (in thousands of 2002 dollars) Expenditures for the five most expensive conditions, 1997 and 2002 1997 2002 $80,000 $70,002 $67,621 $60,000 $55,423 $53,748 $55,834 $48,425 $47,508 $40,000 $36,195 $45,263 $35,272 $20,000 $0 Heart conditions Cancer Trauma Mental disorders Pulmonary conditions An Example of a Recent Chart book Health Care in Urban and Rural Areas Combined Years 1998-2000, Sharon Larson and Amy Taylor Average number of ambulatory care visits by type of metro area Average number of ambulatory care visits by age group 12 10.9 10.3 10 9.9 8 6.3 6 6.3 6.0 5.1 5.5 4 2 0 Under age 65 Age 65 and over Source: pooled 1998-2000 MEPS HC Data Metro Near-metro Near-rural Rural Example of Recent Findings Trends in Children’s Antibiotic Use: 1996-2001, Ed Miller and Bill Carroll Antibiotic Use of Children 14 and Under 1996-2001 1996 1997 Population size 59.2 59.8 59.8 2001 61.0 60.6 60.6 28.9 28.6 29.0 0.6 2.0 0.5 1.9 0.5 1.9 Percent Percent of kids w/antibiotics 39.0 33.7 Avg number of antibiotic prescriptions: 1998 1999 2000 Number in millions All kids Kids w/ any antibiotic use 0.9 2.4 30.6 Number 0.7 2.1 0.6 1.9 Recent and Upcoming MEPS Data Releases 2003 Use File - Including Quality Variables (May 2005) 2003 Jobs file (May 2005) 2003 NHIS Link file (May 2005) 2004 Insurance File (July 2005) 2004 IC Tables (July 2005) More Upcoming Data Releases 2003 Event files (September-November 2005) Panel 7 Longitudinal Weight ( January 2006) 2003 Conditions (December 2005) 2003 Use and Expenditures (December 2005) MEPS Tables Compendia MEPS-HC Tables Compendia Sets of Static tables with flexibility to redefine categories Full year tables for expenditures First part of year tables for insurance coverage Expenditure by Condition Tables (people, events, and total expenditures by site of service) MEPS-net MEPSnet An on-line interactive statistical computer system Provides immediate access to data in a non-programming environment MEPSnet is a set of statistical tools – MEPSnet/HC – MEPSnet/IC MEPS-net HC Currently has the capacity to produce use, expenditure, source of payment and health insurance estimates for all years (including standard errors) Plans to add Access data in 2005 MEPSnet/IC Interactive Web-based tool provides national, and State-by-State, and public sector insurance data in tabular format MEPSnet IC Interactive Data Tool Step-by-Step search for estimates. Estimates shown for all years available. Graphical display of year-to-year trend with two-standard deviation error bars displayed. Links back to table from which data derived. AHRQ Data Center Provides researchers access to non- public use MEPS data (except directly identifiable information); Mode of data analysis – on a secure LAN at AHRQ, Rockville – task order agreement with data contractor – combinations of both. ADC Facilities Secure room Terminal connected to secure LAN SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS software available, and others upon request Limited staff support by people who know: – the data – the confidentiality issues – the software Application And Review Process Application procedures are on the MEPS web site Submit proposal to data center coordinator Review within 1 week for feasibility, and data availability Internal review board (IRB) review required Data Center Fees User fee of $150.00 for approved projects to cover technical assistance, simple file construction, and/or up 2 hours of programming support from data contractor (additional programming support available at cost of 80.00/hr) User fee waived for full-time students ADC Procedures May bring data in, but not out Access only to data needed for approved project Tabular data will be reviewed for confidentiality Only approved tables can leave the Center Center will store data files, foreign merge files, and all outputs needed for replication Limited Remote Access Once you have an established data center project, and have worked on site to develop and debug programs, jobs may be submitted to our Data Center Supervisor to run. Out-put will be reviewed for confidentiality and mailed to you. Confidential Data Available for Data Center Projects 1996 Nursing Home Data Linked HC - Secondary Data (full geo- coding for 1996, 1997 , 2000- 2002; FIPS codes for other years) Non-identifiable MPC data Confidential Data Available for Data Projects Fully specified industry/occupation codes Imputed NDC codes Continuous poverty measure Linked HC-IC Data