1. Medical Expenditure Panel Survey Health Care Utilization And Expenditures Data

2. Health Care Utilization Utilization is called an “event” in MEPS Utilization is called an “event” in MEPS Event is a catch-all term for Event is a catch-all term for – Hospital and office-based medical provider visits – Dental visits – Purchases and refills of prescribed medicines – Home health care – Purchases of certain types of medical supplies and equipment Each event in MEPS is a unique record based on household-reported utilization data Each event in MEPS is a unique record based on household-reported utilization data

3. Event Types Hospital Inpatient Stays (IP) Hospital Inpatient Stays (IP) Emergency Room Visits (ER) Emergency Room Visits (ER) Outpatient Department Visits (OP) Outpatient Department Visits (OP) Office-Based Medical Provider Visits (OB) Office-Based Medical Provider Visits (OB) Dental Visits (DV) Dental Visits (DV) Prescription Medicine Purchases (RX) Prescription Medicine Purchases (RX) Home Health Care (HH) Home Health Care (HH) Other Medical Expenses (OM) Other Medical Expenses (OM)

4. Health Care Expenditures Collected at the event level Collected at the event level Represent payments to providers of the health care Represent payments to providers of the health care Payments are shown by source, e.g., the individual, a private insurance plan, or a public program Payments are shown by source, e.g., the individual, a private insurance plan, or a public program Total expenditure is the sum of payments by all sources Total expenditure is the sum of payments by all sources

5. Sources of Expenditure Data Expenditures derived from two sources Expenditures derived from two sources – Household component (HC) of MEPS – Medical provider component (MPC) of MEPS MPC data used to replace or supplement household -reported expenditures MPC data used to replace or supplement household -reported expenditures Incomplete data on expenditures for an event is imputed - no missing values Incomplete data on expenditures for an event is imputed - no missing values

6. MPC Data Collected for: – – Physician Office Visits – – Outpatient Department Visits – – Hospital Inpatient Stays – – Emergency Room Visits – – Prescribed Medicines (Pharmacy Component) – – Home Health Agency Care Not collected for: – – Non-physician Office Visits – – Dental Visits – – Home Health - Independent Providers – – Other Medical Expenses

7. Source of Payment Categories Self or family (SF) Self or family (SF) Medicare (MR) Medicare (MR) Medicaid (MD) Medicaid (MD) Private insurance (PV) Private insurance (PV) Veterans (VA) Veterans (VA) TRICARE (TR) TRICARE (TR) Other federal gov’t (OF) Other federal gov’t (OF) State or local gov’t (SL) State or local gov’t (SL) Worker’s comp (WC) Worker’s comp (WC) Other private (OR) Other private (OR) Other public (OU) Other public (OU) Other insurance (OT) Other insurance (OT)

8. Expenditure Variable Names DVSF04X - AMOUNT PAID, FAMILY DVSF04X - AMOUNT PAID, FAMILY DVMR04X - AMOUNT PAID, MEDICARE DVMR04X - AMOUNT PAID, MEDICARE DVMD04X - AMOUNT PAID, MEDICAID DVMD04X - AMOUNT PAID, MEDICAID DVPV04X - AMOUNT PAID, PRIVATE INSURANCE DVPV04X - AMOUNT PAID, PRIVATE INSURANCE DVVA04X - AMOUNT PAID, VETERANS DVVA04X - AMOUNT PAID, VETERANS DVTR04X - AMOUNT PAID, TRICARE DVTR04X - AMOUNT PAID, TRICARE DVOF04X - AMOUNT PAID, OTHER FED DVOF04X - AMOUNT PAID, OTHER FED DVSL04X - AMOUNT PAID, STATE/LOCAL DVSL04X - AMOUNT PAID, STATE/LOCAL DVWC04X - AMOUNT PAID, WORKERS COMP DVWC04X - AMOUNT PAID, WORKERS COMP DVOR04X - AMOUNT PAID, OTHER PRIVATE DVOR04X - AMOUNT PAID, OTHER PRIVATE DVOU04X - AMOUNT PAID, OTHER PUBLIC DVOU04X - AMOUNT PAID, OTHER PUBLIC DVOT04X - AMOUNT PAID, OTHER INSURANCE DVOT04X - AMOUNT PAID, OTHER INSURANCE

9. Expenditures for OB, DV, OM, HH, and RX Events 12 Source of payment variables (evSF04X through evOT04X) 12 Source of payment variables (evSF04X through evOT04X) Total expenditure variable (evXP04X) Total expenditure variable (evXP04X) – The sum of payments by all sources Total charge variable (evTCH04X) Total charge variable (evTCH04X) – The provider’s charge before adjustment or discount – Not included for RX events

10. Expenditures for Hospital Care (IP, ER, and OP Events) Facility Expenditure Variables Facility Expenditure Variables – evFSF04X, …, evFOT04X – evFXP04X (total payments) – evFTC04X (total charge) Separately Billing Doctor Expenditure Variables Separately Billing Doctor Expenditure Variables – evDSF04X, …, evDOT04X – evDXP04X (total payments) – evDTC04X (total charge) Total Charges and Expenditures for hospital event Total Charges and Expenditures for hospital event – evTC04X (evFTC04X + evDTC04X) – evXP04X (evFXP04X + evDXP04X)

11. General Expenditure Caveats Flat fee events Flat fee events Zero dollar events Zero dollar events

12. Flat Fee Payment Groups What is a Flat Fee? What is a Flat Fee? – A fixed dollar amount paid for a group of health care services (e.g., orthodontic care) Flat fee structure Flat fee structure – Stem - Initial medical visit - expenditures – Leaf - subsequent medical visits - zero expenditures

13. Flat Fee Variables Flat Fee ID: FFEEIDX Flat Fee ID: FFEEIDX Stem (1) or Leaf (2): FFevTYPE Stem (1) or Leaf (2): FFevTYPE Pre-2004 Events in group: FFBEF04 Pre-2004 Events in group: FFBEF04 Post-2004 Events in group: FFTOT05 Post-2004 Events in group: FFTOT05

14. Zero Dollar Events Leaf event in flat fee bundle from prior year Leaf event in flat fee bundle from prior year Bad debt Bad debt Free care Free care Post-operative care covered by a global surgical package Post-operative care covered by a global surgical package

15. Expenditure Data Files Full Year Consolidated File Full Year Consolidated File – One record for each person in MEPS – Summary of all events and expenditures – No detail on expenditures for or characteristics of individual events Event Files (8) Event Files (8) – One record for each reported event – Detail on expenditures for and characteristics of an event

16. Event File Detail Unique person/event identifiers Unique person/event identifiers Type of provider Type of provider Services/procedures Services/procedures Date(s) of care Date(s) of care Reason for event Reason for event Conditions/procedures Conditions/procedures Any medicine prescribed Any medicine prescribed VA facility indictor VA facility indictor Flat fee information Flat fee information Payments by source Payments by source Total payment/charge Total payment/charge Imputation flag Imputation flag Variance estimation variables Variance estimation variables Full year person weight Full year person weight

17. IP File Caveats Number of newborns in year Number of newborns in year Mother/Newborn expenditures Mother/Newborn expenditures IP stays beginning with an ER visit IP stays beginning with an ER visit

18. Number of Newborns Cannot use “reason entered hospital” to determine number of newborns in the calendar year Cannot use “reason entered hospital” to determine number of newborns in the calendar year RSNINHOS = 4 (to give birth to a baby) does not always indicate a live birth—false labor pains or a still birth RSNINHOS = 4 (to give birth to a baby) does not always indicate a live birth—false labor pains or a still birth Infants born during 2003 should be identified by using AGE03X = 0 in the Full Year Consolidated File Infants born during 2003 should be identified by using AGE03X = 0 in the Full Year Consolidated File

19. Mother/Newborn Expenditures

20. IP Stays Beginning with ER Visit EMERROOM is an unedited variable showing whether the IP stay began with an ER visit EMERROOM is an unedited variable showing whether the IP stay began with an ER visit ERHEVIDX is a constructed variable identifying the corresponding ER event in the ER file ERHEVIDX is a constructed variable identifying the corresponding ER event in the ER file In the 2004 IP file, only 562 of the 1,597 events identified as beginning with an ER visit could be linked to the corresponding event in the ER file. In the 2004 IP file, only 562 of the 1,597 events identified as beginning with an ER visit could be linked to the corresponding event in the ER file.

21. IP Stays Beginning with ER Visit (cont’d) If ERHEVIDX is a valid ID, facility expenditures for the corresponding ER event are on the IP record If ERHEVIDX is a valid ID, facility expenditures for the corresponding ER event are on the IP record The corresponding ER record can have separately billing doctor expenses but no facility expenses The corresponding ER record can have separately billing doctor expenses but no facility expenses – ERFXP04X = $0 – ERDXP04X > $0

22. Other Event File Detail Other Event File Detail Emergency room events Emergency room events Outpatient department events Outpatient department events Office-based medical provider events Office-based medical provider events Dental events Dental events Other medical events Other medical events

23. Services Received During ER, OP or OB Visit Laboratory tests Laboratory tests Sonogram/Ultrasound Sonogram/Ultrasound X-ray X-ray Mammogram Mammogram MRI/CAT SCAN MRI/CAT SCAN EKG/ECG EKG/ECG EEG EEG Vaccination Vaccination Anesthesia Anesthesia Other tests or exams Other tests or exams

24. Main Medical Provider (OP and OB Visits) Specialty if physician Specialty if physician Chiropractor Chiropractor Dentist/dental care person Dentist/dental care person Midwife Midwife Nurse/Nurse Practitioner Nurse/Nurse Practitioner Optometrist Optometrist Podiatrist Podiatrist Physician’s Assistant Physician’s Assistant Social Worker Social Worker Acupuncturist Acupuncturist Massage Therapist Massage Therapist Homeo/naturopathic or Herbalist Homeo/naturopathic or Herbalist Other Alternative or Complementary Care Other Alternative or Complementary Care

25. Treatments During an OP or OB Visit Physical therapy Physical therapy Occupational therapy Occupational therapy Speech therapy Speech therapy Chemotherapy Chemotherapy Radiation therapy Radiation therapy Kidney dialysis Kidney dialysis IV therapy IV therapy Treatment for drug or alcohol Treatment for drug or alcohol Received allergy shot Received allergy shot Psychotherapy or counseling Psychotherapy or counseling

26. Type of Provider Seen in Dental Visit General dentist General dentist Dental Hygienist Dental Hygienist Dental Technician Dental Technician Dental Surgeon Dental Surgeon Orthodontist Orthodontist Endodontist Endodontist Periodontist Periodontist Other Other

27. Dental Services and Procedures Diagnostic or preventative Diagnostic or preventative Restorative or endodontic Restorative or endodontic Periodontic Periodontic Oral surgery Oral surgery Prosthetics Prosthetics Orthodontics Orthodontics Other procedures Other procedures

28. Other Medical Expenses  Glasses/contacts  Insulin/diabetic supplies  Ambulance services  Orthopedic items  Hearing devices  Prostheses  Medical equipment  Disposable supplies  Bathroom aids  Home alterations

29. OM Data Collection Not included in MPC Not included in MPC Expenses are collected in Round 3 as a summary for the entire year Expenses are collected in Round 3 as a summary for the entire year Exceptions -- collected every round Exceptions -- collected every round – Glasses – Insulin and diabetic supplies

30. OM File Caveats A record can represent 1 or more purchases of an item or service; e.g., A record can represent 1 or more purchases of an item or service; e.g., – A $1,000 expenditure for ambulance services represents an unknown number of trips Not linked to conditions Not linked to conditions – It is not known which condition required the use of an ambulance

31. OM File Caveats (cont’d) Purchases of insulin and diabetic supplies are shown on the OM file Purchases of insulin and diabetic supplies are shown on the OM file Expenditures for the insulin and diabetic supplies are shown on the Prescribed Medicines File Expenditures for the insulin and diabetic supplies are shown on the Prescribed Medicines File – All expenditure variables for insulin and diabetic supplies on the OM file have a value of “-1”

32. MEPS Home Health File MEPS Home Health File

33. MEPS Home Health File What Is a Home Health Event? What Is a Home Health Event? – A home health event is a month of similar services provided by the same provider

34. MEPS Home Health File Who Are Home Health Providers? Who Are Home Health Providers? – Formal Providers (paid) Home health agency, hospital, or nursing home Home health agency, hospital, or nursing home Independent paid provider Independent paid provider – Informal Providers (unpaid) family family friends friends

35. MEPS Home Health File Type of home health worker was asked for home health care provided by an agency, hospital or nursing home Type of home health worker was asked for home health care provided by an agency, hospital or nursing home Check all that apply – can have more than one type of worker on a single record Check all that apply – can have more than one type of worker on a single record

36. MEPS Home Health File Treatments, therapies and services variables Treatments, therapies and services variables – For all home health events Was event due to a hospitalization Was event due to a hospitalization Was event due to a condition Was event due to a condition Was person helped with daily activities Was person helped with daily activities Did person receive companionship services Did person receive companionship services Did person receive other type of services Did person receive other type of services – Additional variables on file for formal providers only Was person taught how to use medical equipment Was person taught how to use medical equipment Did person receive medical treatment Did person receive medical treatment

37. MEPS Home Health File Frequency of visits variables Frequency of visits variables – Weeks per month – Days per week – Days per month – Summary variable – number of home health days person received care in a month (HHDAYS) Length of visits variables Length of visits variables – Times per day – Length of visit (hours, minutes)

38. MEPS Home Health File From where are the expenditure data derived? From where are the expenditure data derived? – Home health agency, hospital, and nursing home Sampled at a rate of 100% for MPC Sampled at a rate of 100% for MPC No household responses No household responses – Independent paid providers Not included in MPC Not included in MPC Household responses only Household responses only – Informal providers No expenditure data No expenditure data

39. MEPS Prescribed Medicines File

40. each record represents a unique prescribed medicine purchase and includes drug characteristics associated with that purchase each record represents a unique prescribed medicine purchase and includes drug characteristics associated with that purchase includes all prescribed medicines purchases reported by household respondents for the year (includes diabetic supply/equipment and insulin) includes all prescribed medicines purchases reported by household respondents for the year (includes diabetic supply/equipment and insulin) includes data collected from the household component and pharmacy component includes data collected from the household component and pharmacy component

41. MEPS Prescribed Medicines File Household Component (HC) variables collected in each round Household Component (HC) variables collected in each round – Medicine name – Number of times purchased – Used to treat a condition – Date first used – Pharmacy information – Names of free samples – Who files prescribed drug insurance claims

42. MEPS Prescribed Medicines File Pharmacy Component (PC) Pharmacy Component (PC) – Sample of approximately 8,000 pharmacies per year – Need signed permission form from respondent – Telephone and mail contact – Ask for computerized printout or “patient profile” to include: Date filled Date filled National drug code (NDC) National drug code (NDC) Drug name Drug name Drug characteristics Drug characteristics Sources and amounts of payment Sources and amounts of payment

43. MEPS Prescribed Medicines File Data Editing/Imputation Data Editing/Imputation – Pharmacy Component used as edit/imputation source – Generic codes assigned to each Household Component and Pharmacy Component event to assist with matching – Utilization is based on what the household reports – Outliers, data inconsistencies and missing data were identified and edited, as necessary

44. MEPS Prescribed Medicines File Drug characteristics included for each prescribed medicine event Drug characteristics included for each prescribed medicine event – Medication name – National drug code (NDC) – Quantity dispensed (e.g., 50) – Form (e.g., suspension) – Strength (e.g., 10) – Unit of measurement of form (e.g., cc) and strength (e.g., mg) – Brand/generic designation (from Multum Lexicon) – Therapeutic class, sub-class, and sub sub-class (from Multum Lexicon) – Pregnancy category (from Multum Lexicon)

45. MEPS Prescribed Medicines File Additional information included for each prescribed medicine record Additional information included for each prescribed medicine record – Round purchased – Date prescribed medicine was first taken – Type(s) of pharmacy – Conditions associated with prescribed medicine – Sources and amounts of payment – Total payment

46. Caveats of the Prescribed Medicines File Does not include expenditure imputation flag Does not include expenditure imputation flag Does not include a total charge variable Does not include a total charge variable Does not include flat fee variables Does not include flat fee variables