1. MEPS: A National Information Resource to Support Health Care Research & Policy AcademyHealth Meetings June 6, 2004 Steven B. Cohen PhD Joel W. Cohen PhD & Karen Beauregard MHA.

2. Presentation AHRQ new mission and emphasis on information and research effort that translate into policy and practice AHRQ new mission and emphasis on information and research effort that translate into policy and practice MEPS overview and design enhancements MEPS overview and design enhancements Program outreach and impact Program outreach and impact Research Update Research Update MEPS Data Products and Dissemination MEPS Data Products and Dissemination

3. New AHRQ Mission Statement To improve the quality, safety, efficiency, and effectiveness of health care for all Americans

4. 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.

5. WWW.MEPS.AHRQ.GOV

6. 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 Distribution of expenditures and sources of payment Role of demographics, family structure, insurance Role of demographics, family structure, insurance Measurement of expenditures in managed care Measurement of expenditures in managed care Expenditures for specific conditions Expenditures for specific conditions Trends over time Trends over time

7. MEPS Components Household Component (HC) Household Component (HC) Medical Provider Component (MPC) Medical Provider Component (MPC) Insurance Component (IC) Insurance Component (IC)

8. HC - Purpose Estimates annual health care use and expenditures Estimates annual health care use and expenditures Provides distributional estimates Provides distributional estimates Supports person and family level analysis Supports person and family level analysis Tracks changes in insurance coverage and employment Tracks changes in insurance coverage and employment

9. MEPS Household Component Sample Design Oversampling of policy relevant domains 1996 Minorities (Blacks & Hispanics) 1997 Minorities Low income Children with activity limitations Children with activity limitations Adults with functional limitations Adults with functional limitations Predicted high expenditure cases Predicted high expenditure cases Elderly Elderly 1998-2001 Minorities 2002+Minorities, Asians, Low Income

10. HC - Sample Sizes YearHouseholdsPersons 1996 9,400 23,500 1997 13,500 33,000 1998-2000 10,000 25,000 2001 13,500 33,000 2002 to present 15,000 37,000

11. MPC - Purpose Compensate for household nonresponse Compensate for household nonresponse Accuracy and detail Accuracy and detail Imputation source Imputation source Methodological studies Methodological studies

12. MPC - Targeted Sample All hospitals and associated physicians All hospitals and associated physicians All office-based physicians All office-based physicians All home health agencies All home health agencies All pharmacies All pharmacies

13. IC - Purpose Availability of health insurance Availability of health insurance Access to health insurance Access to health insurance Cost of health insurance Cost of health insurance Benefit and payment provisions of private health insurance Benefit and payment provisions of private health insurance

14. IC - Samples IC - Samples 30,000 establishments: derived from Census Bureau frame 30,000 establishments: derived from Census Bureau frame Employers linked to HC sample Employers linked to HC sample Data released in tabular form on MEPS website Data released in tabular form on MEPS website

15. Uninsured Status for the Non-elderly, 1996-2002

16. Concentration of Medical Expenditures 1987 and 1996 1% of the population accounts for almost 30% of expenses 1% of the population accounts for almost 30% of expenses 50% of the population accounts for only 3% of expenses 50% of the population accounts for only 3% of expenses This degree of concentration has been consistent over time This degree of concentration has been consistent over time Source: Berk and Monheit, “Concentration of Expenditures Revisited,” Health Affairs, March/April 2001.

17. Conditional Distributions by Percentile for Persistence of Expenditures

20. Targeted Research Efforts Trends in Cost, Coverage and Access Trends in Cost, Coverage and Access microsimulations of generic versions of health care reforms on coverage and expenditures PA on IMPACT OF PAYMENT AND ORGANIZATION ON COST, QUALITY AND EQUITY PA on IMPACT OF PAYMENT AND ORGANIZATION ON COST, QUALITY AND EQUITY Co-ordination of DHHS LTC Research and Data Development Plan Co-ordination of DHHS LTC Research and Data Development Plan

21. Recent MEPS Impact MEPS used to derive estimates of additional aggregate cost to nation of covering the uninsured: IOM Report “Hidden Costs, Value Lost” (June 2003). MEPS used to derive estimates of additional aggregate cost to nation of covering the uninsured: IOM Report “Hidden Costs, Value Lost” (June 2003). IOM report on “Health Insurance is a Family Matter” indicates “the most comprehensive data on who uses what health care services and how much is paid for those services comes from the Medical Expenditure Panel Survey” (Fall 2002). IOM report on “Health Insurance is a Family Matter” indicates “the most comprehensive data on who uses what health care services and how much is paid for those services comes from the Medical Expenditure Panel Survey” (Fall 2002). MEPS data used to estimate the costs of "uncompensated care”. The study revealed that in 2001, uninsured Americans received ~$35 billion worth of uncompensated care (Health Affairs, March/April 2003: J. Hadley and J. Holahan). MEPS data used to estimate the costs of "uncompensated care”. The study revealed that in 2001, uninsured Americans received ~$35 billion worth of uncompensated care (Health Affairs, March/April 2003: J. Hadley and J. Holahan).

22. AHRQ-Sponsored Research on Temporary Health Insurance Gaps Improves Estimates of the Uninsured and the Cost of the Provision of Coverage J.A. Rhoades, J.P. Vistnes, J.W. Cohen, The uninsured in America:1996-2000, MEPS Chartbook No. 9, 2002 Number of Uninsured In Millions Any Time in Year MEPS, 1996-1999 Uninsured Status, Non-elderly USA Today Bridge Temporary Insurance Gaps, 9/26/02 “…the focus should shift to measures of the number of Americans each year who have any gap in their coverage. From 1996 to 1999, between 59 million and 62 million Americans were uninsured at some point each year, according to a large- scale survey conducted by the federal Agency for Healthcare Research and Quality.”

23. Example of Use of MEPS Data Consumers’ Checkbook Guide to Health Plans

24. Annual publication Annual publication Rates every plan available to federal employees and retirees Rates every plan available to federal employees and retirees Compares likely cost of various plan options to employee Compares likely cost of various plan options to employee

25. Estimated 2004 cost to average family of 3 with head under 55

26. Pharmaceutical Costs Significance Significance – Recent spending on prescription drugs were over 10% of all health care expenditures – Recent annual growth rates exceed 15% – Insurance coverage an important policy issue AHRQ research can clarify: AHRQ research can clarify: – Effects of new drugs on overall health care costs – How prices vary by insurance status & type of drug – Effects of different coverage and payment options – Outcomes and effectiveness of pharmaceuticals

27. MEPS: Pharmacy Component 8000 pharmacies sampled 8000 pharmacies sampled – data on prescribed medicines purchased by households Data obtained: Data obtained: – Medication Name – National Drug Code (NDC) – Quantity Dispensed – Strength and Form – Sources of Payment – Amount Paid by Each Source

28. Types of Analyses Supported by MEPS Prescribed Medicine Data Trends in out of pocket burdens across all major population subgroups Trends in out of pocket burdens across all major population subgroups Examine burden on individuals and families Examine burden on individuals and families Prevalence of potentially inappropriate prescribing patterns Prevalence of potentially inappropriate prescribing patterns Trends in use and expenditures by therapeutic category: e.g. statins, anti-depressants, analgesics, proton pump inhibitors Trends in use and expenditures by therapeutic category: e.g. statins, anti-depressants, analgesics, proton pump inhibitors

29. Recent AHRQ Sponsored Medical Care Supplement “Health Care Costs, Coverage, and Access in the United States: Research Findings from the Medical Expenditure Panel Survey” This volume is dedicated to the memory of Dr. John M. Eisenberg in honor of his commitment to ensuring that health care is based on a strong foundation of research

31. Recent Conference on Policy Impact MEPS: Informing Policy on Health Insurance Coverage and Health Care Costs Highlight recent research efforts from the survey focused on healthcare costs and coverage that help inform consumer and purchaser decisions. Highlight recent research efforts from the survey focused on healthcare costs and coverage that help inform consumer and purchaser decisions. Facilitate discussion of utility of MEPS to inform policy and decisions by consumers and purchasers Facilitate discussion of utility of MEPS to inform policy and decisions by consumers and purchasers

32. Conference Agenda Patterns in Prescription Drug Expenditures Patterns in Prescription Drug Expenditures Moderator: Joel Cohen, AHRQ Private Insurance Markets Private Insurance Markets Moderator: Gail Shearer, Consumers Union Disabled, Rural, and Racial/Ethnic Minorities Disabled, Rural, and Racial/Ethnic Minorities Moderator: Alan Monheit, Univ. of Medicine, NJ Children’s Health Insurance Coverage Children’s Health Insurance Coverage Moderator: Linda Bilheimer, RWJF

33. The National Healthcare Quality Report

34. Background Mandated by Congress in the Healthcare Research and Quality Act (PL. 106-129) Mandated by Congress in the Healthcare Research and Quality Act (PL. 106-129) – “Beginning in fiscal year 2003, the Secretary, acting through the Director, shall submit to Congress an annual report on national trends in the quality of health care provided to the American people.”

36. Conceptual Framework

37. MEPS Enhancements to Measure Healthcare Quality Data to Support Quality of Care Analyses at the National Level Data currently collected on: access to care, patient/customer satisfaction, health insurance coverage, health status, health services utilization and expenditures.

38. MEPS Enhancements to Measure Healthcare Quality Content CAHPS: Patient satisfaction and accountability measures CAHPS: Patient satisfaction and accountability measures SF-12 SF-12 Attitude Items Attitude Items

42. Research Uses of the Medical Expenditure Panel Survey

43. Areas of Research Using MEPS Data Access, use, and quality Access, use, and quality Expenditures Expenditures Private and public health insurance Private and public health insurance Health status and health behaviors Health status and health behaviors Microsimulation modeling Microsimulation modeling Statistics and methods Statistics and methods

44. Outline Descriptive data Descriptive data – Insurance and expenditures Illustrative research findings Illustrative research findings Current research Current research

45. Percent Uninsured First Half of Year for Persons < 65 by Age, 2003 Source: 2003 Medical Expenditure Panel Survey

46. Insurance Status of Children for First Half of Year, 1996-2003 Source: 1996-2003 Medical Expenditure Panel Survey

47. Insurance Status of Children for First Half of Year, 1996-2003 Source: 1996-2003 Medical Expenditure Panel Survey

48. Health Insurance Premiums - Employee/Employer Contributions for Single Coverage 1996 - 2001 Average premiums increased 8.8% & employee contributions increased 10.8% over 2000, continuing the trend from previous years. AHRQ MEPS Insurance Component Index to Tables, www.meps.ahrq.gov/data pub/ic tables.htm

49. Health Insurance Premiums -Employee/Employer Contributions for Family Coverage 1996 - 2000 Average premiums increased 10.9% and employee contributions increased 7.8% over 2000, continuing the trend from previous years. AHRQ MEPS Insurance Component Index to Tables www.meps.ahrq.gov/data pub/ic tables.htm

50. Distribution of Health Expenses by Source of Payment, 2001 Source: Center for Financing, Access and Cost Trends,. Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2001.

51. Distribution of Health Expenses by Type of Service, 2001 Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2001.

52. Median and average medical expenses per person, 2001 Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2001

53. Concentration of Expenditures

54. Recent Publications CFACT staff CFACT staff – More than 50 publications in 2003-04 – Dedicated journal issues External users External users – Identified more than 70 articles in 2003-04 – Prescription drug costs and use – Expenditures by condition – Coverage of the uninsured

55. Ten Highest Cost Conditions Heart Disease ($58B) Heart Disease ($58B) Cancer ($46B) Cancer ($46B) Trauma ($44B) Trauma ($44B) Mental Disorders ($30B) Mental Disorders ($30B) Pulmonary Conditions ($29B) Pulmonary Conditions ($29B) Diabetes ($20B) Diabetes ($20B) Hypertension ($18B) Hypertension ($18B) Cerebrovascular Disease ($16B) Cerebrovascular Disease ($16B) Osteoarthritis ($16B) Osteoarthritis ($16B) Pneumonia ($16B) Pneumonia ($16B) Source: J. Cohen and N. Krauss, “Spending and Service Use Among People with the Fifteen Most Costly Medical Conditions, 1997,” Health Affairs, March/April 2003.

56. Percent of Population and Expenditures for Persons with Top 7 Conditions, 1997-98 Source: J. Cohen, “The Persistence of Expenditures for Persons With High Cost Conditions,” Center for Financing, Access and Cost Trends, AHRQ, 2003.

57. Rural-Urban Differences in Access and Use of Ambulatory Care Using a 9-category rural-urban scale, the most rural residents were more likely than metro residents to report a usual source of care. Using a 9-category rural-urban scale, the most rural residents were more likely than metro residents to report a usual source of care. However, the most rural residents also had fewer ambulatory visits than metro residents. However, the most rural residents also had fewer ambulatory visits than metro residents. Intermediate areas on the rural-urban scale did not differ from metro areas in number of visits. Intermediate areas on the rural-urban scale did not differ from metro areas in number of visits. The metropolitan-nonmetropolitan dichotomy may be too gross to capture geographic differences in health service use. The metropolitan-nonmetropolitan dichotomy may be too gross to capture geographic differences in health service use. Source: Larson and Fleishman, “Rural-urban differences in usual sources of care and ambulatory service use: analyses of National data using urban influence codes, Medical Care, July 2003.

58. Percent with Employer-Sponsored Health Insurance Source: Rural-Urban Differences in Employment-Related Health Insurance Sharon L. Larson, Ph.D. Steven C. Hill, Ph.D., Center for Financing, Access and Cost Trends, AHRQ. 1996-1998 MEPS Round 1(pooled).

59. Offer and Take-up of Employer Sponsored Insurance OfferTake-up Source: Rural-Urban Differences in Employment-Related Health Insurance Sharon L. Larson, Ph.D., Steven C. Hill, Ph.D., Center for Financing, Access and Cost Trends, AHRQ 1996-1998 MEPS Round 1(pooled)..

60. Employer-Sponsored Health Insurance Offers 19971998199920002001 % of Estabs that Offer Insurance 5255585958 % of Estabs with Health Insurance that Offer 1 Plan 7268707170 % of Estabs with Health Insurance that Offer >1 Plan 2832302930 Source: “Contributions to Health Insurance Premiums When Does the Employer Pay 100 Percent?” Alice M. Zawacki, Ph.D.,U.S. Census Bureau and Amy K. Taylor, Ph.D.,Agency for Healthcare Research and Quality

61. Percent of Establishments that Pay 100% of Premium for at Least One Plan Source: “Contributions to Health Insurance Premiums When Does the Employer Pay 100 Percent?” Alice M. Zawacki, Ph.D.,U.S. Census Bureau and Amy K. Taylor, Ph.D.,Agency for Healthcare Research and Quality

62. Enrollment Rates by Wage Distribution and Single Employee Contribution Levels 1999 Enrollment rates at establishments with zero employee contributions were higher than at those with positive employee contributions. Enrollment rates at establishments with zero employee contributions were higher than at those with positive employee contributions. Low-wage establishments had lower enrollment rates than other establishments under either contribution scenario. Low-wage establishments had lower enrollment rates than other establishments under either contribution scenario. Source: Cooper and Vistnes,” Workers’ Decisions to Take-Up Offered Health Insurance Coverage: Assessing the Importance of Out-of-Pocket Premiums Costs,” Medical Care, July 2003.

63. Insurance Take-Up Decisions are Sensitive to Tax Subsidies Tax responsiveness is greater among three groups of great policy interest: workers in small firms workers in small firms workers with low incomes workers with low incomes workers with low health risks workers with low health risks Source: D. Bernard and T. Selden, ” Private Health Coverage and the Tax Subsidy for Insurance: 1987 and 1996,” 2003, International Journal of Health Care Finance and Economics

64. Medicaid expansions reduced financial burdens for health care among eligible children and their families between 1987 and 1996 The percent of children eligible for the Medicaid expansions who lived in families spending 10% or more of family income on health care dropped from 30% to 24% between 1987 and 1996, compared to the control group where this measure increased from 20% to 21%. The percent of children eligible for the Medicaid expansions who lived in families spending 10% or more of family income on health care dropped from 30% to 24% between 1987 and 1996, compared to the control group where this measure increased from 20% to 21%. Source: JBanthin and TSelden, “The ABC’s of Children’s Health Care…” Inquiry 40:73-85 (Summer 2003)

65. Marginal Cost of SCHIP (Savings from cuts to program) StateFedTotal Budget$282$596$878 Rev Crowd $5$48$54 Med Need $128$149$277 Uncomp$51$0$51 Net Saving $98$399$496 “How Much Can States Really Save by Rolling Back SCHIP?” T. Selden and J. Hudson, Center for Financing, Access and Cost Trends, AHRQ.

66. Examples of Current Research SCHIP and employer crowd out SCHIP and employer crowd out Factors associated with persistence of expenditures Factors associated with persistence of expenditures Use of capitation and effects on provider behavior Use of capitation and effects on provider behavior Prescription drugs and mental health treatment Prescription drugs and mental health treatment

67. MEPS Data Products and Dissemination

68. MEPS Public Use Data Methods of Dissemination MEPS web site MEPS web site – www.meps.ahrq.gov AHRQ clearinghouse AHRQ clearinghouse – CD-ROM – 800-358-9295 Questions? Questions? – MEPSPD@ahrq.gov

69. WWW.MEPS.AHRQ.GOV

70. New Workshops September 20-21 - Hands-on Workshop in Rockville- Using the MEPS Prescribed Drug and Condition Files September 20-21 - Hands-on Workshop in Rockville- Using the MEPS Prescribed Drug and Condition Files November 30-Dec 1 - Hands-on Workshop in Rockville – MEPS Linking Issues (NHIS, Conditions, Jobs, PRPL, Events, Pooling, Longitudinal Analysis) November 30-Dec 1 - Hands-on Workshop in Rockville – MEPS Linking Issues (NHIS, Conditions, Jobs, PRPL, Events, Pooling, Longitudinal Analysis) Cyber Seminars- 2005 Cyber Seminars- 2005

71. MEPS Mailing List/List Server Mailing List/List Server Mailing List/List Server click on “Mail List/List Server” from Web site click on “Mail List/List Server” from Web site both receive e-mail notices of data and publications released on the Web both receive e-mail notices of data and publications released on the Web List Server allows for interactive exchange of ideas and information List Server allows for interactive exchange of ideas and information

72. MEPS Data Product Information Types of Products Types of Products Upcoming Data Releases Upcoming Data Releases MEPS Data Center MEPS Data Center

73. MEPS Data Products Publications (Findings, Methods, Chartbooks) Publications (Findings, Methods, Chartbooks) Stat Briefs Stat Briefs On-line tables On-line tables MEPS-NET MEPS-NET Micro-data files Micro-data files – Public use – Data Center

74. Recent Statistical Briefs Health Care Expenditures and Percentage Uninsured 10 Large MSA’s, 2000 Health Care Expenditures and Percentage Uninsured 10 Large MSA’s, 2000 Estimates of Uninsured in Working Families, 2002 Estimates of Uninsured in Working Families, 2002 Health Insurance Coverage and Income Levels, 2001 Health Insurance Coverage and Income Levels, 2001 Out-patient Prescribed Medicines: A comparison of Use and Expenditures, 1987 and 2001 Out-patient Prescribed Medicines: A comparison of Use and Expenditures, 1987 and 2001

78. Figure 2. Average total and out-of-pocket costs for prescribed medicines for those with a prescribed medicine purchase, 1987 and 2001 Note: Estimates for 1987 were adjusted for inflation to 2001 dollars using data from the 1987 and 2001 Consumer Price Index for All Urban Consumers.

79. Brand New Insurance Stat Briefs Uninsured in America, 2003 Uninsured in America, 2003 Trends in Health Insurance, 96-03 Trends in Health Insurance, 96-03 Uninsured Children, 2003 Uninsured Children, 2003

80. Source: Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey Figure 5: Percent Uninsured by Marital Status People Under Age 65, First Half of 2003 Percent

81. Source: Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey Figure 2: MEPS, 1996-2003 Uninsured Status, Non-elderly Number in Millions

82. Source: Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey Figure 3: Percent of Children Under 18 years with Public Only Health Insurance by Age, 1996-2003 Percent

83. Statistical Briefs Planned for 2004 P-med Expenditures by Condition P-med Expenditures by Condition Hypertension Hypertension PSA Screening PSA Screening Children’s Usual Sources of Care Children’s Usual Sources of Care

84. Recent Chartbooks Outpatient Prescribed Drug Expenses, 1999 Outpatient Prescribed Drug Expenses, 1999 Health Care Expenses in the Community Population, 1999 Health Care Expenses in the Community Population, 1999

85. Chartbooks Planned for 2004 Health Care in Urban and Rural Areas (1998-2000 combined) Health Care in Urban and Rural Areas (1998-2000 combined) Race and Ethnic Differences in Health:1996-2001 Race and Ethnic Differences in Health:1996-2001

86. Recent Findings Health Care Expenses for Injuries 1997 Health Care Expenses for Injuries 1997 Dental Services, Use, Expenses, and Sources of Payment 1996-2000 Dental Services, Use, Expenses, and Sources of Payment 1996-2000

87. Findings Reports Planned for 2004 Restricted Activity Days: 97-2001 Restricted Activity Days: 97-2001 Health Care Expenditures: 2000 Health Care Expenditures: 2000 Medical Expenditures for Women: 2000 Medical Expenditures for Women: 2000 Children with Special Health Care Needs: 2000 Children with Special Health Care Needs: 2000 Trends in Antibiotic Use 96-2001 Trends in Antibiotic Use 96-2001

88. Upcoming MEPS Data Releases 2002 Use File - Including Quality Variables (June 2004) 2002 Use File - Including Quality Variables (June 2004) 2002 Jobs file (June 2004) 2002 Jobs file (June 2004) 2002 NHIS Link file (June 2004 2002 NHIS Link file (June 2004 2003 Insurance File (July 2004) 2003 Insurance File (July 2004) 2003 IC Tables (August 2004) 2003 IC Tables (August 2004)

89. Upcoming Data Releases 2002 Event files (September-November 2004) 2002 Event files (September-November 2004) Panel 5 Longitudinal Weight ( October 2004) Panel 5 Longitudinal Weight ( October 2004) 2002 Conditions (December 2004) 2002 Conditions (December 2004) 2002 Use and Expenditures (December 2004) 2002 Use and Expenditures (December 2004) Multim P-med Data (TBD ) Multim P-med Data (TBD )

90. MEPS Tables Compendia

91. MEPS-HC Tables Compendia Sets of Static tables with flexibility to redefine categories Sets of Static tables with flexibility to redefine categories Full year tables for expenditures Full year tables for expenditures First part of year tables for insurance coverage First part of year tables for insurance coverage Expenditure by Condition Tables (people, events, and total expenditures by site of service) Expenditure by Condition Tables (people, events, and total expenditures by site of service)

94. National-level MEPS-IC Tables (Table I) Firm Size by: Firm Size by: – Industry Groups – Ownership type (Profit / Non-Profit) – Age of firm – % full-time employees – % low-wage employees – Union presence

95. MEPS-IC State Tables (II, V, VI, VII, and VIII) State by: State by: – Size of firm (Table II) – Industry groupings (Table V) – Ownership type (Table VI) – Age of firm (Table VI)

96. MEPS-IC State Tables (II, V, VI, VII, and VIII) State by: State by: – Proportion of Employees who are Full-time (Table VII) – Proportion of Employees who are Low-wage (Table VII) – Average Wage Quartiles (Table VIII)

97. MEPS-IC Public-Sector Tables (Table III) State and local governments by: State and local governments by: – Size of government – Census division

98. Table Structure Establishments Establishments Employees Employees Single Premiums and Employee Contributions Single Premiums and Employee Contributions Family Premiums and Employee Contributions Family Premiums and Employee Contributions Employee-Plus-One Premiums and Employee Contributions Employee-Plus-One Premiums and Employee Contributions

99. National Totals of Enrollees and Cost of Health Insurance (Table IV) Public and private sectors Public and private sectors Private-sector by: Private-sector by: – Industry – Purchased/self-insured plans – Optional coverage (single service plans) Public-sector by: Public-sector by: – Purchased/self-insured plans – Optional coverage (single service plans)

100. MEPS-net

101. MEPSnet An on-line interactive statistical computer system An on-line interactive statistical computer system Provides immediate access to data in a non-programming environment Provides immediate access to data in a non-programming environment MEPSnet is a set of statistical tools MEPSnet is a set of statistical tools – MEPSnet/HC – MEPSnet/IC

102. MEPS-net HC Currently has the capacity to produce use, expenditure, source of payment and health insurance estimates for all years (including standard errors) Currently has the capacity to produce use, expenditure, source of payment and health insurance estimates for all years (including standard errors) Plans to add quality data in 2004, and Access data in 2005 Plans to add quality data in 2004, and Access data in 2005

103. MEPSnet IC Interactive Data Tool Step-by-Step search for estimates. Step-by-Step search for estimates. Estimates shown for all years available. Estimates shown for all years available. Graphical display of year-to-year trend with two- standard deviation error bars displayed. Graphical display of year-to-year trend with two- standard deviation error bars displayed. Links back to table from which data derived. Links back to table from which data derived.

104. AHRQ Data Center Provides researchers access to non-public use MEPS data (except directly identifiable information); Provides researchers access to non-public use MEPS data (except directly identifiable information); Mode of data analysis Mode of data analysis – on a secure LAN at AHRQ, Rockville – task order agreement with data contractor – combinations of both.

105. ADC Facilities Secure room Secure room Terminal connected to secure LAN Terminal connected to secure LAN SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS software available, and others upon request SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS software available, and others upon request Limited staff support by people who know: Limited staff support by people who know: – the data – the confidentiality issues – the software

106. Application And Review Process Application procedures are on the MEPS web site Application procedures are on the MEPS web site Submit proposal to data center coordinator Submit proposal to data center coordinator Review within 1 week for feasibility, and data availability Review within 1 week for feasibility, and data availability Internal review board (IRB) review required Internal review board (IRB) review required

107. 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 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) (additional programming support available at cost of 80.00/hr) User fee waived for full-time students User fee waived for full-time students

108. ADC Procedures May bring data in, but not out May bring data in, but not out Access only to data needed for approved project Access only to data needed for approved project Tabular data will be reviewed for confidentiality Tabular data will be reviewed for confidentiality Only approved tables can leave the Center Only approved tables can leave the Center Center will store data files, foreign merge files, and all outputs needed for replication Center will store data files, foreign merge files, and all outputs needed for replication

109. 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. 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.

110. Confidential Data Available for Data Center Projects 1996 Nursing Home Data 1996 Nursing Home Data Linked HC - Secondary Data (full geo-coding for 1996, 1997 and 2000, FIPS codes for other years) Linked HC - Secondary Data (full geo-coding for 1996, 1997 and 2000, FIPS codes for other years) MPC data MPC data

111. Confidential Data Available for Data Projects Fully specified industry/occupation codes Fully specified industry/occupation codes Imputed NDC codes Imputed NDC codes Continuous poverty measure Continuous poverty measure Linked HC-IC Data Linked HC-IC Data

112. Summary MEPS overview and design enhancements MEPS overview and design enhancements Patient satisfaction and healthcare quality measurement: NHQR, NHDR Patient satisfaction and healthcare quality measurement: NHQR, NHDR Program outreach and impact Program outreach and impact Research Update Research Update MEPS Data Products and Dissemination MEPS Data Products and Dissemination Greater emphasis on program initiatives that enhance analytic utility of data and research efforts that inform health care policy and practice Greater emphasis on program initiatives that enhance analytic utility of data and research efforts that inform health care policy and practice