MEPS HC-059B: 2001 Dental Visits
December 2003
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406
Table of Contents
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Insurance Component
4.0 Survey Management
C. Technical and Programming Information
1.0 General Information
2.0 Data File Information
2.1 Using MEPS Data for Trend and
Longitudinal Analysis
2.2 Codebook Structure
2.3 Reserved Codes
2.4 Codebook Format
2.5 Variable Source and Naming Conventions
2.5.1 Variable - Source Crosswalk
2.5.2 Expenditure and Sources of Payment Variables
2.6 File Contents
2.6.1 Survey Administration Variables
2.6.1.1 Person Identifiers (DUID, PID, DUPERSID)
2.6.1.2 Record Identifiers (EVNTIDX, FFEEIDX)
2.6.1.3 Round Indicator (EVENTRN)
2.6.2 Dental Event Variables
2.6.2.1 Date of Visit (DVDATEYR – DVDATEDD)
2.6.2.2 Type of Provider Seen (GENDENT - DENTYPE)
2.6.2.3 Treatment, Procedures, and Services (EXAMINE -
DENTMED)
2.6.3 Flat Fee Variables (FFEEIDX, FFDVTYPE, FFBEF01,
FFTOT02)
2.6.3.1 Definition of Flat Fee Payments
2.6.3.2 Flat Fee Variable Descriptions
2.6.3.2.1 Flat Fee ID (FFEEIDX)
2.6.3.2.2 Flat Fee Type (FFDVTYPE)
2.6.3.2.3 Counts of Flat Fee Events that Cross Years
(FFBEF01, FFTOT02)
2.6.3.3 Caveats of Flat Fee Groups
2.6.4 Expenditure Data
2.6.4.1 Definition of Expenditures
2.6.4.2 Data Editing and Imputation Methodologies of
Expenditure Variables
2.6.4.2.1 General Data Editing Methodology
2.6.4.2.2 General Hot-Deck Imputation
2.6.4.2.3 Dental Data Editing and
Imputation
2.6.4.4 Imputation Flag Variable (IMPFLAG)
2.6.4.5 Flat Fee Expenditures
2.6.4.6 Zero Expenditures
2.6.4.7 Sources of Payment
2.6.4.8 Dental Expenditure Variables (DVSF01X- DVTC01X)
2.6.4.9 Rounding
3.0 Sample Weight (PERWT01F)
3.1 Overview
3.2 Details on Person Weight Construction
3.2.1 MEPS Panel 5 Weight
3.2.2 MEPS Panel 6 Weight
3.2.3 The Final Weight for 2001
3.2.4 Coverage
4.0 Strategies for Estimation
4.1 Variables with Missing Values
4.2 Basic Estimates of Utilization, Expenditures, and
Sources of Payment
4.3 Estimates of the Number of Persons with Dental Visits
4.4 Person-Based Ratio Estimates
4.4.1 Person-Based Ratio Estimates Relative to Persons
with Dental Visits
4.4.2 Person-Based Ratio Estimates Relative to the Entire
Population
4.5 Sampling Weights for Merging Previous Releases of MEPS
Household Data with this Event File
4.6 Variance Estimation (VARPSU01, VARSTR01)
5.0 Merging/Linking MEPS Data Files
5.1 Linking a 2001 Person-Level File to the 2001 Dental
File
5.2 Linking the 2001 Dental File to the 2001 Prescribed
Medicines File
5.2.1 Limitations/Caveats of RXLK (the Prescribed Medicine
Link File)
References
D. Variable-Source Crosswalk
A. Data Use Agreement
Individual identifiers have been removed from the
micro-data contained in these files. Nevertheless, under sections 308 (d) and
903 (c) of the Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1),
data collected by the Agency for Healthcare Research and Quality (AHRQ) and/or
the National Center for Health Statistics (NCHS) may not be used for any purpose
other than for the purpose for which they were supplied; any effort to determine
the identity of any reported cases is prohibited by law.
Therefore in accordance with the above referenced Federal
Statute, it is understood that:
- No one is to use the data in this data set in any
way except for statistical reporting and analysis; and
- If the identity of any person or establishment
should be discovered inadvertently, then (a) no use will be made of this
knowledge, (b) the Director, Office of Management, AHRQ will be advised of
this incident, (c) the information that would identify any individual or
establishment will be safeguarded or destroyed, as requested by AHRQ, and
(d) no one else will be informed of the discovered identity; and
- No one will attempt to link this data set with
individually identifiable records from any data sets other than the
Medical Expenditure Panel Survey or the National Health Interview Survey.
By using these data you signify your agreement to comply
with the above stated statutorily based requirements with the knowledge that
deliberately making a false statement in any matter within the jurisdiction of
any department or agency of the Federal Government violates Title 18 part 1
Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5
years in prison.
The Agency for Healthcare Research and Quality requests
that users cite AHRQ and the Medical Expenditure Panel Survey as the data source
in any publications or research based upon these data.
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B. Background
The Medical Expenditure Panel Survey (MEPS) provides
nationally representative estimates of health care use, expenditures, sources of
payment, and insurance coverage for the U.S. civilian noninstitutionalized
population. MEPS is cosponsored by the Agency for Healthcare Research and
Quality (AHRQ) and the National Center for Health Statistics (NCHS).
MEPS is a family of three surveys. The Household Component
(HC) is the core survey and forms the basis for the Medical Provider Component (MPC)
and part of the Insurance Component (IC). Together these surveys yield
comprehensive data that provide national estimates of the level and distribution
of health care use and expenditures, support health services research, and can
be used to assess health care policy implications.
MEPS is the third in a series of national probability
surveys conducted by AHRQ on the financing and use of medical care in the United
States. The National Medical Care Expenditure Survey (NMCES, also known as
NMES-1) was conducted in 1977 and the National Medical Expenditure Survey
(NMES-2) in 1987. Since 1996, MEPS continues this series with design
enhancements and efficiencies that provide a more current data resource to
capture the changing dynamics of the health care delivery and insurance systems.
The design efficiencies incorporated into MEPS are in
accordance with the Department of Health and Human Services (DHHS) Survey
Integration Plan of June 1995, which focused on consolidating DHHS surveys,
achieving cost efficiencies, reducing respondent burden, and enhancing
analytical capacities. To advance these goals, MEPS includes linkage with the
National Health Interview Survey (NHIS) - a survey conducted by NCHS from which
the sample for the MEPS HC is drawn - and enhanced longitudinal data collection
for core survey components. The MEPS HC augments NHIS by selecting a sample of
NHIS respondents, collecting additional data on their health care expenditures,
and linking these data with additional information collected from the
respondents’ medical providers, employers, and insurance providers.
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1.0 Household Component
The MEPS HC, a nationally representative survey of the
U.S. civilian noninstitutionalized population, collects medical expenditure data
at both the person and household levels. The HC collects detailed data on
demographic characteristics, health conditions, health status, use of medical
care services, charges and payments, access to care, satisfaction with care,
health insurance coverage, income, and employment.
The HC uses an overlapping panel design in which data are
collected through a preliminary contact followed by a series of five rounds of
interviews over a 2 ½-year period. Using computer-assisted personal interviewing
(CAPI) technology, data on medical expenditures and use for two calendar years
are collected from each household. This series of data collection rounds is
launched each subsequent year on a new sample of households to provide
overlapping panels of survey data and, when combined with other ongoing panels,
will provide continuous and current estimates of health care expenditures.
The sampling frame for the MEPS HC is drawn from
respondents to NHIS. NHIS provides a nationally representative sample of the
U.S. civilian noninstitutionalized population, with oversampling of Hispanics
and blacks.
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2.0 Medical Provider Component
The MEPS MPC supplements and/or replaces information on
medical care events reported in the MEPS HC by contacting medical providers and
pharmacies identified by household respondents. The MPC sample includes all home
health agencies and pharmacies reported by HC respondents. Office-based
physicians, hospitals, and hospital physicians are also included in the MPC but
may be subsampled at various rates, depending on burden and resources, in
certain years.
Data are collected on medical and financial
characteristics of medical and pharmacy events reported by HC respondents. The
MPC is conducted through telephone interviews and record abstraction.
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3.0 Insurance Component
The MEPS IC collects data on health insurance plans
obtained through private and public-sector employers. Data obtained in the IC
include the number and types of private insurance plans offered, benefits
associated with these plans, premiums, contributions by employers and employees,
eligibility requirements, and employer characteristics.
Establishments participating in the MEPS IC are selected
through three sampling frames:
- A list of employers or other insurance providers
identified by MEPS HC respondents who report having private health insurance
at the Round 1 interview.
- A Bureau of the Census list frame of private sector
business establishments.
- The Census of Governments from Bureau of the Census.
To provide an integrated picture of health insurance, data
collected from the first sampling frame (employers and insurance providers
identified by MEPS HC respondents) are linked back to data provided by those
respondents. Data from the two Census Bureau sampling frames are used to produce
annual national and state estimates of the supply and cost of private health
insurance available to American workers and to evaluate policy issues pertaining
to health insurance. National estimates of employer contributions to group
insurance from the MEPS IC are used in the computation of Gross Domestic Product
(GDP) by the Bureau of Economic Analysis.
The MEPS IC is an annual survey. Data are collected from
the selected organizations through a prescreening telephone interview, a mailed
questionnaire, and a telephone follow-up for nonrespondents.
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4.0 Survey Management
MEPS data are collected under the authority of the Public
Health Service Act. They are edited and published in accordance with the
confidentiality provisions of this act and the Privacy Act. NCHS provides
consultation and technical assistance.
As soon as data collection and editing are completed, the
MEPS survey data are released to the public in staged releases of summary
reports, microdata files and compendiums of tables. Data are released through
MEPSnet, an online interactive tool developed to give users the ability to
statistically analyze MEPS data in real time. Summary reports and compendiums of
tables are released as printed documents and electronic files. Microdata files
are released as electronic files.
Selected printed documents are available through the AHRQ
Publications Clearinghouse. Write or call:
AHRQ Publications Clearinghouse
Attn: (publication number)
P.O. Box 8547
Silver Spring, MD 20907
800-358-9295
410-381-3150 (callers outside the United States
only)
888-586-6340 (toll-free TDD service; hearing
impaired only)
Be sure to specify the AHRQ number of the document you are
requesting.
Additional information on MEPS is available from the MEPS
project manager or the MEPS public use data manager at the Center for Financing,
Access and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither
Road, Rockville, Md 20850 (301-427-1406).
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C. Technical and Programming Information
1.0 General Information
This documentation describes one in a series of public use
event files from the 2001 Medical Expenditure Panel Survey (MEPS) Household
Component (HC). Released as an ASCII data file and a SAS transport file, the
2001 Dental public use file provides detailed information on dental events for a
nationally representative sample of the civilian noninstitutionalized population
of the United States. Data from the Dental file can be used to make estimates of
dental event utilization and expenditures for calendar year 2001. As illustrated
below, this file consists of MEPS survey data obtained in the 2001 portion of
Round 3 and Rounds 4 and 5 for Panel 5, as well as Rounds 1, 2 and the 2001
portion of Round 3 for Panel 6 (i.e., the rounds for the MEPS panels covering
calendar year 2001).
301 Moved Permanently
301 Moved Permanently
Each record on this event file represents a unique dental
event; that is, a dental event reported by the household respondent. Counts of
dental event utilization are based entirely on household reports. Dental events
were not included in the Medical Provider Component (MPC); therefore, all
expenditure and payment data on the Dental event file are reported by the
household.
Data from this event file can be merged with other 2001
MEPS HC data files for the purposes of appending person-level data such as
demographic characteristics or health insurance coverage to each Dental record.
This file can also be used to construct summary variables
of expenditures, sources of payment, and related aspects of the dental event.
Aggregate annual person-level information on the use of dental events and other
health services use is provided on the MEPS 2001 Full Year Consolidated Data
File where each record represents a MEPS sampled person.
The following documentation offers a brief overview of the
types and levels of data provided, and the content and structure of the file and
the codebook. It contains the following sections:
Data File Information
Sample Weights
Strategies for Estimation
Merging/Linking MEPS Data Files
References
Variable - Source Crosswalk
For more information on MEPS HC survey design, see S.
Cohen, 1997; J. Cohen, 1997; and S. Cohen, 1996. A copy of the MEPS HC survey
instrument used to collect the information on the dental file is available on
the MEPS web site at the following address: <http://www.meps.ahrq.gov>.
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2.0 Data File Information
The 2001 Dental public use data set consists of one
event-level data file. The file contains characteristics associated with the
dental event and imputed expenditure data. For users wanting to impute
expenditures, pre-imputed data are available through the Center for Financing,
Access and Cost Trends (CFACT) data center. Please visit the CFACT Data Center
web site for details: <http://www.meps.ahrq.gov/mepsweb/data_stats/onsite_datacenter.jsp>.
The data user/analyst is forewarned that the imputation of expenditures will
necessitate a sizable commitment of resources: financial, staff, and time.
The 2001 Dental public use data set contains 30,927 dental
event records; of these records, 30,339 are associated with persons having a
positive person-level weight (PERWT01F). This file includes dental event records
for all household survey respondents who resided in eligible responding
households and reported at least one dental event. Each record represents one
household-reported dental event that occurred during calendar year 2001. Dental
visits known to have occurred before January 1, 2001 and after December 31, 2001
are not included on this file. Some household respondents may have multiple
dental events and thus will be represented in multiple records on this file.
Other household respondents may have reported no dental events and thus will
have no records on this file. These data were collected during the 2001 portion
of Round 3, and Rounds 4 and 5 for Panel 5, as well as Rounds 1, 2, and the 2001
portion of Round 3 for Panel 6 of the MEPS HC. The persons represented on this
file had to meet either (a) or (b) below:
- Be classified as a key in-scope person who
responded for his or her entire period of 2001 eligibility (i.e.,
persons with a positive 2001 full-year person-level weight (PERWT01F >
0)), or
- Be an eligible member of a family all of whose key
in-scope members have a positive person-level weight (PERWT01F > 0).
(Such a family consists of all persons with the same value for FAMIDYR.)
That is, the person must have a positive full-year family-level weight
(FAMWT01F >0). Note that FAMIDYR and FAMWT01F are variables on the 2001
Population Characteristics file.
Persons with no dental events for 2001 are not included on
this event-level file but are represented on the 2001 MEPS person-level file. A
codebook for that data file is provided in H55CB.PDF and H55CB.ASP.
Each dental event record includes the following: date of
the dental event; type of provider seen; procedure(s) associated with the dental
event; whether or not medicines were prescribed; flat fee information; imputed
sources of payment; total payment and total charge of the dental event
expenditure; and a full-year person-level weight.
Data from this file can be merged with the MEPS 2001 Full
Year Population Characteristics File using the unique person identifier,
DUPERSID, to append person-level information such as demographic or health
insurance characteristics to each record. Dental events can also be linked to
the MEPS 2001 Prescribed Medicine File. Please see section 5.0 or the 2001
Appendix for details on how to merge MEPS data files.
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2.1 Using MEPS Data for Trend and
Longitudinal Analysis
MEPS began in 1996 and several annual data files have been
released. As more years of data are produced, MEPS will become increasingly
valuable for examining health care trends. However, it is important to consider
a variety of factors when examining trends over time using MEPS. Statistical
significance tests should be conducted to assess the likelihood that observed
trends are attributable to sampling variation. MEPS expenditures estimates are
especially sensitive to sampling variation due to the underlying skewed
distribution of expenditures. For example, 1 percent of the population accounts
for about one-quarter of all expenditures. The extent to which observations with
extremely high expenditures are captured in the MEPS sample varies from year to
year (especially for smaller population subgroups), which can produce
substantial shifts in estimates of means or totals that are simply an artifact
of the sample(s). The length of time being analyzed should also be considered.
In particular, large shifts in survey estimates over short periods of time (e.g.
from one year to the next) that are statistically significant should be
interpreted with caution, unless they are attributable to known factors such as
changes in public policy or MEPS survey methodology. Looking at changes over
longer periods of time can provide a more complete picture of underlying trends.
Analysts may wish to consider using techniques to smooth or stabilize trends
analyses of MEPS data such as pooling time periods for comparison (e.g. 1996-97
versus 1998-99), working with moving averages, or using modeling techniques with
several consecutive years of MEPS data to test the fit of specified patterns
over time. Finally, researchers should be aware of the impact of multiple
comparisons on Type I error because performing numerous statistical significance
tests of trends increases the likelihood of inappropriately concluding a change
is statistically significant.
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2.2 Codebook Structure
For each variable on the Dental Events
file, both weighted and unweighted frequencies are provided in the codebook
files (H59BCB.PDF and H59BCB.ASP). The codebook and data file sequence list
variables in the following order:
Unique person identifier
Unique dental event identifier
Dental characteristic variables
Imputed expenditure variables
Weight and variance estimation
variables
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2.3 Reserved Codes
The following reserved code values are used:
Value |
Definition |
-1 INAPPLICABLE |
Question was not asked due to skip pattern. |
-7 REFUSED |
Question was asked and respondent refused to answer question. |
-8 DK |
Question was asked and respondent did not know answer. |
-9 NOT ASCERTAINED |
Interviewer did not record the data. |
Generally, values of -1, -7, -8, and -9 for
non-expenditure variables have not been edited on this file. The values of -1
and -9 can be edited by the data users/analysts by following the skip patterns
in the HC survey questionnaire (located on the MEPS web site: <http://www.meps.ahrq.gov/mepsweb/survey_comp/survey.jsp>).
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2.4 Codebook Format
The codebook describes an ASCII data set
(although the data are also being provided in a SAS transport file). The
following codebook items are provided for each variable:
Identifier |
Description |
Name |
Variable name (maximum of 8 characters) |
Description |
Variable descriptor (maximum of 40 characters) |
Format |
Number of bytes |
Type |
Type of data: numeric (indicated by NUM) or character (indicated by CHAR) |
Start |
Beginning column position of variable in record |
End |
Ending column position of variable in record |
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2.5 Variable Source and Naming Conventions
In general, variable names reflect the content of the
variable, with an eight-character limitation. All imputed/edited variables end
with an "X".
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2.5.1 Variable - Source Crosswalk
Variables were derived from the HC survey questionnaire or
from the CAPI. The source of each variable is identified in Section D "Variable
- Source Crosswalk" in one of four ways:
- Variables derived from CAPI or assigned in sampling
are so indicated as "Capi derived" or "Assigned in sampling,"
respectively;
- Variables which come from one or more specific
questions have those questionnaire sections and question numbers indicated
in the "Source" column; questionnaire sections are identified as:
- FF - Flat Fee section
- DN - Dental Event section
- CP - Charge Payment section
- Variables constructed from multiple questions using
complex algorithms are labeled "Constructed" in the "Source" column; and
- Variables that have been edited or imputed are so
indicated.
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2.5.2 Expenditure and Sources of Payment
Variables
The names of the expenditure and sources of payment
variables follow a standard convention, are seven characters in length, and end
in an "X" indicating edited/imputed. Please note that imputed means that a
series of logical edits, as well as an imputation process to account for missing
data, have been performed on the variable.
The total sum of payments and 12 sources of payment are
named in the following way:
The first two characters indicate the type of event:
IP - inpatient stay |
OB - office-based visit |
ER - emergency room visit |
OP - outpatient visit |
HH - home health visit |
DV - dental visit |
OM - other medical equipment |
RX - prescribed medicine |
In the case of the source of payment
variables, the third and fourth characters indicate:
SF - self or family |
OF - other Federal Government |
MR – Medicare |
SL - State/local government |
MD – Medicaid |
WC - Workers’ Compensation |
PV - private insurance |
OT - other insurance |
VA – Veterans Administration |
OR - other private |
TR – TRICARE |
OU - other public |
XP - sum of payments |
In addition, the total charge variable is
indicated by TC in the variable name.
The fifth and sixth characters indicate the year (01). The
seventh character, "X", indicates the variable is edited/imputed.
For example, DVSF01X is the edited/imputed amount paid by
self or family for 2001 dental expenditures.
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2.6 File Contents
2.6.1 Survey Administration Variables
2.6.1.1 Person Identifiers (DUID, PID, DUPERSID)
The dwelling unit ID (DUID) is a five-digit random number
assigned after the case was sampled for MEPS. The three-digit person number (PID)
uniquely identifies each person within the dwelling unit. The eight-character
variable DUPERSID uniquely identifies each person represented on the file and is
the combination of the variables DUID and PID. For detailed information on
dwelling units and families, please refer to the documentation for the 2001 Full
Year Population Characteristics File.
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2.6.1.2 Record Identifiers (EVNTIDX,
FFEEIDX)
EVNTIDX uniquely identifies each dental event (i.e., each
record on the dental file) and is the variable required to link dental events to
data files containing details on prescribed medicines (MEPS 2001 Prescribed
Medicines file). For details on linking see Section 5.0 or the MEPS 2001
Appendix File, HC-059I.
FFEEIDX is a constructed variable that uniquely identifies
a flat fee group, that is, all events that were part of a flat fee payment. For
example, a charge for orthodontia is typically covered in a flat fee arrangement
where all visits are covered under one flat fee dollar amount. These events
would have the same value for FFEEIDX. FFEEIDX identifies a flat fee payment
that was identified using information from the Household Component.
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2.6.1.3 Round Indicator (EVENTRN)
EVENTRN indicates the round in which the dental event was
reported. Please note: Rounds 3 (partial), 4, and 5 are associated with MEPS
survey data collected from Panel 5. Likewise, Rounds 1, 2, and 3 (partial) are
associated with data collected from Panel 6.
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2.6.2 Dental Event Variables
This file contains variables describing dental events
reported by household respondents in the Dental Section of the MEPS HC survey
questionnaire.
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2.6.2.1 Date of Visit (DVDATEYR – DVDATEDD)
There are three variables which indicate the day, month,
and year a dental event occurred (DVDATEDD, DVDATEMM, DVDATEYR, respectively).
These variables have not been edited or imputed.
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2.6.2.2 Type of Provider Seen (GENDENT -
DENTYPE)
Respondents were asked about the type of
provider seen during the dental visit (e.g., general dentist, dental hygienist,
or orthodontist). More than one type of provider may have been identified on an
event record.
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2.6.2.3 Treatment, Procedures, and Services (EXAMINE -
DENTMED)
Respondents were asked about the types of services or
treatments received during the visit (EXAMINE - TMDTMJ), such as root canal or
x-rays. More than one type of service or treatment may have been identified on
an event record. Some procedures or services identified in DENTOTHR as "Dental
services other specify" have been edited to appropriate procedure and service
categories. Both the edited and unedited versions of these variables are
included on the file only if editing was done. Therefore, the variable list may
differ from year to year. DENTMED indicates whether or not the respondent
received a prescription medication, including free samples, during the dental
visit.
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2.6.3 Flat Fee Variables (FFEEIDX, FFDVTYPE, FFBEF01,
FFTOT02)
2.6.3.1 Definition of Flat Fee Payments
A flat fee is the fixed dollar amount a person is charged
for a package of services provided during a defined period of time. Examples
would be an orthodontist’s fee, which covers multiple visits; or a dental
surgeon’s fee, which covers surgical procedure and post-surgical care. A flat
fee group is the set of medical services that are covered under the same flat
fee payment. The flat fee groups represented on the dental file include flat fee
groups where at least one of the health care events, as reported by the HC
respondent, occurred during 2001. By definition, a flat fee group can span
multiple years. Furthermore, a single person can have multiple flat fee groups.
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2.6.3.2 Flat Fee Variable Descriptions
2.6.3.2.1 Flat Fee ID (FFEEIDX)
As noted earlier in Section 2.6.1.2 "Record Identifiers,"
the variable FFEEIDX uniquely identifies all events that are part of the same
flat fee group for a person. On any 2001 MEPS event file, every event that is
part of a specific flat fee group will have the same value for FFEEIDX. Note
that prescribed medicine and home health events are never included in a flat fee
group and none of the flat fee variables is on those event files.
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2.6.3.2.2 Flat Fee Type (FFDVTYPE)
FFDVTYPE indicates whether the 2001 dental event is the
"stem" or "leaf" of a flat fee group. A stem (records with FFDVTYPE = 1) is the
initial dental service (event) which is followed by other dental events that are
covered under the same flat fee payment. The leaves of the flat fee group
(records with FFDVTYPE = 2) are those dental events that are tied back to the
initial medical event (the stem) in the flat fee group. These "leaf" records
have their expenditure variables set to zero. For the dental visits that are not
part of a flat fee payment, the FFDVTYPE is set to -1, "INAPPLICABLE".
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2.6.3.2.3 Counts of Flat Fee Events that Cross Years
(FFBEF01, FFTOT02)
As described in Section 2.6.3.1, a flat fee payment covers
multiple events and the multiple events could span multiple years. For
situations where a 2001 dental visit is part of a group of events, and some of
the events occurred before or after 2001, counts of the known events are
provided on the dental record. Variables that indicate events occurring before
or after 2001 are the following:
FFBEF01 – indicates total number of pre-2001
events in the same flat fee group as the 2001 dental event. This count
would not include 2001 dental events.
FFTOT02 – indicates the number of 2002 medical
events expected to be in the same flat fee group as the 2001 dental
event record.
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2.6.3.3 Caveats of Flat Fee Groups
Data users/analysts should note that flat fee payments are
common on the dental file. There are 5,667 dental events that are identified as
being part of a flat fee payment group. In general, every flat fee group should
have an initial visit (stem) and at least one subsequent visit (leaf). There are
some situations where this is not true. For some of these flat fee groups, the
initial visit reported occurred in 2001, but the remaining visits that were part
of this flat fee group occurred in 2002. In this case, the 2001 flat fee group
represented on this file would consist of one event (the stem). The 2002 "leaf"
events that are part of this flat fee group are not represented on the file.
Similarly, the household respondent may have reported a flat fee group where the
initial visit began in 2000 but subsequent visits occurred during 2001. In this
case, the initial visit would not be represented on the file. This 2001 flat fee
group would then only consist of one or more leaf records and no stem.
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2.6.4 Expenditure Data
2.6.4.1 Definition of Expenditures
Expenditures on this file refer to what is paid for dental
services. More specifically, expenditures in MEPS are defined as the sum of
payments for care received, including out-of-pocket payments and payments made
by private insurance, Medicaid, Medicare and other sources. The definition of
expenditures used in MEPS differs slightly from its predecessors, the 1987 NMES
and 1977 NMCES surveys, where "charges" rather than sum of payments were used to
measure expenditures. This change was adopted because charges became a less
appropriate proxy for medical expenditures during the 1990's due to the
increasingly common practice of discounting. Although measuring expenditures as
the sum of payments incorporates discounts in the MEPS expenditure estimates,
the estimates do not incorporate any payment not directly tied to specific
medical care visits, such as bonuses or retrospective payment adjustments paid
by third party payers. Another general change from the two prior surveys is that
charges associated with uncollected liability, bad debt, and charitable care
(unless provided by a public clinic or hospital) are not counted as expenditures
because there are no payments associated with those classifications. While
charge data are provided on this file, data users/analysts should use caution
when working with this data because a charge does not typically represent actual
dollars exchanged for services or the resource costs of those services, nor are
they directly comparable to the resource costs of those services, nor are they
directly comparable to the expenditures defined in the 1987 NMES. For details on
expenditure definitions, please reference the following, "Informing American
Health Care Policy" (Monheit et al., 2000). AHRQ has developed factors to apply
to the 1987 NMES expenditure data to facilitate longitudinal analysis. These
factors can be assessed via the CFACT data center. For more information see the
Data Center section of the MEPS web site at <http://www.meps.ahrq.gov/mepsweb/data_stats/onsite_datacenter.jsp>.
If examining trends in MEPS expenditures or performing longitudinal analysis on
MEPS expenditures, please refer to section C, sub-section 2.1 for more
information.
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2.6.4.2 Data Editing and Imputation
Methodologies of Expenditure Variables
The general methodology used for editing and imputing
expenditure data is described below. The MPC did not include either the dental
events or other medical expenditures (such as glasses, contact lenses, and
hearing devices). Therefore, although the general procedures remain the same,
for dental and other medical expenditures, editing and imputation methodologies
were applied only to household-reported data. Please see below for details on
the differences between these editing/imputation methodologies. Separate
imputations were performed for flat fee and simple events, as well.
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2.6.4.2.1 General Data Editing Methodology
Logical edits were used to resolve internal
inconsistencies and other problems in the HC survey-reported data. The edits
were designed to preserve partial payment data from households and providers,
and to identify actual and potential sources of payment for each
household-reported event. In general, these edits accounted for outliers,
copayments or charges reported as total payments, and reimbursed amounts that
were reported as out-of-pocket payments. In addition, edits were implemented to
correct for misclassifications between Medicare and Medicaid and between
Medicare HMOs and private HMOs as payment sources. These edits produced a
complete vector of expenditures for some events, and provided the starting point
for imputing missing expenditures in the remaining events.
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2.6.4.2.2 General Hot-Deck Imputation
A weighted sequential hot-deck procedure was used to
impute for missing expenditures as well as total charge. This procedure uses
survey data from respondents to replace missing data, while taking into account
the respondents’ weighted distribution in the imputation process. Classification
variables vary by event type in the hot-deck imputations, but total charge and
insurance coverage are key variables in all of the imputations. Separate
imputations were performed for nine categories of medical provider care:
inpatient hospital stays, outpatient hospital department visits, emergency room
visits, visits to physicians, visits to non-physician providers, dental
services, home health care by certified providers, home health care by paid
independents, and other medical expenses. Within each event type file, separate
imputations were performed for flat fee and simple events. After the imputations
were finished, visits to physician and non-physician providers were combined
into a single medical provider file. The two categories of home care also were
combined into a single home health file.
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2.6.4.2.3 Dental Data Editing and
Imputation
Expenditures on visits to dentists were developed in a
sequence of logical edits and imputations. The household edits were used to
correct obvious errors in the reporting of expenditures, and to identify actual
and potential sources of payments. Some of the edits were global (i.e., applied
to all events). Others were hierarchical and mutually exclusive. One of the more
important edits separated flat fee events from simple events. This edit was
necessary because groups of events covered by a flat fee (i.e., a flat fee
bundle) were edited and imputed separately from individual events each covered
by a single charge (i.e., simple events). Dental services were imputed as flat
fee events if the charges covered a package of health care services (e.g.,
orthodontia), and all of the services were part of the same event type (i.e., a
pure bundle). If a bundle contained more than one type of event, the services
were treated as simple events in the imputations (See Section 2.6.3 for more
detail on the definition and imputation of events in flat fee bundles.)
Logical edits were also used to sort each event into a
specific category for the imputations. Events with complete expenditures were
flagged as potential donors for the hot-deck imputations, while events with
missing expenditure data were assigned to various recipient categories. Each
event with missing expenditure data was assigned to a recipient category based
on the extent of its missing charge and expenditure data. For example, an event
with a known total charge but no expenditure information was assigned to one
category, while an event with a known total charge and partial expenditure
information was assigned to a different category. Similarly, events without a
known total charge and no or partial expenditure information were assigned to
various recipient categories.
The logical edits produced nine recipient categories for
events with missing data. Eight of the categories were for events with a common
pattern of missing data and a primary payer other than Medicaid. Medicaid events
were imputed separately because persons on Medicaid rarely know the provider’s
charge for services or the amount paid by the state Medicaid program. As a
result, the total charge for Medicaid-covered services was imputed and
discounted to reflect the amount that a state program would pay for the care.
Separate hot-deck imputations were used to impute missing
data in each of the other eight recipient categories. The donor pool included
"free events" because, in some instances, providers are not paid for their
services. These events represent charity care, bad debt, provider failure to
bill, and third party payer restrictions on reimbursement in certain
circumstances. If free events were excluded from the donor pool, total
expenditures would be over-counted because the distribution of free event among
complete events (donors) is not represented among incomplete events
(recipients).
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2.6.4.4 Imputation Flag Variable (IMPFLAG)
IMPFLAG is a six-category variable that indicates if the
event contains complete Household Component (HC) or Medical Provider Component (MPC)
data, was fully or partially imputed, or was imputed in the capitated imputation
process (for OP and MV events only). The following list identifies how the
imputation flag is coded; the categories are mutually exclusive.
IMPFLAG=0 not eligible for
imputation (includes zeroed out and flat fee leaf events)
IMPFLAG=1 complete HC data
IMPFLAG=2 complete MPC data (not applicable to DV events)
IMPFLAG=3 fully imputed
IMPFLAG=4 partially imputed
IMPFLAG=5 complete MPC data through capitation
imputation (not applicable to DV events)
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2.6.4.5 Flat Fee Expenditures
The approach used to count expenditures for flat fees was
to place the expenditure on the first visit of the flat fee group. The remaining
visits have zero payments. Thus, if the first visit in the flat fee group
occurred prior to 2001, all of the events that occurred in 2001 will have zero
payments. Conversely, if the first event in the flat fee group occurred at the
end of 2001, the total expenditure for the entire flat fee group will be on that
event, regardless of the number of events it covered after 2001. See Section
2.6.3 for details on the flat fee variables.
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2.6.4.6 Zero Expenditures
As noted above, there are some dental events reported by
respondents where the payments were zero. This could occur for several reasons
including (1) free care was provided, (2) bad debt was incurred, (3) care was
covered under a flat fee arrangement beginning in an earlier year, or (4)
follow-up visits were provided without a separate charge (e.g., after a surgical
procedure). If all of the medical events for a person fell into one of these
categories, then the total annual expenditures for that person would be zero.
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2.6.4.7 Sources of Payment
In addition to total expenditures,
variables are provided which itemize expenditures according to major source of
payment categories. These categories are:
- Out-of-pocket by user or family,
- Medicare,
- Medicaid,
- Private Insurance,
- Veterans Administration, excluding TRICARE,
- TRICARE,
- Other Federal sources - includes Indian Health
Service, Military Treatment Facilities, and other care by the Federal
government,
- Other State and Local Source - includes community and
neighborhood clinics, State and local health departments, and State programs
other than Medicaid,
- Workers’ Compensation, and
- Other Unclassified Sources - includes sources such as
automobile, homeowner’s, and liability insurance, and other miscellaneous or
unknown sources.
Two additional source of payment variables were created to
classify payments for events with apparent inconsistencies between insurance
coverage and sources of payment based on data collected in the survey. These
variables include:
- Other Private - any type of private insurance
payments reported for persons not reported to have any private health
insurance coverage during the year as defined in MEPS, and
- Other Public - Medicare/Medicaid payments reported
for persons who were not reported to be enrolled in the Medicare/Medicaid
program at any time during the year.
Though relatively small in magnitude, data users/analysts
should exercise caution when interpreting the expenditures associated with these
two additional sources of payment. While these payments stem from apparent
inconsistent responses to health insurance and source of payment questions in
the survey, some of these inconsistencies may have logical explanations. For
example, private insurance coverage in MEPS is defined as having a major medical
plan covering hospital and physician services. If a MEPS sampled person did not
have such coverage but had a single service type insurance plan (e.g., dental
insurance) that paid for a particular episode of care, those payments may be
classified as "other private." Some of the "other public" payments may stem from
confusion between Medicaid and other state and local programs or may be from
persons who were not enrolled in Medicaid, but were presumed eligible by a
provider who ultimately received payments from the public payer.
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2.6.4.8 Dental Expenditure Variables
(DVSF01X- DVTC01X)
DVSF01X - DVOT01X are the 12 sources of payment. DVTC01X
is the total charge, and DVXP01X is the sum of the 12 sources of payment for the
Dental expenditures. The 12 sources of payment are: self/family (DVSF01X),
Medicare (DVMR01X), Medicaid (DVMD01X), private insurance (DVPV01X), Veterans
Administration (DVVA01X), TRICARE (DVTR01X), other Federal sources (DVOF01X),
State and Local (non-federal) government sources (DVSL01X), Worker’s
Compensation (DVWC01X), other private insurance (DVOR01X), other public
insurance (DVOU01X), and other insurance (DVOT01X).
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2.6.4.9 Rounding
Expenditure variables on the 2001 dental file have been
rounded to the nearest penny. Person-level expenditure information to be
released on the MEPS 2001 Person-Level Expenditure File will be rounded to the
nearest dollar. It should be noted that using the MEPS event files to create
person-level totals will yield slightly different totals than those found on the
person-level expenditure file. These differences are due to rounding only.
Moreover, in some instances, the number of persons having expenditures on the
event files for a particular source of payment may differ from the number of
persons with expenditures on the person-level expenditure file for that source
of payment. This difference is also an artifact of rounding only. Please see the
MEPS 2001 Appendix File, HC-059I, for details on such rounding differences.
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3.0 Sample Weight (PERWT01F)
3.1 Overview
There is a single full year person-level weight (PERWT01F)
assigned to each record for each key, in-scope person who responded to MEPS for
the full period of time that he or she was in-scope during 2001. A key person
either was a member of an NHIS household at the time of the NHIS interview, or
became a member of a family associated with such a household after being
out-of-scope at the time of the NHIS (examples of the latter situation include
newborns and persons returning from military service, an institution, or living
outside the United States). A person is in-scope whenever he or she is a member
of the civilian noninstitutionalized portion of the U.S. population.
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3.2 Details on Person Weight Construction
The person-level weight PERWT01F was developed in several
stages. Person-level weights for Panels 5 and 6 were created separately. The
weighting process for each panel included an adjustment for nonresponse over
time and poststratification. Poststratification was achieved initially by
controlling to Current Population Survey (CPS) population estimates based on
five variables. The five variables used in the establishment of the initial
person-level poststratification control figures were: census region (Northeast,
Midwest, South, West); MSA status (MSA, non-MSA); race/ethnicity (Hispanic,
black but non-Hispanic, and other); sex; and age. A 2001 composite weight was
then formed by multiplying each weight from Panel 5 by the factor (1/3) and each
weight from Panel 6 by the factor (2/3). The choice of factors reflected the
relative sample sizes of the two panels, helping to limit the variance of
estimates obtained from pooling the two samples. The composite weight was then
poststratified to the same set of CPS-based control totals. When poverty status
information derived from income variables became available, a final
poststratification was done on the previously established weight variable.
Control totals were established based on poverty status (below poverty, from 100
to 125 percent of poverty, from 125 to 200 percent of poverty, from 200 to 400
percent of poverty, at least 400 percent of poverty) as well as the original
five poststratification variables.
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3.2.1 MEPS Panel 5 Weight
The person-level weight for MEPS Panel 5 was developed
using the 2000 full year weight for an individual as a "base" weight for survey
participants present in 2000. For key, in-scope respondents who joined an RU
some time in 2001 after being out-of-scope in 2000, the 2000 family weight
associated with the family the person joined served as a "base" weight. The
weighting process included an adjustment for nonresponse over Rounds 4 and 5 as
well as poststratification to population control figures for December 2001.
These control figures were derived by scaling back the population totals
obtained from the March 2001 CPS to reflect the December 2001 CPS estimated
population distribution across age and sex categories as of December 2001.
Variables used in the establishment of person-level poststratification control
figures included: census region (Northeast, Midwest, South, West); MSA status (MSA,
non-MSA); race/ethnicity (Hispanic, black but non-Hispanic, and other); sex; and
age. Overall, the weighted population estimate for the civilian
noninstitutionalized population on December 31, 2001 is 280,791,812. Key,
responding persons not in-scope on December 31, 2001 but in-scope earlier in the
year retained, as their final Panel 5 weight, the weight after the nonresponse
adjustment.
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3.2.2 MEPS Panel 6 Weight
The person-level weight for MEPS Panel 6 was developed
using the MEPS Round 1 person-level weight as a "base" weight. For key, in-scope
respondents who joined an RU after Round 1, the Round 1 family weight served as
a "base" weight. The weighting process included an adjustment for nonresponse
over Round 2 and the 2001 portion of Round 3 as well as poststratification to
the same population control figures for December 2001 used for the MEPS Panel 5
weights. The same five variables employed for Panel 5 poststratification (census
region, MSA status, race/ethnicity, sex, and age) were used for Panel 6
poststratification. Similarly, for Panel 6, key, responding persons not in-scope
on December 31, 2001 but in-scope earlier in the year retained, as their final
Panel 6 weight, the weight after the nonresponse adjustment.
Note that the MEPS Round 1 weights (for both panels with
one exception as noted below) incorporated the following components: the
original household probability of selection for the NHIS; ratio-adjustment to
NHIS-based national population estimates at the household (occupied dwelling
unit) level; adjustment for nonresponse at the dwelling unit level for Round 1;
and poststratification to figures at the family and person level obtained from
the March 2001 CPS data base.
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3.2.3 The Final Weight for 2001
Variables used in the establishment of person-level
poststratification control figures included: poverty status (below poverty, from
100 to 125 percent of poverty, from 125 to 200 percent of poverty, from 200 to
400 percent of poverty, at least 400 percent of poverty); census region
(Northeast, Midwest, South, West); MSA status (MSA, non-MSA); race/ethnicity
(Hispanic, black but non-Hispanic, and other); sex; and age. Overall, the
weighted population estimate for the civilian noninstitutionalized population
for December 31, 2001 is 280,791,812 (PERWT01F>0 and INSC1231=1). The weights of
some persons out-of-scope on December 31, 2001 were also poststratified.
Specifically, the weights of persons out-of-scope on December 31, 2001 who were
in-scope some time during the year and also entered a nursing home during the
year were poststratified to a corresponding control total obtained from the 1996
MEPS Nursing Home Component. The weights of persons who died while in-scope
during 2001 were poststratified to corresponding estimates derived using data
obtained from the Medicare Current Beneficiary Survey (MCBS) and Vital
Statistics information provided by the National Center for Health Statistics (NCHS).
Separate control totals were developed for the "65 and older" and "under 65"
civilian noninstitutionalized populations. The sum of the person-level weights
across all persons assigned a positive person level weight is 284,247,327.
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3.2.4 Coverage
The target population for MEPS in this file is the 2001
U.S. civilian noninstitutionalized population. However, the MEPS sampled
households are a subsample of the NHIS households interviewed in 1999 (Panel 5)
and 2000 (Panel 6). New households created after the NHIS interviews for the
respective Panels and consisting exclusively of persons who entered the target
population after 1999 (Panel 5) or after 2000 (Panel 6) are not covered by MEPS.
Neither are previously out-of-scope persons who join an existing household but
are unrelated to the current household residents. Persons not covered by a given
MEPS panel thus include some members of the following groups: immigrants;
persons leaving the military; U.S. citizens returning from residence in another
country; and persons leaving institutions. The set of uncovered persons
constitutes only a small segment of the MEPS target population.
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4.0 Strategies for Estimation
This file is constructed for efficient estimation of
utilization, expenditures, and sources of payment for dental events and to allow
for estimates of number of persons with dental utilization in 2001.
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4.1 Variables with Missing Values
It is essential that the analyst examine all variables for
the presence of negative values used to represent missing values. For continuous
or discrete variables, where means or totals may be taken, it may be necessary
to set minus values to values appropriate to the analytic needs. That is, the
analyst should either impute a value or set the value to one that will be
interpreted as missing by the computing language used. For categorical and
dichotomous variables, the analyst may want to consider whether to recode or
impute a value for cases with negative values or whether to exclude or include
such cases in the numerator and/or denominator when calculating proportions.
Methodologies used for the editing/imputation of
expenditure variables (e.g., sources of payment, flat fee, and zero
expenditures) are described in Section 2.6.4.
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4.2 Basic Estimates of Utilization, Expenditures, and
Sources of Payment
While the examples described below
illustrate the use of event-level data in constructing person-level total
expenditures, these estimates can also be derived from the person-level
expenditure file unless the characteristic of interest is event specific.
In order to produce national estimates related to dental
visits utilization, expenditures, and sources of payment, the value in each
record contributing to the estimates must be multiplied by the weight (PERWT01F)
contained on that record.
Example 1
For example, the total number of dental visits, for the
civilian noninstitutionalized population of the U.S. in 2001 is estimated as the
sum of the weight (PERWT01F) across all dental visit event records. That is,
301 Moved Permanently
301 Moved Permanently
|
= 300,797,175 |
(1) |
Example 2
Subsetting to records based on characteristics of interest
expands the scope of potential estimates. For example, the estimate for the mean
out-of-pocket payment per dental visit (where the visit has a total expense greater than 0) should be calculated as the weighted mean of amount paid
by self/family. That is,
301 Moved Permanently
301 Moved Permanently
|
= $121.14 |
(2) |
where
301 Moved Permanently
301 Moved Permanently
= 244,789,017 and Xj =
DVSF01Xj
for all records with DVXP01Xj > 0.
This gives $121.14 as the estimated mean amount of
out-of-pocket payment of expenditures associated with dental visits and
244,789,017 as an estimate of the total number of dental visits with
expenditures. Both of these estimates are for the civilian noninstitutionalized
population of the U.S. in 2001.
Example 3
Another example would be to estimate the average
proportion of total expenditures (where event expense is greater than 0) paid by
private insurance per dental visit. This should be calculated as the weighted
mean of the proportion of the total dental visit expenditures paid by private
insurance at the dental visit-level. That is,
301 Moved Permanently
301 Moved Permanently
|
= 0.4651 |
(3) |
where
301 Moved Permanently
301 Moved Permanently
= 244,789,017 and Yj =
DVPV01Xj / DVXP01Xj
for all records with DVXP01Xj > 0.
This gives 0.4651 as the estimated mean proportion of
total expenditures paid by private insurance for dental visits with expenditures
for the civilian noninstitutionalized population of the U.S. in 2001.
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4.3 Estimates of the Number of Persons
with Dental Visits
When calculating an estimate of the total number of
persons with dental visits, users can use a person-level file or this event
file. However, this event file must be used when the measure of interest is
defined at the event-level. For example, to estimate the number of
persons in the civilian noninstitutionalized population of
the U.S. with a dental visit in 2001 where an orthodontist was seen, this event
file must be used. This would be estimated as
301 Moved Permanently
301 Moved Permanently
|
Wi Xi across all
unique persons i on this file |
(4) |
where
Wi is the sampling weight (PERWT01F) for person i
and
Xi = 1 if ORTHODNTi = 1 for
any dental visit record of person i
= 0 otherwise.
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4.4 Person-Based Ratio Estimates
4.4.1 Person-Based Ratio Estimates
Relative to Persons with Dental Visits
This file may be used to derive person-based ratio
estimates. However, when calculating ratio estimates where the denominator is
persons, care should be taken to properly define and estimate the unit of
analysis up to person-level. For example, the mean expense for persons with
dental visits is estimated as,
301 Moved Permanently
301 Moved Permanently
across all unique persons i on this file |
(5) |
where
Wi is the sampling weight (PERWT01F) for person i
and
Zi =
301 Moved Permanently
301 Moved Permanently
DVXP01Xj across all dental visit events of person i.
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4.4.2 Person-Based Ratio Estimates
Relative to the Entire Population
If the ratio relates to the entire population, this file
cannot be used to calculate the denominator, as only those persons with at least
one dental visit are represented on this data file. In this case, the Full Year
Consolidated File, which has data for all sampled persons, must be used to
estimate the total number of persons (i.e., those with events and those without
events).
For example, to estimate the proportion of civilian
noninstitutionalized population of the U.S. with at least one dental visit
occurred where an orthodontist was seen, the numerator would be derived from
data on this event file, and the denominator would be derived from data on the
person-level file. That is,
301 Moved Permanently
301 Moved Permanently
across all unique persons i on the MEPS HC-person-level file |
(6) |
where
Wi is the sampling weight (PERWT01F) for person i
and
Zi = 1 if ORTHODNTi = 1
for any dental visit record of person i
= 0 otherwise.
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4.5 Sampling Weights for Merging Previous
Releases of MEPS Household Data with this Event File
There have been several previous releases of MEPS
Household Survey public use data. Unless a variable name common to several files
is provided, the sampling weights contained on these data files are
file-specific. The file-specific weights reflect minor adjustments to
eligibility and response indicators due to birth, death, or institutionalization
among respondents.
For estimates from a MEPS data file that do not require
merging with variables from other MEPS data files, the sampling weight(s)
provided on that data file are the appropriate weight(s). When merging one MEPS
Household data file to another, the major analytical variable (i.e., the
dependent variable) determines the correct sampling weight to use.
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4.6 Variance Estimation (VARPSU01, VARSTR01)
To obtain estimates of variability (such as the standard
error of sample estimates or corresponding confidence intervals) for estimates
based on MEPS survey data, one needs to take into account the complex sample
design of MEPS. Various approaches can be used to develop such estimates of
variance including use of the Taylor Series or various replication
methodologies. Replicate weights have not been developed for the MEPS 2001 data.
Variables needed to implement a Taylor Series estimation approach are provided
in the file and are described in the paragraph below.
Using a Taylor Series approach, variance estimation strata
and the variance estimation PSUs within these strata must be specified. The
corresponding variables on the MEPS full year utilization database are VARSTR01
and VARPSU01, respectively. Specifying a "with replacement" design in a computer
software package such as SUDAAN (Shah, 1996) should provide standard errors
appropriate for assessing the variability of MEPS survey estimates. It should be
noted that the number of degrees of freedom associated with estimates of
variability indicated by such a package may not appropriately reflect the actual
number available. For MEPS sample estimates for characteristics generally
distributed throughout the country (and thus the sample PSUs), there are over
100 degrees of freedom associated with the corresponding estimates of variance.
The following illustrates these concepts using two examples from section 4.2.
Examples 2 and 3 from Section 4.2
Using a Taylor Series approach, specifying VARSTR01 and
VARPSU01 as the variance estimation strata and PSUs (within these strata)
respectively and specifying a "with replacement" design in a computer software
package (i.e., SUDAAN) will yield standard error estimate of $3.32 and 0.0072
for the estimated mean of out-of-pocket payment and the estimated mean
proportion of total expenditures paid by private insurance respectively.
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5.0 Merging/Linking MEPS Data Files
Data from this file can be used alone or in conjunction
with other files. This section provides instructions for linking the 2001 dental
file with other 2001 MEPS public use files, including the 2001 prescribed
medicines file and a 2001 person-level file.
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5.1 Linking a 2001 Person-Level File to
the 2001 Dental File
Merging characteristics of interest from other MEPS files
(e.g., 2001 Full Year Population Characteristics File or 2001 Prescribed
Medicines File) expands the scope of potential estimates. For example, to
estimate the total number of dental events of persons with specific demographic
characteristics (such as age, race, and sex), population characteristics from a
person-level file need to be merged onto the dental file. This procedure is
shown below. The MEPS 2001 Appendix File, HC-059I, provides additional details
of how to merge other MEPS data files.
- Create data set PERSX by sorting the 2001 Full
Year Population Characteristics File, by the person identifier, DUPERSID.
Keep only variables to be merged onto the dental file and DUPERSID.
- Create data set DENT by sorting the dental event
file by person identifier, DUPERSID.
- Create final data set NEWDENT by merging these two
files by DUPERSID, keeping only records on the dental event file.
The following is an example of SAS code which completes
these steps:
PROC SORT DATA=HCXXX (KEEP=DUPERSID AGE31X AGE42X
AGE53X SEX RACEX EDUCYR) OUT=PERSX;
BY DUPERSID;
RUN;
PROC SORT DATA=DENT;
BY DUPERSID;
RUN;
DATA NEWDENT;
MERGE DENT (IN=A) PERSX(IN=B);
BY DUPERSID;
IF A;
RUN;
The MEPS 2001 Appendix File, HC-059I, provides examples of
how to merge other MEPS data files.
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5.2 Linking the 2001 Dental File to the
2001 Prescribed Medicines File
Due to survey design issues, there are limitations/caveats
that data users/analysts must keep in mind when linking the different files.
These limitations/caveats are listed below. For detailed linking examples,
including SAS code, data users/analysts should refer to the MEPS 2001 Appendix
File, HC-059I.
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5.2.1 Limitations/Caveats of RXLK (the
Prescribed Medicine Link File)
The RXLK file provides a link from the MEPS event files to
the 2001 Prescribed Medicine Event File. When using RXLK, data users/analysts
should keep in mind that one dental visit can link to more than one prescribed
medicine record. Conversely, a prescribed medicine event may link to more than
one dental visit or different types of events. When this occurs, it is up to the
data user/analyst to determine how the prescribed medicine expenditures should
be allocated among those medical events.
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References
Cohen, S.B. (1997). Sample Design of the 1996 Medical
Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health
Care Policy and Research; 1997. MEPS Methodology Report, No. 2. AHCPR Pub. No. 97-0027.
Cohen, J.W. (1997). Design and Methods of the Medical
Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health
Care Policy and Research; 1997. MEPS Methodology Report, No. 1. AHCPR Pub. No. 97-0026.
Cohen, S.B. (1996). The Redesign of the Medical
Expenditure Panel Survey: A Component of the DHHS Survey Integration Plan.Proceedings of the COPAFS Seminar on Statistical
Methodology in the Public Service.
Monheit, A.C., Wilson, R., and Arnett, III, R.H. (Editors)
(1999). Informing American Health Care Policy. Jossey-Bass Inc, San Francisco.
Shah, B.V., Barnwell, B.G., Bieler, G.S., Boyle, K.E.,
Folsom, R.E., Lavange, L., Wheeless, S.C., and Williams, R. (1996). Technical
Manual: Statistical Methods and Algorithms Used in SUDAAN Release 7.0, Research Triangle Park, NC: Research Triangle Institute.
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D. Variable-Source Crosswalk
FOR MEPS HC-059B: 2001 DENTAL VISITS
Survey Administration Variables
Variable |
Description |
Source |
DUID |
Dwelling unit ID |
Assigned in sampling |
PID |
Person number |
Assigned in sampling |
DUPERSID |
Person ID (DUID
+ PID) |
Assigned in sampling |
EVNTIDX |
Event ID |
Assigned in sampling |
EVENTRN |
Event round number |
CAPI derived |
FFEEIDX |
Flat fee ID |
CAPI derived |
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Dental Events Variables
Variable |
Description |
Source |
DVDATEYR |
Event date – year |
CAPI derived |
DVDATEMM |
Event date – month |
CAPI derived |
DVDATEDD |
Event date – day |
CAPI derived |
GENDENT |
General dentist seen |
DN03 |
DENTHYG |
Dental hygienist seen |
DN03 |
DENTTECH |
Dental technician seen |
DN03 |
DENTSURG |
Dental surgeon seen |
DN03 |
ORTHODNT |
Orthodontist seen |
DN03 |
ENDODENT |
Endodontist seen |
DN03 |
PERIODNT |
Periodontist seen |
DN03 |
DENTYPE |
Other dental specialist seen |
DN03 |
EXAMINE |
General exam or consultation |
DN04 |
CLENTETH |
Cleaning, prophylaxis, or polishing |
DN04 |
JUSTXRAY |
X-rays, radiographs or bitewings |
DN04 |
FLUORIDE |
Fluoride treatment |
DN04 |
SEALANT |
Sealant application |
DN04 |
FILLINGX |
Edited FILLING |
DN04 (Edited) |
FILLING |
Fillings |
DN04 |
INLAY |
Inlays |
DN04 |
CROWNSX |
Edited CROWNS |
DN04 (Edited) |
CROWNS |
Crowns or caps |
DN04 |
ROOTCANX |
Edited ROOTCANL |
DN04 (Edited) |
ROOTCANL |
Root canal |
DN04 |
GUMSURGX |
Edited GUMSURG |
DN04 (Edited) |
GUMSURG |
Periodontal scaling, root planing or gum |
DN04 |
RECLVISX |
Edited RECLVIS |
DN04 (Edited) |
RECLVIS |
Periodontal recall visit |
DN04 |
EXTRACT |
Extraction, tooth pulled |
DN04 |
IMPLANT |
Implants |
DN04 |
ABSCESS |
Abscess or infection treatment |
DN04 |
ORALSURX |
Edited ORALSURG |
DN04 (Edited) |
ORALSURG |
Oral surgery |
DN04 |
BRIDGESX |
Edited BRIDGES |
DN04 (Edited) |
BRIDGES |
Bridges |
DN04 |
DENTUREX |
Edited DENTURES |
DN04 (Edited) |
DENTURES |
Dentures or partial dentures |
DN04 |
REPAIR |
Repair of bridges/dentures or relining |
DN04 |
ORTHDONX |
Edited ORTHDONT |
DN04 (Edited) |
ORTHDONT |
Orthodontia, braces or retainers |
DN04 |
WHITEN |
Bonding, whitening or bleaching |
DN04 |
TMDTMJ |
Treatment for TMD or TMJ |
DN04 |
DENTPROX |
Edited DENTPROC |
DN04OV (Edited) |
DENTPROC |
Other dental procedures |
DN04OV |
DENTOTHX |
Edited DENTOTHR |
DN04 (Edited) |
DENTOTHR |
Other specified dental procedures |
DN04OV |
DENTMED |
Received medicine including free sample |
DN05 |
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Flat Fee Variables
Variable |
Description |
Source |
FFDVTYPE |
Flat fee bundle |
Constructed |
FFBEF01 |
Total # of visits in FF before 2001 |
FF05 |
FFTOT02 |
Total # of visits in FF after 2001 |
FF10 |
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Imputed Expenditure Variables
Variable |
Description |
Source |
DVSF01X |
Amount paid, self/family (Imputed) |
CP Section (Edited) |
DVMR01X |
Amount paid, Medicare (Imputed) |
CP Section (Edited) |
DVMD01X |
Amount paid, Medicaid (Imputed) |
CP Section (Edited) |
DVPV01X |
Amount paid, private insurance (Imputed) |
CP Section (Edited) |
DVVA01X |
Amount paid, Veterans Administration (Imputed) |
CP Section (Edited) |
DVTR01X |
Amount paid, TRICARE (Imputed) |
CP Section (Edited) |
DVOF01X |
Amount paid, other federal (Imputed) |
CP Section (Edited) |
DVSL01X |
Amount paid, state & local government (Imputed) |
CP Section (Edited) |
DVWC01X |
Amount paid, workers’ compensation (Imputed) |
CP Section (Edited) |
DVOR01X |
Amount paid, other private insurance (Imputed) |
Constructed |
DVOU01X |
Amount paid, other public (Imputed) |
Constructed |
DVOT01X |
Amount paid, other insurance (Imputed) |
CP Section (Edited) |
DVXP01X |
Sum of DVSF01X – DVOT01X (Imputed) |
Constructed |
DVTC01X |
Household reported total charge (Imputed) |
CP Section (Edited) |
IMPFLAG |
Imputation status |
Constructed |
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Weights
Variable |
Description |
Source |
PERWT01F |
Final Person Level Weight, 2001 |
Constructed |
VARSTR01 |
Variance estimation stratum, 2001 |
Constructed |
VARPSU01 |
Variance estimation PSU, 2001 |
Constructed |
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