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MEPS HC-051H: 2000 Home Health Visits
February 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 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Source and Naming Conventions
2.4.1 Variable-Source Crosswalk
2.4.2 Expenditure and Source of Payment Variables
2.5 File Contents
2.5.1 Survey Administration Variables
2.5.1.1 Person Identifiers (DUID,
PID, DUPERSID)
2.5.1.2 Record Identifier (EVNTIDX)
2.5.1.3 Round Indicator (EVENTRN)
2.5.2 Home Health Event Variables
2.5.2.1 Date of Event (HHDATEYR,
HHDATEMM)
2.5.2.2 Characteristics of Event
(MPCELIG-OTHCWOS)
2.5.2.3 Treatments, Therapies, and Services
(HOSPITAL-OTHSVCOS)
2.5.2.4 Frequency of Event
(FREQCY-HHDAYS)
2.5.3 Condition, Procedure, and Clinical Classification Codes
2.5.4 Expenditure Data
2.5.4.1 Definition of Expenditures
2.5.4.2 Data Editing and Imputation Methodologies of
Expenditure
Variables
2.5.4.2.1 General Data Editing Methodology
2.5.4.2.2 General Hot-Deck Imputation
2.5.4.2.3 Home Health Data Editing and Imputaiton
2.5.4.3 Imputation Flag Variable
(IMPFLAG)
2.5.4.4 Zero Expenditures
2.5.4.5 Sources of Payment
2.5.4.6 Home Health Expenditure Variables (HHSF00X - HHXP00X)
2.5.4.7 Rounding
3.0 Sample Weight (PERWT00F)
3.1 Overview
3.2 Details on Person Weight Construction
3.2.1 MEPS Panel 4 Weight
3.2.2 MEPS Panel 5 Weight
3.2.3 The Final Weight for 2000
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 Home Health Events Due to
Hospitalization
4.4 Person-Based Ratio Estimates
4.4.1 Person-Based Ratio Estimates Relative to Persons with Home
Health
Events by Paid Independent Providers
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 (VARPSU00, VARSTR00)
5.0 Merging/Linking MEPS Data Files
5.1 Linking a 2000 Person-Level File to the 2000 Home Health Event
File
5.2 Linking the 2000 Home Health Event File to the 2000 Medical
Conditions
File
5.2.1 Limitations/Caveats of CLNK (the Medical Conditions 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 18 U.S.C. 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 system.
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 panel 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 Cost and Financing Studies,
Agency for Healthcare Research and Quality.
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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 2000 Medical Expenditure Panel Survey (MEPS) Household Component (HC) and
Medical Provider Component (MPC). Released as an ASCII data file and a SAS
transport file, the 2000 Home Health public use file provides detailed
information on home health events for a nationally representative sample of the
civilian noninstitutionalized population of the United States. Data from the
Home Health event file can be used to make estimates of home health event
utilization and expenditures for calendar year 2000. As illustrated below, this
file consists of MEPS survey data obtained in the 2000 portion of Round 3, and
Rounds 4 and 5 for Panel 4, as well as Rounds 1, 2, and the 2000 portion of
Round 3 for Panel 5 (i.e., the rounds for the MEPS panels covering calendar year
2000).
301 Moved Permanently
301 Moved Permanently
Counts of home health utilization are based entirely on household reports.
Agency home health providers were sampled into the MEPS MPC (see Section B.
2.0). Only those providers for whom the respondent signed a permission form were
included in MPC. Information from MPC was used to supplement expenditure and
payment data reported by the household.
Data from this event file can be merged with other 2000 MEPS HC data files
for the purposes of appending person-level data, such as demographic or health
insurance coverage, to each Home Health record.
This file can also be used to construct summary variables for expenditures,
sources of payment, and related aspects of home health events for calendar year
2000. Aggregate annual person-level information on the use of home health
providers and other health services use is provided on the 2000 Population
Characteristics 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. For information on the MEPS MPC design, see S. Cohen,
1999. A copy of the survey instruments used to collect the information on
this 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 2000 Home Health public use data set consists of one event-level data
file. The file contains characteristics associated with the home health event
and imputed expenditure data. For users wanting to impute expenditures,
pre-imputed data are available through the CCFS Data Center. Please visit the
CCFS 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 Home Health use data set contains characteristics associated with the
home health event and imputed expenditure data. Each record represents a
household-reported home health event. A home health event is a MONTH of similar
service provided by the same PROVIDER -- a month of home health services from a
single provider entity (i.e., paid independent, informal or agency). For
example, if a person received four events from a nurse, ten events from a
homemaker and four events from a physical therapist each from the same provider
every month for three months, then there will be three event records on the
file, one for each month (NOT 54 records). Data were collected in this manner
because agencies, hospitals, and nursing homes provide expenditure data in this
manner. In order to be consistent with the definition of what is considered a
home health event on this file, this same definition (i.e., a month of similar
services) was applied to all types of home health providers.
This public use data set contains 2,838 home health records; of the records,
2,820 are associated with persons having a positive person-level weight
(PERWT00F). It includes all records related to home health events for all
household survey respondents who resided in eligible responding households and
reported at least one home health event. Each record represents one
household-reported home health event that occurred during calendar year 2000.
Some household respondents may have multiple events and thus will be represented
in multiple records on the file. Other household respondents may have reported
no events and thus will have no records on this file. These data were collected
during the 2000 portion of Round 3, and Rounds 4 and 5 for Panel 4, as well as
Rounds 1, 2, and the 2000 portion of Round 3 for Panel 5 of the MEPS HC. The
persons represented on this file had to meet either (a) or (b):
- Be classified as a key in-scope person who responded for his or her
entire period of 2000 eligibility (i.e., persons with a positive 2000
full-year person-level weight (PERWT00F > 0)), or
- Be an eligible member of a family all of whose key in-scope members
have a positive person-level weight (PERWT00F > 0). (Such a family
consists of all persons with the same value for FAMIDYR.) That is, the
person must a positive full-year family-level weight (FAMWT00F >0).
Note that FAMIDYR and FAMWT00F are variables on the 2000 Population
Characteristics file.
Persons with no home health events for 2000 are not included on this file but
are represented on the 2000 MEPS person-level files. A codebook for the data
file is provided in files H51HCB.PDF and H51HCB.ASP.
Home health providers include formal or paid, and informal or unpaid
providers. Formal or paid providers include: home health agency, hospital, or
nursing home; and other independent paid providers. Informal or unpaid providers
include family and friends.
For home health agencies, hospitals, and nursing homes, it is important to
distinguish between the provider and the home health worker. In these cases, the
provider is the agency or the facility that employs the workers. The home health
workers are the people who administer the care. Examples of home health care
workers are the following: nurses, physical therapists, home health aides,
homemakers, and hospice workers, among others. These examples are generally the
types of workers associated with agencies, hospitals, and nursing homes. Paid
independent providers generally include companions, nursing assistants,
physicians, etc. For each record on this file, one or more types of workers can
be reported. The respondent is asked to mention all of the types of home health
workers who provided home health care (since records represent a month of
service, there can be more than one type of worker on a single record). For
example, an agency that provides two types of aides that provide home health
care to the same person during a specific month is represented as one event on
the file even though two workers
employed at the same agency provided care. When using this file, analysts
must keep in mind that a record on the file corresponds to a provider entity,
not an individual or particular worker.
Expenditure data for home health agency events are collected exclusively in
the MPC. Expenditure data for other paid independent home health care events are
collected from the household, since these types of events are not included in
the MPC. Friends, family and volunteers providing home health care to a person
are considered unpaid and are not included in the MPC. No expenditure
information is available for them.
Each home health record also includes the following: date the provider
started seeing the respondent; type of provider; types of services provided and
if this was a repeat event; whether or not care was received due to
hospitalization; whether or not a person was taught how to use medical
equipment; imputed sources of payment, total payment and total charge for the
home health event expenditure; and a full-year person-level weight.
Data from this file can be merged with previously released 2000 MEPS HC
person-level data, such as the MEPS 2000 Full-Year Population Characteristics
file, using the unique person identifier, DUPERSID, to append person-level
information, such as demographic or health insurance coverage, to each record.
Home Health events can also be linked to the MEPS 2000 Medical Conditions File
and the MEPS 2000 Prescribed Medicines File. Please see Section 5.0 and the MEPS
2000 Appendix File, HC-051I, for details on how to link MEPS data files.
Panel 4 cases (PANEL00=4 on the MEPS 2000 person-level file) can be linked
back to the 1999 MEPS HC Public Use Data Files. However, the user should be
aware that at this time no weight is being provided to facilitate two-year
analysis of Panel 4 data.
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2.1 Codebook Structure
For each variable on the Home Health event file, both weighted and unweighted
frequencies are provided in the codebook (files H51HCB.PDF and H51HCB.ASP). The
codebook and data file sequence list variables in the following order:
Unique person identifier
Unique home health event identifier
Home health characteristic variables
Imputed expenditure variables
Weight and variance estimation variables
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2.2 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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2.3 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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2.4 Variable Source and Naming Conventions
In general, variable names reflect the content of the variable, with an
eight-character limitation. Generally, imputed/edited variables end with an
"X."
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2.4.1 Variable-Source Crosswalk
Variables were derived either from the HC questionnaire itself, the MPC data
collection instrument, 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:
- EV - Event Roster section
- HH - Home Health 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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2.4.2 Expenditure and Source of Payment
Variables
The names of the expenditure and source 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 the 12 source 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 event |
DV - dental visit |
| OM - other medical equipment |
RX - prescribed medicine |
In the case of 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 (00). The last character
indicates whether the variable is edited/imputed (X).
For example, HHSF00X is the edited/imputed amount paid by self or family for
2000 home health expenditures.
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2.5 File Contents
2.5.1 Survey Administration Variables
2.5.1.1 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 2000 Full Year
Population Characteristics file.
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2.5.1.2 Record Identifier (EVNTIDX)
EVNTIDX uniquely identifies each event (i.e., each record on the file) and is
the variable required to link home health events to data files containing
details on conditions (MEPS 2000 Medical Conditions File). For details on
linking see Section 5.0 or the MEPS 2000 Appendix File, HC-051I.
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2.5.1.3 Round Indicator (EVENTRN)
EVENTRN indicates the round in which the home health event was reported.
Please note: Rounds 3, 4, and 5 are associated with MEPS survey data collected
from Panel 4. Likewise, Rounds 1, 2, and 3 are associated with data collected
from Panel 5.
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2.5.2 Home Health Event Variables
This file contains variables describing home health events reported by
household respondents in the Home Health Section of the MEPS HC survey
questionnaire.
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2.5.2.1 Date of Event (HHDATEYR, HHDATEMM)
The start date variables (HHDATEYR and HHDATEMM) indicate the year and month
that the household respondent reported as the start date (or the first time) for
this type of home health event. An artifact of the data collection for the
variable HHDATEYR is that all events are reported as having started in 2000 even
though a person could have started receiving that type of home health care from
that provider year(s) before 2000. These variables should not be interpreted as
"true" start dates.
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2.5.2.2 Characteristics of Event
(MPCELIG-OTHCWOS)
The HC questionnaire asked the respondent to indicate whether the home
health provider event(s) for each month's services were provided through an
agency or an independent paid provider (SELFAGEN). The response to the SELFAGEN
question dictated the skip pattern CAPI followed regarding the questions in the
home health section of the HC questionnaire. The questionnaire also asked
respondents if the provider was paid or whether a friend, relative, or volunteer
(HHTYPE) provided the home health services. The constructed variable MPCELIG
indicates whether the home health provider event was eligible for MPC data
collection and the type of imputation process the event went through. MPCELIG is
a more accurate variable for determining whether the event was an agency, a paid
independent or an informal care event. However, SELFAGEN is a more accurate
variable for determining the home health questions asked of the respondent. All
respondents receiving care from an agency, hospital or nursing home were asked
to identify the type of home health worker they saw (CNA-SPEECTHP) - for
example, certified nursing assistant, home health aide, registered nurse, etc.
Analysts should keep in mind that these identifications by household
respondents are subjective in nature, are not mutually exclusive or collectively
exhaustive, and should not be used to make certain estimates. For example, a
person on one type of insurance may identify an individual providing home health
care services to them as a personal care attendant while an individual having a
different type of insurance coverage may identify that same worker as a home
care aide. Making estimates of personal care attendants or home care aides based
on their identification by household respondents and treating these types of
workers as mutually exclusive groups will result in inaccurate estimates.
Respondents may also have indicated that they were seen by more than one home
health care worker during a single event. For example, since an event is a month
of services, a respondent may have reported being seen by a nurse, a physical therapist,
and/or a home health aide during a single event. Respondents were also asked to
identify other non-skilled and skilled workers seen during that month of care (NONSKILL-OTHCWOS).
However, "other specify" variables (SKILLWOS and OTHCWOS) were not
reconciled with the type of health care worker variable (CNA-SPEECTHP). In
addition, the type of health care worker variables (CNA-SPEECTHP) were not
reconciled with MPCELIG, SELFAGEN and HHTYPE, so inconsistencies between these
variables are possible.
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2.5.2.3 Treatments, Therapies, and Services
(HOSPITAL-OTHSVCOS)
Regardless of the type of provider, all respondents were asked if the home
health services received were due to a hospitalization (HOSPITAL), whether
services were due to a medical condition (VSTRELCN), if the person was helped
with daily activities (DAILYACT), if the person received companionship services
(COMPANY), and whether or not the person received any other type of services (OTHSVCE
and OTHSVCOS). Only persons receiving care from an agency, hospital, or nursing
home were asked if they were taught how to use medical equipment (MEDEQUIP) and
whether or not they received a medical treatment (TREATMT).
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2.5.2.4 Frequency of Event (FREQCY-HHDAYS)
Several variables identify the frequency and length of home health events (FREQCY-MINLONG)
and whether or not the same services were received during each month (SAMESVCE).
Frequency of event variables (FREQCY- TMSPDAY) were used as building blocks to
construct HHDAYS. HHDAYS indicates the number of days the person received care
during that event (i.e., month of care). HHDAYS has not been reconciled with
DAYSPMO. Frequency variables can be combined to get a measure of the intensity
of care. For example, HHDAYS can be used in conjunction with HRSLONG and TMSPDAY
to form a measure of intensity of care, that is, how many hours of care were
provided in one month.
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2.5.3 Condition, Procedure, and Clinical
Classification Codes
Information on household reported medical conditions and procedures
(including condition codes, procedure codes, and clinical classification codes)
associated with each home health event are NOT provided on this file. To obtain
complete condition information associated with an event, the analyst must link
to the 2000 Medical Conditions File. Details on how to link to the MEPS 2000
Medical Conditions File are provided in the MEPS 2000 Appendix File, HC-051I.
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2.5.4 Expenditure Data
2.5.4.1 Definition of Expenditures
Expenditures on this file refer to what is paid for health care 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,
these estimates do not incorporate any payment not directly tied to specific
medical care events, 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 expenditures defined in the 1987 NMES (for
details on expenditure definitions, see Monheit et al, 1999). For details on
expenditure definitions, please refer to 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 accessed via the CCFS 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>.
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2.5.4.2 Data Editing and Imputation
Methodologies of Expenditure Variables
The general methodology used for editing and imputing expenditure data is
described below. However, please note, the MPC included home health events
provided by an agency, hospital or nursing home and did not include home health
care provided by paid independent providers. Although the general procedures
remain the same for all home health events, there were some differences in the
editing and imputation methodologies applied to those events followed in the MPC
and those events not followed in the MPC. Analysts should note that home health
care provided by friends, family, or volunteers was assumed to be free and was
not included in any imputation process. 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.
Home health expenditure data for agency, hospital, and nursing home providers
were collected exclusively from the MPC (i.e., household respondents were not
asked to report home health expenditures from these types of providers). The MPC
contacted 100 percent of the agency, hospital, and nursing home health providers
identified by household respondents. Since paid independent home health
providers were not included in the MPC, all expenditure data from these
providers were collected from household respondents.
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2.5.4.2.1 General Data Editing Methodology
Logical edits were used to resolve internal inconsistencies and other
problems in the HC and MPC 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, co-payments 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 mis-classifications
between Medicare and Medicaid and between Medicare HMO's and private HMO's
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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2.5.4.2.2 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 file, flat fee and simple events were imputed separately.
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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2.5.4.2.3 Home Health Data Editing and Imputation
Expenditures for home health events were developed in a sequence of logical
edits and imputations. (Analysts should note that home health care provided by
friends, family, or volunteers was assumed not to have associated expenditures and was not
included in any imputation process. All expenditures for home health care
provided by informal care providers were assigned "-1"
(INAPPLICABLE) because those types of events were skipped out (never asked) of
the questions regarding expenditures.) "Household" edits were applied
to sources and amounts of payment for all events reported for paid independent
providers by HC respondents. "MPC" edits were applied to
provider-reported sources and amounts of payment for records matched to
household-reported events for all agency, hospital, and nursing home home health
providers. Both sets of edits were used to correct obvious errors in the
reporting of expenditures. Imputations for independent paid providers and for
agencies, hospitals, and nursing homes were conducted separately.
Logical edits were 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 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 HHP and eight
recipient categories for HHA for events with missing data. Expenditures were
imputed through separate hot-deck imputations for each of the eight recipient
categories. The donor pool in these imputations was restricted to events with
complete expenditures from either the HC or the MPC.
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. (This does not include MPCELIG=3
(informal) events. As stated previously, home health care provided by friends,
family, or volunteers (informal, MPCELIG=3) was assumed not to have expenditures
associated with it and was not included in any imputation process.)
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2.5.4.3 Imputation Flag Variable
(IMPFLAG)
Only one imputation flag was created for 2000 event files. This flag, 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. 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 leaf
events)
IMPFLAG=1 complete HC data
IMPFLAG=2 complete MPC data
IMPFLAG=3 fully imputed
IMPFLAG=4 partially imputed
IMPFLAG=5 complete MPC data through capitation imputation (not applicable
to HH)
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2.5.4.4 Zero Expenditures
There are some medical 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 events 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. All expenditures for home health
care provided by informal care providers (family, friends, or volunteers,
MPCELIG=3) were assigned -1 "INAPPLICABLE" because those types of
events were skipped out (never asked) of the questions regarding expenditures.
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2.5.4.5 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, formerly CHAMPUS/CHAMPVA,
- Other Federal sources - includes Indian Health Service, Military
Treatment Facilities, and other care by the Federal government,
- Other State and Local sources - includes community and
neighborhood clinics, State and local health departments, and State
programs other than Medicaid,
- Worker's Compensation, and
- Other Unclassified sources - includes sources such as automobile,
homeowner's, liability, 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
program.
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2.5.4.6 Home Health Expenditure Variables (HHSF00X - HHXP00X)
Home health agency, hospital, and nursing home events are sampled at a rate
of 100% for the MPC. Households were not asked any expenditure-related questions
in regards to these types of events; therefore, there are no household reported
expenditure data for these events. Conversely, paid independent providers are
not included in the MPC. Household reported responses are the only data
available for these types of events. All expenditure data for paid independent
providers are fully imputed from household reported expenditures. There are no
expenditure data for informal care providers. Informal care (MPCELIG=3, unpaid
care provided by family, friends, or volunteers) was assigned -1,
"INAPPLICABLE", in all expenditure categories.
The constructed variable MPCELIG is provided on this file. MPCELIG indicates
whether the home health provider event was eligible for MPC data collection, and
MPCELIG determines the imputation process applied to that event.
All of these expenditures have gone through an editing and imputation process
and have been rounded to the nearest penny. HHSF00X - HHOT00X are the 12 sources
of payment. HHTC00X is the total charge, and HHXP00X is the sum of the 12
sources of payment for the home health expenditures. The 12 source of payment
are: self/family (HHSF00X), Medicare (HHMR00X), Medicaid (HHMD00X), private
insurance (HHPV00X), Veterans Administration (HHVA00X), TRICARE (HHTR00X), other
Federal sources (HHOF00X), State and Local (non-federal) government sources
(HHSL00X), Worker's Compensation (HHWC00X), other private insurance (HHOR00X),
other public insurance (HHOU00X), and other insurance (HHOT00X). Analysts can
determine if a home health event was paid by an agency or some other paid
independent provider by subsetting the variable MPCELIG to the appropriate and
desired value.
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2.5.4.7 Rounding
Expenditure variables on the 2000 home health event file have been rounded to
the nearest penny. Person-level expenditure information released on the 2000
Person-Level Expenditure File was rounded to the nearest dollar. It should be
noted that using the 2000 MEPS event files to create person-level totals will
yield slightly different totals than those 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 2000 Appendix File,
HC-051I, for details on such rounding differences.
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3.0 Sample Weight (PERWT00F)
3.1 Overview
There is a single full year person-level weight (PERWT00F) 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 2000. A key person either was a
member of an NHIS household at the time of the NHIS interview, or became a
member of 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 PERWT00F was developed in several stages. Person
level weights for Panels 4 and 5 were created separately. The weighting process
for each panel included an adjustment for nonresponse over time and
poststratification. Poststratification was achieved by controlling to Current
Population Survey (CPS) population estimates based on five variables. 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. A
2000 composite weight was then formed by multiplying each panel weight by .5 and
then poststratifying the resulting weight 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 resulting weight variable,
including 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 in the establishment of control totals.
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3.2.1 MEPS Panel 4
Weight
The person-level weight for MEPS Panel 4 was developed using the 1999 full
year weight for an individual as a "base" weight for survey
participants present in 1999. For key, in-scope respondents who joined an RU
some time in 2000 after being out of scope in 1999, the 1999 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
2000. These control figures were derived by scaling back the population totals
obtained from the March 2000 CPS to reflect the December 2000 CPS estimated
population distribution across age and sex categories as of December 2000.
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, 2000 is 275,158,755. Key,
responding persons not in-scope on December 31, 2000 but in-scope earlier in the
year retained, as their final Panel 4 weight, the weight after the nonresponse
adjustment.
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3.2.2 MEPS Panel 5
Weight
The person-level weight for MEPS Panel 5 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 2000 portion of Round 3 as well as
poststratification to the same population control figures for December 2000 used
for the MEPS Panel 4 weights. The same five variables employed for Panel 4
poststratification (census region, MSA status, race/ethnicity, sex, and age)
were used for Panel 5 poststratification. Similarly, for Panel 5, key,
responding persons not in-scope on December 31, 2000 but in-scope earlier in the
year retained, as their final Panel 5 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 2000 CPS data
base.
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3.2.3 The Final Weight for 2000
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, 2000
is 275,158,755 (PERWT00F>0 and INSC1231=1). The weights of some persons
out-of-scope on December 31, 2000 were also poststratified. Specifically, the
weights of persons out-of-scope on December 31, 2000 who were inscope 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 inscope during
2000 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.
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3.2.4 Coverage
The target population for MEPS in this file is the 2000 U.S.
civilian noninstitutionalized population. However, the MEPS sampled households
are a subsample of the NHIS households interviewed in 1998
(Panel 4) and 1999 (Panel 5). New households created after the NHIS interviews
for the respective Panels and consisting exclusively of persons who entered the
target population after 1998 (Panel 4) or after 1999 (Panel 5) 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 proportion 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 home health provider visits and to
allow for estimates of number of persons with home health provider visits in
2000.
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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
2.5.4.2.
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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 home health provider visits
utilization, expenditures, and sources of payment, the value in each record
contributing to the estimates must be multiplied by the weight (PERWT00F)
contained on that record.
Example 1
For example, the total number of home health paid independent provider
visits, for the civilian noninstitutionalized population of the U.S. in 2000, is
estimated as the sum of the weight (PERWT00F) across all home health paid
independent provider records. That is,
301 Moved Permanently
301 Moved Permanently
|
= 3,683,952 across all
records with MPCELIG = 2 |
(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 paid independent home health provider event (for those who had such
expense greater than 0) should be calculated as the weighted mean of the paid
independent home health provider's bill paid by self/family. That is,
301 Moved Permanently
301 Moved Permanently
|
= $683.79 |
(2) |
where
| |
301 Moved Permanently
301 Moved Permanently
|
= 3,637,483 and Xj =
HHSF00Xj |
for all home health visits by paid independent provider (MPCELIG=2) with
HHXP00Xj > 0
This gives $683.79 as the estimated mean amount of out-of-pocket payment of
expenditures associated with home health events by paid independent providers
and 3,637,483 as an estimate of the total number of home health events by paid
independent providers with expenditure. Both of these estimates are for the
civilian noninstitutionalized population of the U.S. in 2000.
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
for home health events by paid independent providers. This should be calculated
as the weighted mean of the proportion of total expenditures paid by private
insurance at the home health event-level. That is
301 Moved Permanently
301 Moved Permanently
|
= 0.0344 |
(3) |
where
301 Moved Permanently
301 Moved Permanently
|
= 3,637,483 and Yj =
HHPV00Xj / HHXP00Xj |
for all home health visits by paid independent provider (MPCELIG=2)
with HHXP00Xj > 0
This gives 0.0344 as the estimated mean proportion of total expenditures paid
by private insurance for home health events by paid independent providers with
expenditures for the civilian noninstitutionalized population of the U.S. in
2000.
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4.3 Estimates of the Number of Persons with Home
Health Events Due to Hospitalization
When calculating an estimate of the total number of persons with home health
events by paid independent providers, 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 home
health events where services were provided due to hospitalization, this event
file must be used. This would be estimated as,
301 Moved Permanently
301 Moved Permanently
|
across all
unique persons i on this file |
(4) |
where
Wi is the sampling weight (PERWT00F) for
person i
and
Xi = 1 if HOSPITALj =
1 for any home health visits by paid independent provider 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 Home Health Events by Paid Independent Providers
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 home health events by paid
independent providers (MPCELIG =2) is estimated as,
301 Moved Permanently
301 Moved Permanently
|
across all unique persons i on this file |
(5) |
where
Wi is the sampling weight (PERWT00F) for
person i
and
| Zi = |
301 Moved Permanently
301 Moved Permanently
|
HHXP00Xj across all home health visits by paid
independent provider for 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 home health
provider event are represented on this data file. In this case, the Full Year
Consolidated, 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 the civilian noninstitutionalized
population of the U.S. with at least one home health event by a paid independent
provider, 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 FY person-level file |
(6) |
where
Wi is the sampling weight (PERWT00F) for
person i
and
Zi = 1 if MPCELIG j = 2 for any home
health visits by paid independent provider 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 (VARPSU00, VARSTR00)
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 2000 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 VARSTR00 and VARPSU00,
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 VARSTR00 and VARPSU00 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 estimates of $153.12 and 0.0168 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, or the details on where to find the
instructions, for linking the 2000 home health provider events with other 2000
MEPS public use files, including the 2000 conditions file and a 2000
person-level file.
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5.1 Linking a 2000 Person-Level File to the 2000
Home Health Event File
Merging characteristics of interest from other 2000 MEPS files (e.g., the
2000 Full Year Population Characteristics File or the 2000 Prescribed Medicines
File) expands the scope of potential estimates. For example, to estimate the
total number of home health provider events of persons with specific
characteristics (e.g., age, race, and sex), population characteristics from a
person-level file need to be merged onto the home health provider file. This
procedure is illustrated below. The MEPS 2000 Appendix File, HC-051I, provides
additional details on how to merge 2000 MEPS data files.
- Create data set PERSX by sorting the 2000 Full Year Population
Characteristics File by the person identifier, DUPERSID. Keep only
variables to be merged on to the home health provider event file and
DUPERSID.
- Create data set HVIS by sorting the home health provider event file by
person identifier, DUPERSID.
- Create final date set NEWHVIS by merging these two files by DUPERSID,
keeping only records on the home health provider 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=HVIS;
BY DUPERSID;
RUN;
DATA NEWHVIS;
MERGE HVIS (IN=A) PERSX(IN=B);
BY DUPERSID;
IF A;
RUN;
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5.2 Linking the 2000 Home Health Event File to
the 2000 Medical Conditions 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 2000 Appendix File,
HC-051I.
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5.2.1 Limitations/Caveats of CLNK (the 2000
Medical Conditions Link File)
The CLNK provides a link from 2000 MEPS event files to the 2000 Medical
Conditions File. When using the CLNK, data users/analysts should keep in mind
that (1) conditions are self-reported and (2) there may be multiple conditions
associated with a home health provider event. Data users/analysts should also
note that not all home health provider events link to the condition file.
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References
Cohen, S.B. (1999). Sample Design of the 1996 Medical Expenditure Panel
Survey Medical Provider Component. Journal of Economic and Social Measurement. Vol 24, 25-53.
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.
Cox, B.G. and Cohen, S.B. (1985). Chapter 8: Imputation Procedures to
Compensate for Missing Responses to Data Items. In Methodological Issues for
Health Care Surveys. Marcel Dekker, New York.
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-051H: 2000 Home Health 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 |
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Home Health Events Variables
| Variable |
Description |
Source |
|
HHDATEYR |
Event date - year |
CAPI derived |
|
HHDATEMM |
Event date - month |
CAPI derived |
|
MPCELIG |
MPC eligibility flag |
Constructed |
|
SELFAGEN |
Does provider work for agency or self |
EV06A |
|
HHTYPE |
Home health event type |
EV06 |
|
CNA |
Type of health care worker - certified nurse assistant |
HH01 |
|
COMPANN |
Type of health care worker - companion |
HH01 |
|
DIETICN |
Type of health care worker - dietitian/nutritionist |
HH01 |
|
HHAIDE |
Type of health care worker - home care aide |
HH01 |
|
HOSPICE |
Type of health care worker - hospice worker |
HH01 |
|
HMEMAKER |
Type of health care worker - homemaker |
HH01 |
|
IVTHP |
Type of health care worker - IV therapist |
HH01 |
|
MEDLDOC |
Type of health care worker - medical doctor |
HH01 |
|
NURPRACT |
Type of health care worker - nurse/practitioner |
HH01 |
|
NURAIDE |
Type of health care worker - nurse's aide |
HH01 |
|
OCCUPTHP |
Type of health care worker - occupational therapist |
HH01 |
|
PERSONAL |
Type of health care worker - personal care attendant |
HH01 |
|
PHYSLTHP |
Type of health care worker - physical therapy |
HH01 |
|
RESPTHP |
Type of health care worker - respiratory therapy |
HH01 |
|
SOCIALW |
Type of health care worker - social worker |
HH01 |
|
SPEECTHP |
Type of health care worker - speech therapy |
HH01 |
|
OTHRHCW |
Type of health care worker - other |
HH01 |
|
NONSKILL |
Type of health care worker - non-skilled |
HH02 |
|
SKILLED |
Type of health care worker - skilled |
HH02 |
|
SKILLWOS |
Specify type of skilled worker |
HH02OV1 |
|
OTHCW |
Type of health care worker - some other |
HH02 |
|
OTHCWOS |
Specify other type health care worker |
HH02OV2 |
|
HOSPITAL |
Any home health care service due to hospitalization |
HH03 |
|
VSTRELCN |
Any Home Health Care Service Related to Health Condition |
HH04 |
|
TREATMT |
Person received medical treatment |
HH06 |
|
MEDEQUIP |
Person was taught use of medical equipment |
HH07 |
|
DAILYACT |
Person was helped with daily activities |
HH08 |
|
COMPANY |
Person received companionship services |
HH09 |
|
OTHSVCE |
Person received other home care services |
HH10 |
|
OTHSVCOS |
Specify other home care services received |
HH10OV |
|
FREQCY |
Provider helped every week/some weeks |
HH11 |
|
DAYSPWK |
# days per week provider came (agency only) |
HH12 |
|
DAYSPMO |
# days per month provider came (agency only) |
HH13 |
|
HOWOFTEN |
Provider came once per day/more than once per day |
HH14 |
|
TMSPDAY |
Times/day provider came to home to help |
HH15 |
|
HRSLONG |
Hours each visit lasted |
HH16 |
|
MINLONG |
Minutes each visit lasted |
HH16 |
|
SAMESVCE |
Any other months person received same services |
HH17 |
|
HHDAYS |
Days per month in home health, 2000 |
Constructed |
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Imputed Expenditure Variables
| Variable |
Description |
Source |
|
HHSF00X |
Amount paid, self/family (Imputed) |
CP Section (Edited) |
|
HHMR00X |
Amount paid, Medicare (Imputed) |
CP Section (Edited) |
|
HHMD00X |
Amount paid, Medicaid (Imputed) |
CP Section (Edited) |
|
HHPV00X |
Amount paid, private insurance (Imputed) |
CP Section (Edited) |
|
HHVA00X |
Amount paid, Veterans Administration (Imputed) |
CP Section (Edited) |
|
HHTR00X |
Amount paid, TRICARE (Imputed) |
CP Section (Edited) |
|
HHOF00X |
Amount paid, other federal (Imputed) |
CP Section (Edited) |
|
HHSL00X |
Amount paid, state & local government (Imputed) |
CP Section (Edited) |
|
HHWC00X |
Amount paid, workers' compensation (Imputed) |
CP Section (Edited) |
|
HHOR00X |
Amount paid, other private insurance (Imputed) |
Constructed |
|
HHOU00X |
Amount paid, other public insurance (Imputed) |
Constructed |
|
HHOT00X |
Amount paid, other insurance (Imputed) |
CP Section (Edited) |
|
HHXP00X |
Sum of HHSF00X - HHOT00X (Imputed) |
Constructed |
|
HHTC00X |
Household reported total charge (Imputed) |
CP Section (Edited) |
|
IMPFLAG |
Imputation status |
Constructed |
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Weights
| Variable |
Description |
Source |
|
PERWT00F |
Final person level weight, 2000 |
Constructed |
|
VARPSU00 |
Variance estimation PSU, 2000 |
Constructed |
|
VARSTR00 |
Variance estimation stratum, 2000 |
Constructed |
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