MEPS: A National Information Resource to MEPS: A National Information Resource to Support Health Care Research & PolicySupport Health Care Research & Policy

AcademyHealth MeetingsAcademyHealth MeetingsJune 6, 2004June 6, 2004

Steven B. Cohen PhD Steven B. Cohen PhD Joel W. Cohen PhD & Karen Beauregard MHAJoel W. Cohen PhD & Karen Beauregard MHA

..

Presentation Presentation

AHRQ new mission and emphasis on information and AHRQ new mission and emphasis on information and research effort that translate into policy and practiceresearch effort that translate into policy and practice

MEPS overview and design enhancementsMEPS overview and design enhancements Program outreach and impactProgram outreach and impact Research UpdateResearch Update MEPS Data Products and DisseminationMEPS Data Products and Dissemination

New AHRQ Mission StatementNew AHRQ Mission Statement

To improve the quality, safety, To improve the quality, safety, efficiency, and effectiveness of efficiency, and effectiveness of health care for all Americanshealth care for all Americans

Center for Financing, Access Center for Financing, Access and Cost Trendsand Cost Trends

Conducts, supports and manages studies of the cost and financing of Conducts, supports and manages studies of the cost and financing of health care, the access to health care services and related trends. health care, the access to health care services and related trends.

Develops data sets to support policy and behavioral research and Develops data sets to support policy and behavioral research and analyses. analyses.

These studies and data development activities are designed to These studies and data development activities are designed to provide health care leaders and policymakers with the information provide health care leaders and policymakers with the information and tools they need to improve decisions on health care financing, and tools they need to improve decisions on health care financing, access, coverage and cost.access, coverage and cost.

WWW.MEPS.AHRQ.GOV

Medical Expenditure Panel Medical Expenditure Panel Survey (MEPS)Survey (MEPS)

Annual Survey of 15,000 households:Annual Survey of 15,000 households: provides national estimates of health care use, expenditures, provides national estimates of health care use, expenditures, insurance coverage, sources of payment, access to care and health insurance coverage, sources of payment, access to care and health care qualitycare quality

Permits studies of:Permits studies of: Distribution of expenditures and sources of paymentDistribution of expenditures and sources of payment Role of demographics, family structure, insuranceRole of demographics, family structure, insurance Measurement of expenditures in managed careMeasurement of expenditures in managed care Expenditures for specific conditionsExpenditures for specific conditions Trends over timeTrends over time

MEPS ComponentsMEPS Components

Household Component (HC)Household Component (HC)

Medical Provider Component (MPC)Medical Provider Component (MPC)

Insurance Component (IC)Insurance Component (IC)

HC - PurposeHC - Purpose

Estimates annual health care use and expendituresEstimates annual health care use and expenditures Provides distributional estimatesProvides distributional estimates Supports person and family level analysisSupports person and family level analysis Tracks changes in insurance coverage and Tracks changes in insurance coverage and

employmentemployment

MEPS Household ComponentMEPS Household ComponentSample DesignSample Design

Oversampling of policy relevant domainsOversampling of policy relevant domains19961996 Minorities (Blacks & Hispanics)Minorities (Blacks & Hispanics)19971997 MinoritiesMinorities

Low income Low income Children with activity limitationsChildren with activity limitations Adults with functional limitationsAdults with functional limitations Predicted high expenditure casesPredicted high expenditure cases ElderlyElderly

1998-20011998-2001 MinoritiesMinorities2002+2002+ Minorities, Asians, Low IncomeMinorities, Asians, Low Income

HC - Sample SizesHC - Sample Sizes

YearYear HouseholdsHouseholds PersonsPersons

19961996 9,400 9,400 23,500 23,500

19971997 13,500 33,000 13,500 33,000

1998-20001998-2000 10,000 10,000 25,000 25,000

20012001 13,500 13,500 33,000 33,000

20022002 to present to present 15,000 15,000 37,000 37,000

MPC - PurposeMPC - Purpose

Compensate for household nonresponseCompensate for household nonresponse Accuracy and detailAccuracy and detail Imputation sourceImputation source Methodological studiesMethodological studies

MPC - Targeted SampleMPC - Targeted Sample

All hospitals and associated physiciansAll hospitals and associated physicians All office-based physiciansAll office-based physicians All home health agenciesAll home health agencies All pharmaciesAll pharmacies

IC - PurposeIC - Purpose

Availability of health insuranceAvailability of health insurance Access to health insuranceAccess to health insurance Cost of health insuranceCost of health insurance Benefit and payment provisions of private Benefit and payment provisions of private

health insurancehealth insurance

IC - SamplesIC - Samples

30,000 establishments: derived from Census 30,000 establishments: derived from Census Bureau frameBureau frame

Employers linked to HC sampleEmployers linked to HC sample Data released in tabular form on MEPS websiteData released in tabular form on MEPS website

Uninsured Status for theUninsured Status for theNon-elderly, 1996-2002Non-elderly, 1996-2002

Number of Uninsured in Millions

61.961.758.559.162.262.0

45.945.743.844.5 44.2 42.0 42.6

31.331.531.6 32.1 31.0 28.7

0

10

20

30

40

50

60

70

1996 1997 1998 1999 2000 2001 2002

Any Time in Year 1st 1/2 of Year Full Year

Concentration of Medical ExpendituresConcentration of Medical Expenditures1987 and 19961987 and 1996

0%10%20%30%40%50%60%70%80%90%

100%

Top1%

Top5%

Top10%

Top50%

1987

1996

1% of the population accounts 1% of the population accounts for almost 30% of expensesfor almost 30% of expenses

50% of the population 50% of the population accounts for only 3% of accounts for only 3% of expensesexpenses

This degree of concentration This degree of concentration has been consistent over timehas been consistent over time

Source: Berk and Monheit, “Concentration of Expenditures Revisited,” Health Affairs, March/April 2001.

Conditional Distributions by Percentile for Conditional Distributions by Percentile for Persistence of ExpendituresPersistence of Expenditures

0-10%10-20%

20-30%30-40%

40-50%50-60%

60-70%70-80%

80-90%90-100%

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

55.0

60.0

Percent (%)

Expenditure Group1999

Expenditure Group 2000

Persistence of Level of Health Care Expenditures: 1999-2000

Targeted Research EffortsTargeted Research Efforts

Trends in Cost, Coverage and AccessTrends in Cost, Coverage and Access microsimulations of generic versions of health care reforms

on coverage and expenditures PA on IMPACT OF PAYMENT AND ORGANIZATION ON PA on IMPACT OF PAYMENT AND ORGANIZATION ON

COST, QUALITY AND EQUITY COST, QUALITY AND EQUITY Co-ordination of DHHS LTC Research and Data Co-ordination of DHHS LTC Research and Data

Development Plan Development Plan

Recent MEPS ImpactRecent MEPS Impact

MEPS used to derive estimates of additional aggregate cost to MEPS used to derive estimates of additional aggregate cost to nation of covering the uninsured: IOM Report “Hidden Costs, nation of covering the uninsured: IOM Report “Hidden Costs, Value Lost” (June 2003).Value Lost” (June 2003).

IOM report on “Health Insurance is a Family Matter” indicates IOM report on “Health Insurance is a Family Matter” indicates “the most comprehensive data on who uses what health care “the most comprehensive data on who uses what health care services and how much is paid for those services comes from the services and how much is paid for those services comes from the Medical Expenditure Panel Survey” (Fall 2002).Medical Expenditure Panel Survey” (Fall 2002).

MEPS data used to estimate the costs of "uncompensated care”. MEPS data used to estimate the costs of "uncompensated care”. The study revealed that in 2001, uninsured Americans received The study revealed that in 2001, uninsured Americans received ~$35 billion worth of uncompensated care (Health Affairs, ~$35 billion worth of uncompensated care (Health Affairs, March/April 2003: J. Hadley and J. Holahan).March/April 2003: J. Hadley and J. Holahan).

AHRQ-Sponsored Research on Temporary HealthAHRQ-Sponsored Research on Temporary HealthInsurance Gaps Improves Estimates of the UninsuredInsurance Gaps Improves Estimates of the Uninsured

and the Cost of the Provision of Coverageand the Cost of the Provision of Coverage

J.A. Rhoades, J.P. Vistnes, J.W. Cohen, The uninsured J.A. Rhoades, J.P. Vistnes, J.W. Cohen, The uninsured in America:1996-2000, MEPS Chartbook No. 9, 2002in America:1996-2000, MEPS Chartbook No. 9, 2002

62.0 62.259.1 59.2

1996 1997 1998 1999

Number of Uninsured In Millions Any Time in YearNumber of Uninsured In Millions Any Time in Year

MEPS, 1996-1999MEPS, 1996-1999Uninsured Status, Non-elderlyUninsured Status, Non-elderly

USA TodayBridge Temporary Insurance Gaps,

9/26/02

“…the focus should shift to measures of the number of Americans each year who have any gap in their coverage.

From 1996 to 1999, between 59 million and 62 million Americans were uninsured at some point each year, according to a large- scale survey conducted by the federal Agency for Healthcare Research and Quality.”

Example of Use of MEPS DataExample of Use of MEPS Data

Consumers’ Checkbook Guide to Health Consumers’ Checkbook Guide to Health PlansPlans

Consumers’ Checkbook Guide to Consumers’ Checkbook Guide to Health PlansHealth Plans

Annual publication Annual publication Rates every plan available to federal Rates every plan available to federal

employees and retirees employees and retirees Compares likely cost of various plan options to Compares likely cost of various plan options to

employeeemployee

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

Approximate Yearly Cost to You ($)

Plan Code Plan Name Yearly

Premium ($) If Your Health Care Usage were Low

If Your Health Care Usage

were Average

If Your Health Care Usage were High

Yearly Limit on Cost to

You Excluding Dental($)

Local HMOs and Point of Service

E32 Kaiser Mid-Atlantic 1510 1650 2350 3890 5480

JP2 M.D. IPA 1530 1690 2460 4160 7330

JN5 Aetna Health-St 1070 1270 2620 5390 5530

JN2 Aetna Health-Hi 1570 1760 2880 5330 6030

222 Aetna Consumer Driven

1290 1290 3450 7340 16950

2G2 CareFirst 2280 2480 3530 5850 9530

Pharmaceutical CostsPharmaceutical Costs SignificanceSignificance

– Recent spending on prescription drugs were over Recent spending on prescription drugs were over 10% of all health care expenditures10% of all health care expenditures

– Recent annual growth rates exceed 15% Recent annual growth rates exceed 15% – Insurance coverage an important policy issueInsurance coverage an important policy issue

AHRQ research can clarify:AHRQ research can clarify:– Effects of new drugs on overall health care costsEffects of new drugs on overall health care costs– How prices vary by insurance status & type of drugHow prices vary by insurance status & type of drug– Effects of different coverage and payment optionsEffects of different coverage and payment options– Outcomes and effectiveness of pharmaceuticalsOutcomes and effectiveness of pharmaceuticals

MEPS: Pharmacy ComponentMEPS: Pharmacy Component

8000 pharmacies sampled8000 pharmacies sampled– data on prescribed medicines purchased by households data on prescribed medicines purchased by households

Data obtained:Data obtained:– Medication NameMedication Name– National Drug Code (NDC)National Drug Code (NDC)– Quantity DispensedQuantity Dispensed– Strength and FormStrength and Form– Sources of Payment Sources of Payment – Amount Paid by Each SourceAmount Paid by Each Source

Types of Analyses Supported by Types of Analyses Supported by MEPS Prescribed Medicine DataMEPS Prescribed Medicine Data

Trends in out of pocket burdens across all major Trends in out of pocket burdens across all major population subgroupspopulation subgroups

Examine burden on individuals and familiesExamine burden on individuals and families Prevalence of potentially inappropriate prescribing patternsPrevalence of potentially inappropriate prescribing patterns Trends in use and expenditures by therapeutic category: Trends in use and expenditures by therapeutic category:

e.g. statins, anti-depressants, analgesics, proton pump e.g. statins, anti-depressants, analgesics, proton pump inhibitorsinhibitors

Recent AHRQ Sponsored Recent AHRQ Sponsored Medical Medical CareCare Supplement Supplement

““Health Care Costs, Coverage, and Access in the Health Care Costs, Coverage, and Access in the United States: Research Findings from the Medical United States: Research Findings from the Medical

Expenditure Panel Survey”Expenditure Panel Survey”

This volume is dedicated to the memory of Dr. John This volume is dedicated to the memory of Dr. John M. Eisenberg in honor of his commitment to ensuring that M. Eisenberg in honor of his commitment to ensuring that health care is based on a strong foundation of researchhealth care is based on a strong foundation of research

Recent Conference on Policy ImpactRecent Conference on Policy Impact

MEPS: Informing Policy on Health Insurance MEPS: Informing Policy on Health Insurance Coverage and Health Care CostsCoverage and Health Care Costs

Highlight recent research efforts from the survey Highlight recent research efforts from the survey focused on healthcare costs and coverage that help focused on healthcare costs and coverage that help inform consumer and purchaser decisions. inform consumer and purchaser decisions.

Facilitate discussion of utility of MEPS to inform Facilitate discussion of utility of MEPS to inform policy and decisions by consumers and purchaserspolicy and decisions by consumers and purchasers

Conference AgendaConference Agenda

Patterns in Prescription Drug ExpendituresPatterns in Prescription Drug ExpendituresModerator: Joel Cohen, AHRQModerator: Joel Cohen, AHRQ

Private Insurance MarketsPrivate Insurance Markets

Moderator: Gail Shearer, Consumers UnionModerator: Gail Shearer, Consumers Union

Disabled, Rural, and Racial/Ethnic MinoritiesDisabled, Rural, and Racial/Ethnic Minorities

Moderator: Alan Monheit, Univ. of Medicine, NJModerator: Alan Monheit, Univ. of Medicine, NJ

Children’s Health Insurance CoverageChildren’s Health Insurance CoverageModerator: Linda Bilheimer, RWJFModerator: Linda Bilheimer, RWJF

The National Healthcare The National Healthcare Quality ReportQuality Report

BackgroundBackground

Mandated by Congress in the Healthcare Mandated by Congress in the Healthcare Research and Quality Act (PL. 106-129)Research and Quality Act (PL. 106-129)– ““Beginning in fiscal year 2003, the Secretary, Beginning in fiscal year 2003, the Secretary,

acting through the Director, shall submit to acting through the Director, shall submit to Congress an annual report on national trends in Congress an annual report on national trends in the quality of health care provided to the the quality of health care provided to the American people.”American people.”

Conceptual FrameworkConceptual Framework

COMPONENTS OF HEALTH CARE QUALITY 1/

CONSUMER PERSPECTIVES ON PATIENTHEALTH CARE NEEDS 2/ EFFECTIVENESS SAFETY TIMELINESS CENTEREDNESS

STAYING HEALTHY

GETTING BETTER

LIVING WITH ILLNESS OR DISABILITY

COPING WITH THE END OF LIFE

1/ These are the health care aims defined by the Institute of Medicine in Crossing the Quality Chasm .

2/ Adapted from the Foundation for Accountability's Consumer Information Framework.

NOTE: EQUITY IS ANOTHER COMPONENT OF HEALTH CARE QUALITY AND APPLIES TO EACH CELL

OF THE MATRIX.

MEPS Enhancements to Measure MEPS Enhancements to Measure Healthcare Quality Healthcare Quality

Data to Support Quality of Care Analyses at the National Level

Data currently collected on: access to care, patient/customer satisfaction, health insurance coverage, health status, health services utilization and expenditures.

MEPS Enhancements to Measure MEPS Enhancements to Measure Healthcare Quality Healthcare Quality

ContentContent CAHPS: Patient satisfaction and accountability CAHPS: Patient satisfaction and accountability

measures measures SF-12 SF-12 Attitude ItemsAttitude Items

Research Uses of the Research Uses of the Medical Expenditure Panel SurveyMedical Expenditure Panel Survey

Areas of Research Using MEPS DataAreas of Research Using MEPS Data

Access, use, and qualityAccess, use, and quality ExpendituresExpenditures Private and public health insurancePrivate and public health insurance Health status and health behaviorsHealth status and health behaviors Microsimulation modelingMicrosimulation modeling Statistics and methodsStatistics and methods

OutlineOutline

Descriptive dataDescriptive data– Insurance and expendituresInsurance and expenditures

Illustrative research findingsIllustrative research findings

Current researchCurrent research

Percent Uninsured First Half of Year for Percent Uninsured First Half of Year for Persons < 65 by Age, 2003Persons < 65 by Age, 2003

16.6%11.9%

20.6%

36.4%

31.1%

22.2%17.6%

14.1%

0%5%

10%15%20%25%30%35%40%

AllAges

Under18

18 19-24 25-29 30-34 35-54 55-64

Source: 2003 Medical Expenditure Panel SurveySource: 2003 Medical Expenditure Panel Survey

Insurance Status of Children for First Half Insurance Status of Children for First Half of Year, 1996-2003of Year, 1996-2003

Percent

60.6%

27.5%

11.9%

63.8% 60.8%62.0%64.8%64.9%63.7%63.0%

26.3%23.5%22.4%21.3% 21.4% 20.4% 21.7%

12.9%14.5%13.9%15.7% 14.9% 14.7% 13.4%0%

10%

20%

30%

40%

50%

60%

70%

1996 1997 1998 1999 2000 2001 2002 2003

Private Public Uninsured

Source: 1996-2003 Medical Expenditure Panel SurveySource: 1996-2003 Medical Expenditure Panel Survey

Insurance Status of Children for First Half Insurance Status of Children for First Half of Year, 1996-2003of Year, 1996-2003

Number in Millions

44.1

20.0

8.7

43.0 44.241.541.843.140.640.9

19.215.715.113.8 13.6 13.6 14.0

9.49.79.410.2 9.5 9.8 8.70

10

20

30

40

50

1996 1997 1998 1999 2000 2001 2002 2003

Private Public Uninsured

Source: 1996-2003 Medical Expenditure Panel SurveySource: 1996-2003 Medical Expenditure Panel Survey

Health Insurance Premiums - Employee/Employer Health Insurance Premiums - Employee/Employer Contributions for Single Coverage 1996 - 2001Contributions for Single Coverage 1996 - 2001

$342

$320

$383

$420

$450

$498

$1,650

$1,731

$1,791

$1,905

$2,205

$2,391

$0 $1,000 $2,000 $3,000 $4,000

1996

1997

1998

1999

2000

2001

EmployeeContribution

EmployerContribution

Average premiums increased 8.8% & employee contributions increased 10.8% over 2000, continuing the trend from previous years.

AHRQ MEPS Insurance Component Index to Tables, www.meps.ahrq.gov/data pub/ic tables.htm

Health Insurance Premiums -Employee/Employer Health Insurance Premiums -Employee/Employer Contributions for Family Coverage 1996 - 2000Contributions for Family Coverage 1996 - 2000

$1,275

$1,614

$1,741

$3,679

$4,027

$4,208

$4,620

$5,158

$5,768

$1,305

$1,438

$1,382

$0 $2,000 $4,000 $6,000 $8,000

1996

1997

1998

1999

2000

2001

EmployeeContribution

EmployerContribution

Average premiums increased 10.9% and employee contributions increased 7.8% over 2000, continuing the trend from previous years.

AHRQ MEPS Insurance Component Index to Tableswww.meps.ahrq.gov/data pub/ic tables.htm

Distribution of Health Expenses by Source Distribution of Health Expenses by Source of Payment, 2001of Payment, 2001

Total = $726.4 Billion

22%

20%

9%

8%

42%

PrivateMedicareOut-of-pocketMedicaidOther

Source: Center for Financing, Access and Cost Trends,Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2001 ..

Distribution of Health Expenses by Type of Distribution of Health Expenses by Type of Service, 2001Service, 2001

35%

19%

8%4% 2%

32%Inpatient

Ambulatory

Prescribed Meds

Dental

Home Health

Other

Source: Center for Financing, Access and Cost Trends,Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2001.

Median and average medical Median and average medical expenses per person, 2001expenses per person, 2001

$595$856

$2,555

$2,994

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

Persons with expenditures Per capita expenditures

Median

Average

Source: Center for Financing, Access and Cost Trends,Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2001

Concentration of ExpendituresConcentration of Expenditures

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%T

ota

l E

xpen

dit

ure

s

Top5%

Top10%

Top50%

Population

Panel 1 Year 1

Panel 1 Year 2

Panel 2 Year 1

Panel 2 Year 2

Panel 3 Year 1

Panel 3 Year 2

Recent PublicationsRecent Publications

CFACT staffCFACT staff– More than 50 publications in 2003-04More than 50 publications in 2003-04– Dedicated journal issuesDedicated journal issues

External usersExternal users– Identified more than 70 articles in 2003-04Identified more than 70 articles in 2003-04– Prescription drug costs and usePrescription drug costs and use– Expenditures by conditionExpenditures by condition– Coverage of the uninsuredCoverage of the uninsured

Ten Highest Cost ConditionsTen Highest Cost Conditions

Heart Disease ($58B)Heart Disease ($58B) Cancer ($46B)Cancer ($46B) Trauma ($44B)Trauma ($44B) Mental Disorders ($30B)Mental Disorders ($30B) Pulmonary Conditions Pulmonary Conditions

($29B)($29B)

Diabetes ($20B)Diabetes ($20B) Hypertension ($18B)Hypertension ($18B) Cerebrovascular Cerebrovascular

Disease ($16B)Disease ($16B) Osteoarthritis ($16B)Osteoarthritis ($16B) Pneumonia ($16B)Pneumonia ($16B)

Source: J. Cohen and N. Krauss, “Spending and Service Use Among People with the Fifteen Most Costly Medical Conditions, 1997,” Health Affairs, March/April 2003.

Percent of Population and Expenditures for Percent of Population and Expenditures for

Persons with Top 7 Conditions, 1997-98Persons with Top 7 Conditions, 1997-98

0%5%

10%15%20%25%30%

He

art

Dis

ea

se

Ca

nc

er

Tra

um

a

Me

nta

lD

iso

rde

r

Pu

lmo

na

ryC

on

dit

ion

s

Dia

be

tes

Hy

pe

rte

ns

ion

Condition

Pe

rce

nt

% of Population

% of Expenditures

Source: J. Cohen, “The Persistence of Expenditures for Persons With High Cost Conditions,” Center for Financing, Access and Cost Trends, AHRQ, 2003.

Rural-Urban Differences in Access and Use Rural-Urban Differences in Access and Use of Ambulatory Careof Ambulatory Care

Using a 9-category rural-urban scale, the most rural Using a 9-category rural-urban scale, the most rural residents were more likely than metro residents to residents were more likely than metro residents to report a usual source of care. report a usual source of care.

However, the most rural residents also had fewer However, the most rural residents also had fewer ambulatory visits than metro residents.ambulatory visits than metro residents.

Intermediate areas on the rural-urban scale did not Intermediate areas on the rural-urban scale did not differ from metro areas in number of visits.differ from metro areas in number of visits.

The metropolitan-nonmetropolitan dichotomy may be The metropolitan-nonmetropolitan dichotomy may be too gross to capture geographic differences in health too gross to capture geographic differences in health service use. service use.

Source: Larson and Fleishman, “Rural-urban differences in usual sources of care and ambulatory service use: analyses of National data using urban influence codes, Medical Care, July 2003.

Percent with Employer-Sponsored Percent with Employer-Sponsored Health InsuranceHealth Insurance

70 6760 57

0

20

40

60

80

Urban

Adjacent

Not Adjacent-Large

Not Adjacent-Small

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

Offer and Take-up of Employer Offer and Take-up of Employer Sponsored InsuranceSponsored Insurance

6884

63

86

60

83

57

82

0

20

40

60

80

100

Urban Adjacent Not Adjacent-Large Not adjacent-Small

Offer Take-up

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

Employer-Sponsored Employer-Sponsored Health Insurance OffersHealth Insurance Offers

19971997 19981998 19991999 20002000 20012001

% of Estabs that % of Estabs that

Offer InsuranceOffer Insurance 5252 5555 5858 5959 5858

% of Estabs with % of Estabs with

Health Insurance that Health Insurance that

Offer 1 PlanOffer 1 Plan7272 6868 7070 7171 7070

% of Estabs with % of Estabs with

Health Insurance that Health Insurance that

Offer >1 PlanOffer >1 Plan2828 3232 3030 2929 3030

Source: “Contributions to Health Insurance Premiums When Does the Employer Pay 100 Percent?”Source: “Contributions to Health Insurance Premiums When Does the Employer Pay 100 Percent?”Alice M. Zawacki, Ph.D.,U.S. Census Bureau and Amy K. Taylor, Ph.D.,Agency for Healthcare Research and QualityAlice M. Zawacki, Ph.D.,U.S. Census Bureau and Amy K. Taylor, Ph.D.,Agency for Healthcare Research and Quality

Percent of Establishments that Pay Percent of Establishments that Pay 100% of Premium for at Least One Plan100% of Premium for at Least One Plan

0

10

20

30

40

50

60

70

1997 1998 1999 2000 2001

Pe

rce

nt

of

Es

tab

lis

hm

en

ts

% of Estabs Offering 1 Planthat Pay 100% for SingleCoverage

% of Estabs Offering 1 Planthat Pay 100% for FamilyCoverage

% of Estabs Offering >1 Planthat Pay 100% for SingleCoverage for at Least 1 Plan

% of Estabs Offering >1 Planthat Pay 100% for FamilyCoverage for at Least 1 Plan

Source: “Contributions to Health Insurance Premiums When Does the Employer Pay 100 Percent?”Source: “Contributions to Health Insurance Premiums When Does the Employer Pay 100 Percent?”Alice M. Zawacki, Ph.D.,U.S. Census Bureau and Amy K. Taylor, Ph.D.,Agency for Healthcare Research and QualityAlice M. Zawacki, Ph.D.,U.S. Census Bureau and Amy K. Taylor, Ph.D.,Agency for Healthcare Research and Quality

Enrollment Rates by Wage Distribution and Enrollment Rates by Wage Distribution and Single Employee Contribution LevelsSingle Employee Contribution Levels

1999 1999

Enrollment rates at Enrollment rates at establishments with zero establishments with zero employee contributions were employee contributions were higher than at those with higher than at those with positive employee positive employee contributions.contributions.

Low-wage establishments Low-wage establishments had lower enrollment rates had lower enrollment rates than other establishments than other establishments under either contribution under either contribution scenario.scenario.

Source: Cooper and Vistnes,” Workers’ Decisions to Take-Up Offered Health Insurance Coverage: Assessing the Importance of Out-of-Pocket Premiums Costs,” Medical Care, July 2003.

50

60

70

80

90

Low Wage >=50% Low Wage <50% High Wage >=50%

0 contributions + contributions

Insurance Take-Up Decisions are Insurance Take-Up Decisions are Sensitive to Tax SubsidiesSensitive to Tax Subsidies

Tax responsiveness is Tax responsiveness is greatergreater among three among three groups of great policy interest:groups of great policy interest:

workers in small firmsworkers in small firms

workers with low incomesworkers with low incomes

workers with low health risksworkers with low health risks

Source: D. Bernard and T. Selden, ”Private Health Coverage and the Tax Subsidy for Insurance: 1987 and 1996,” 2003, International Journal of Health Care Finance and Economics

Medicaid expansions reduced financial burdens Medicaid expansions reduced financial burdens for health care among eligible children and their for health care among eligible children and their

families between 1987 and 1996families between 1987 and 1996

0

10

20

30

1987 1996

MCD- expansions

low income control grp

The percent of children eligible The percent of children eligible for the Medicaid expansions for the Medicaid expansions who lived in families spending who lived in families spending 10% or more of family income 10% or more of family income on health care dropped from on health care dropped from 30% to 24% between 1987 and 30% to 24% between 1987 and 1996, compared to the control 1996, compared to the control group where this measure group where this measure

increased from 20% to 21%.increased from 20% to 21%.

Source: JBanthin and TSelden, “The ABC’s of Children’s Health Care…” Inquiry 40:73-85 (Summer 2003)

Marginal Cost of SCHIPMarginal Cost of SCHIP(Savings from cuts to program)(Savings from cuts to program)

StateState FedFed TotalTotal

BudgetBudget $282$282 $596$596 $878$878

Rev CrowdRev Crowd $5$5 $48$48 $54$54

Med NeedMed Need $128$128 $149$149 $277$277

UncompUncomp $51$51 $0$0 $51$51

Net SavingNet Saving $98$98 $399$399 $496$496

“How Much Can States Really Save by Rolling Back SCHIP?” T. Selden and J. Hudson, Center for Financing, Access and Cost Trends, AHRQ.

Examples of Current ResearchExamples of Current Research

SCHIP and employer crowd outSCHIP and employer crowd out Factors associated with persistence of Factors associated with persistence of

expendituresexpenditures Use of capitation and effects on provider behaviorUse of capitation and effects on provider behavior Prescription drugs and mental health treatmentPrescription drugs and mental health treatment

MEPS Data Products and MEPS Data Products and DisseminationDissemination

MEPS Public Use DataMEPS Public Use Data Methods of Dissemination Methods of Dissemination

MEPS web siteMEPS web site– www.meps.ahrq.govwww.meps.ahrq.gov

AHRQ clearinghouseAHRQ clearinghouse– CD-ROMCD-ROM– 800-358-9295800-358-9295

Questions?Questions?– MEPSPD@ahrq.govMEPSPD@ahrq.gov

WWW.MEPS.AHRQ.GOV

New WorkshopsNew Workshops

September 20-21 - Hands-on Workshop in Rockville- September 20-21 - Hands-on Workshop in Rockville- Using the MEPS Prescribed Drug and Condition FilesUsing the MEPS Prescribed Drug and Condition Files

November 30-Dec 1 - Hands-on Workshop in Rockville November 30-Dec 1 - Hands-on Workshop in Rockville – MEPS Linking Issues (NHIS, Conditions, Jobs, – MEPS Linking Issues (NHIS, Conditions, Jobs, PRPL, Events, Pooling, Longitudinal Analysis) PRPL, Events, Pooling, Longitudinal Analysis)

Cyber Seminars- 2005Cyber Seminars- 2005

MEPS Mailing List/List ServerMEPS Mailing List/List Server

Mailing List/List ServerMailing List/List Server click on “Mail List/List Server” from Web site click on “Mail List/List Server” from Web site both receive e-mail notices of data and both receive e-mail notices of data and

publications released on the Webpublications released on the Web List Server allows for interactive exchange of List Server allows for interactive exchange of

ideas and informationideas and information

MEPS Data Product InformationMEPS Data Product Information

Types of ProductsTypes of Products

Upcoming Data ReleasesUpcoming Data Releases

MEPS Data CenterMEPS Data Center

MEPS Data ProductsMEPS Data Products

Publications (Findings, Methods, Chartbooks)Publications (Findings, Methods, Chartbooks) Stat BriefsStat Briefs On-line tablesOn-line tables MEPS-NETMEPS-NET Micro-data filesMicro-data files

– Public usePublic use– Data CenterData Center

Recent Statistical BriefsRecent Statistical Briefs

Health Care Expenditures and Percentage Uninsured 10 Health Care Expenditures and Percentage Uninsured 10 Large MSA’s, 2000Large MSA’s, 2000

Estimates of Uninsured in Working Families, 2002Estimates of Uninsured in Working Families, 2002

Health Insurance Coverage and Income Levels, 2001Health Insurance Coverage and Income Levels, 2001

Out-patient Prescribed Medicines: A comparison of Use and Out-patient Prescribed Medicines: A comparison of Use and Expenditures, 1987 and 2001 Expenditures, 1987 and 2001

Figure 2. Average total and out-of-pocket costs for prescribed medicines for those with a prescribed

medicine purchase, 1987 and 2001

253321

144

730

0

200

400

600

800

Average total cost Average out-of-pocket cost

Do

lla

rs

1987 2001

Note: Estimates for 1987 were adjusted for inflation to 2001 dollars using data from the 1987 and 2001 Consumer Price Index for All Urban Consumers.

Brand New Insurance Stat BriefsBrand New Insurance Stat Briefs

Uninsured in America, 2003Uninsured in America, 2003

Trends in Health Insurance, 96-03Trends in Health Insurance, 96-03

Uninsured Children, 2003Uninsured Children, 2003

Source: Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey

Figure 5: Percent Uninsured by Marital StatusPeople Under Age 65, First Half of 2003

29.7 29.4

24.327.6

15.0

0

15

30

Married Widowed Divorced Separated Never married

Marital status

Per

cen

t

Source: Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey

Figure 2: MEPS, 1996-2003Uninsured Status, Non-elderly

Number of uninsured in millions

61.761.962.2 59.1 58.561.762.0

47.045.945.742.642.0

44.5 44.2 43.8

32.031.331.528.731.032.131.6

0

10

20

30

40

50

60

70

1996 1997 1998 1999 2000 2001 2002 2003

Any time in year First half of year Full year

Nu

mb

er i

n M

illi

on

s

Source: Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey

Figure 3: Percent of Children Under 18 years withPublic Only Health Insurance by Age, 1996-2003

Public Health Insurance Only

25.9

34.032.1

29.329.9 28.2 28.1 29.226.2 30.931.1

27.9

23.424.424.3 25.8 26.5 25.623.7

20.519.718.919.0

20.8 22.620.4

16.015.7 14.5 13.818.2 16.6

0

10

20

30

1996 1997 1998 1999 2000 2001 2002 2003

Age 0-3 Age 4-6 Age 7-12 Age 13-17

Per

cen

t

Statistical Briefs Planned for 2004Statistical Briefs Planned for 2004

P-med Expenditures by ConditionP-med Expenditures by Condition Hypertension Hypertension PSA ScreeningPSA Screening Children’s Usual Sources of CareChildren’s Usual Sources of Care

Recent ChartbooksRecent Chartbooks

Outpatient Prescribed Drug Expenses, 1999Outpatient Prescribed Drug Expenses, 1999 Health Care Expenses in the Community Health Care Expenses in the Community

Population, 1999Population, 1999

Chartbooks Planned for 2004Chartbooks Planned for 2004

Health Care in Urban and Rural Areas (1998-2000 Health Care in Urban and Rural Areas (1998-2000 combined) combined)

Race and Ethnic Differences in Health:1996-2001Race and Ethnic Differences in Health:1996-2001

Recent FindingsRecent Findings

Health Care Expenses for Injuries 1997Health Care Expenses for Injuries 1997

Dental Services, Use, Expenses, and Dental Services, Use, Expenses, and Sources of Payment 1996-2000Sources of Payment 1996-2000

Findings Reports Planned Findings Reports Planned for 2004for 2004

Restricted Activity Days: 97-2001Restricted Activity Days: 97-2001 Health Care Expenditures: 2000Health Care Expenditures: 2000 Medical Expenditures for Women: 2000Medical Expenditures for Women: 2000 Children with Special Health Care Needs: 2000Children with Special Health Care Needs: 2000 Trends in Antibiotic Use 96-2001Trends in Antibiotic Use 96-2001

Upcoming MEPS Data ReleasesUpcoming MEPS Data Releases

2002 Use File - Including Quality Variables (June 2004)2002 Use File - Including Quality Variables (June 2004)

2002 Jobs file (June 2004)2002 Jobs file (June 2004)

2002 NHIS Link file (June 20042002 NHIS Link file (June 2004

2003 Insurance File (July 2004)2003 Insurance File (July 2004)

2003 IC Tables (August2003 IC Tables (August 2004) 2004)

Upcoming Data ReleasesUpcoming Data Releases

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

MEPS Tables CompendiaMEPS Tables Compendia

MEPS-HC Tables CompendiaMEPS-HC Tables Compendia

Sets of Static tables with flexibility to redefine categoriesSets of Static tables with flexibility to redefine categories

Full year tables for expendituresFull year tables for expenditures

First part of year tables for insurance coverageFirst part of year tables for insurance coverage

Expenditure by Condition Tables (people, events, and Expenditure by Condition Tables (people, events, and total expenditures by site of service)total expenditures by site of service)

National-level National-level MEPS-IC Tables (Table I)MEPS-IC Tables (Table I)

Firm Size by: Firm Size by: – Industry GroupsIndustry Groups– Ownership type (Profit / Non-Profit)Ownership type (Profit / Non-Profit)– Age of firmAge of firm– % full-time employees% full-time employees– % low-wage employees% low-wage employees– Union presenceUnion presence

MEPS-IC State Tables MEPS-IC State Tables (II, V, VI, VII, and VIII)(II, V, VI, VII, and VIII)

State by: State by: – Size of firm (Table II)Size of firm (Table II)– Industry groupings (Table V)Industry groupings (Table V)– Ownership type (Table VI)Ownership type (Table VI)– Age of firm (Table VI)Age of firm (Table VI)

MEPS-IC State Tables MEPS-IC State Tables (II, V, VI, VII, and VIII)(II, V, VI, VII, and VIII)

State by: State by: – Proportion of Employees who are Full-time Proportion of Employees who are Full-time

(Table VII)(Table VII)– Proportion of Employees who are Low-wage Proportion of Employees who are Low-wage

(Table VII)(Table VII)– Average Wage Quartiles (Table VIII)Average Wage Quartiles (Table VIII)

MEPS-IC MEPS-IC Public-Sector Tables (Table III)Public-Sector Tables (Table III)

State and local governments by:State and local governments by:– Size of governmentSize of government– Census divisionCensus division

Table StructureTable Structure

EstablishmentsEstablishments EmployeesEmployees Single Premiums and Employee ContributionsSingle Premiums and Employee Contributions Family Premiums and Employee ContributionsFamily Premiums and Employee Contributions Employee-Plus-One Premiums and Employee Employee-Plus-One Premiums and Employee

ContributionsContributions

National Totals of Enrollees and National Totals of Enrollees and Cost of Health Insurance (Table IV)Cost of Health Insurance (Table IV)

Public and private sectorsPublic and private sectors Private-sector by:Private-sector by:

– IndustryIndustry– Purchased/self-insured plansPurchased/self-insured plans– Optional coverage (single service plans)Optional coverage (single service plans)

Public-sector by:Public-sector by:– Purchased/self-insured plansPurchased/self-insured plans– Optional coverage (single service plans)Optional coverage (single service plans)

MEPS-netMEPS-net

MEPSnetMEPSnet

An on-line interactive statistical computer systemAn on-line interactive statistical computer system Provides immediate access to data in a non-Provides immediate access to data in a non-

programming environmentprogramming environment MEPSnet is a set of statistical toolsMEPSnet is a set of statistical tools

– MEPSnet/HCMEPSnet/HC– MEPSnet/ICMEPSnet/IC

MEPS-net HCMEPS-net HC

Currently has the capacity to produce use, Currently has the capacity to produce use, expenditure, source of payment and health expenditure, source of payment and health insurance estimates for all years (including insurance estimates for all years (including standard errors) standard errors)

Plans to add quality data in 2004, and Access Plans to add quality data in 2004, and Access data in 2005data in 2005

MEPSnet IC Interactive Data ToolMEPSnet IC Interactive Data Tool

Step-by-Step search for estimates.Step-by-Step search for estimates. Estimates shown for all years available.Estimates shown for all years available. Graphical display of year-to-year trend with two-Graphical display of year-to-year trend with two-

standard deviation error bars displayed.standard deviation error bars displayed. Links back to table from which data derived.Links back to table from which data derived.

AHRQ Data CenterAHRQ Data Center

Provides researchers access to non-public use Provides researchers access to non-public use MEPS data (except directly identifiable information);MEPS data (except directly identifiable information);

Mode of data analysis Mode of data analysis – on a secure LAN at AHRQ, Rockville on a secure LAN at AHRQ, Rockville – task order agreement with data contractor task order agreement with data contractor – combinations of both.combinations of both.

ADC FacilitiesADC Facilities

Secure roomSecure room Terminal connected to secure LANTerminal connected to secure LAN SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS SAS, STATA, GAUSS, Stat Transfer, SUDAAN, Limdep, EQS

software available, and others upon request software available, and others upon request Limited staff support by people who know:Limited staff support by people who know:

– the datathe data– the confidentiality issuesthe confidentiality issues– the softwarethe software

Application And Review ProcessApplication And Review Process Application procedures are on the MEPS web siteApplication procedures are on the MEPS web site

Submit proposal to data center coordinatorSubmit proposal to data center coordinator

Review within 1 week for feasibility, and data Review within 1 week for feasibility, and data availabilityavailability

Internal review board (IRB) review requiredInternal review board (IRB) review required

Data Center FeesData Center Fees

User fee of $150.00 for approved projects to cover technical User fee of $150.00 for approved projects to cover technical assistance, simple file construction, and/or up 2 hours of assistance, simple file construction, and/or up 2 hours of programming support from data contractorprogramming support from data contractor

(additional programming support available at cost of (additional programming support available at cost of 80.00/hr)80.00/hr)

User fee waived for full-time studentsUser fee waived for full-time students

ADC ProceduresADC Procedures

May bring data in, but not outMay bring data in, but not out Access only to data needed for approved projectAccess only to data needed for approved project Tabular data will be reviewed for confidentialityTabular data will be reviewed for confidentiality Only approved tables can leave the CenterOnly approved tables can leave the Center Center will store data files, foreign merge files, Center will store data files, foreign merge files,

and all outputs needed for replicationand all outputs needed for replication

Limited Remote AccessLimited Remote Access

Once you have an established data center Once you have an established data center project, and have worked on site to develop project, and have worked on site to develop and debug programs, jobs may be and debug programs, jobs may be submitted to our Data Center Supervisor to submitted to our Data Center Supervisor to run. Out-put will be reviewed for run. Out-put will be reviewed for confidentiality and mailed to you.confidentiality and mailed to you.

Confidential Data Available for Confidential Data Available for Data Center ProjectsData Center Projects

1996 Nursing Home Data1996 Nursing Home Data

Linked HC - Secondary Data (full geo-coding Linked HC - Secondary Data (full geo-coding for 1996, 1997 and 2000, FIPS codes for other for 1996, 1997 and 2000, FIPS codes for other years)years)

MPC dataMPC data

Confidential Data Available for Confidential Data Available for Data ProjectsData Projects

Fully specified industry/occupation codesFully specified industry/occupation codes

Imputed NDC codesImputed NDC codes

Continuous poverty measure Continuous poverty measure

Linked HC-IC DataLinked HC-IC Data

SummarySummary

MEPS overview and design enhancementsMEPS overview and design enhancements Patient satisfaction and healthcare quality Patient satisfaction and healthcare quality

measurement: NHQR, NHDRmeasurement: NHQR, NHDR Program outreach and impactProgram outreach and impact Research UpdateResearch Update MEPS Data Products and DisseminationMEPS Data Products and Dissemination Greater emphasis on program initiatives that Greater emphasis on program initiatives that

enhance analytic utility of data and research efforts enhance analytic utility of data and research efforts that inform health care policy and practicethat inform health care policy and practice