Does Inclusion of Both Partial and Complete Does Inclusion of Both Partial and Complete Interviews from the Source Sampling Frame Have an Interviews from the Source Sampling Frame Have an Effect on Nonresponse Error and Measurement Error Effect on Nonresponse Error and Measurement Error
in a National Health Survey?in a National Health Survey?
Trena M. Ezzati-Rice, Frederick Rohde, Steven B. Cohen Trena M. Ezzati-Rice, Frederick Rohde, Steven B. Cohen
International Total Survey Error Workshop 2010 Stowe, VT
June 13-16, 2010
Motivation for researchMotivation for research
Large observed differences in Large observed differences in response rates between two types response rates between two types of previously interviewed cases of previously interviewed cases included in the Medical included in the Medical Expenditure Panel Survey (MEPS) Expenditure Panel Survey (MEPS) sample as a result of its integration sample as a result of its integration with another national health survey with another national health survey
MEPS survey backgroundMEPS survey background
Annual survey since 1996; nationally representative Annual survey since 1996; nationally representative sample of householdssample of households
5 rounds of data collection covering 2 calendar years5 rounds of data collection covering 2 calendar years
Used to estimate medical care utilization, access to Used to estimate medical care utilization, access to care, and health care expenses for the U.S. civilian care, and health care expenses for the U.S. civilian noninstitutionalized populationnoninstitutionalized population
Widely used to inform health care policyWidely used to inform health care policy
Integrated survey designIntegrated survey design
– Each annual panel of households is a subsample of Each annual panel of households is a subsample of responding households (from prior year) from another large responding households (from prior year) from another large ongoing U.S. health survey, the National Health Interview ongoing U.S. health survey, the National Health Interview Survey (NHIS)Survey (NHIS)
Integration of NHIS and MEPSIntegration of NHIS and MEPS
MEPS inherits the NHIS complex sample design with its MEPS inherits the NHIS complex sample design with its oversampling of selected minority populationsoversampling of selected minority populations
Reduces household screening costs for MEPS Reduces household screening costs for MEPS
Provides valuable sampling frame information to adjust for Provides valuable sampling frame information to adjust for survey nonresponsesurvey nonresponse
Provides enhanced analytical potential (NHIS and MEPS linked Provides enhanced analytical potential (NHIS and MEPS linked analyses)analyses)
MEPS response rate is conditioned on the NHIS response rateMEPS response rate is conditioned on the NHIS response rate
MEPS inherits the composition of the NHIS interviewed sampleMEPS inherits the composition of the NHIS interviewed sample
– Completed household interviewsCompleted household interviews
– ““Partially Completed” household interviewsPartially Completed” household interviews
Definition of an NHIS Definition of an NHIS “partially completed” interview“partially completed” interview
All questionnaire modules are not completedAll questionnaire modules are not completed
NHIS questionnaire composed of 5 major sectionsNHIS questionnaire composed of 5 major sections
1. Household composition (demographic information)1. Household composition (demographic information)
2. Family core (basic health and sociodemographic data)2. Family core (basic health and sociodemographic data)
Family relationships, marital statusFamily relationships, marital status
Health status, activity limitations, injury, poisoningHealth status, activity limitations, injury, poisoning
Access and utilization and citizenshipAccess and utilization and citizenship
Health insuranceHealth insurance
Educational attainment Educational attainment STOPSTOP
Employment, earnings, or income data for partials Employment, earnings, or income data for partials NO DataNO Data
– 3. Sample adult qx. 3. Sample adult qx. NO DataNO Data
– 4. Sample child qx. 4. Sample child qx. NO DataNO Data
– 5. Immunization section 5. Immunization section NO DataNO Data
Data Matrix: NHIS and MEPS Data Matrix: NHIS and MEPS sample integrationsample integration
NH
IS c
ompl
ete
Int
ervi
ews
MEPS Respondents
MEPS Nonrespondents
MEPS Respondents
MEPS Nonrespondents
NHIS partially completed interviews
NH
IS S
ampl
e F
ram
e
(NH
IS R
espo
nden
ts
elig
ible
for
ME
PS
)
Background for this researchBackground for this research
Previously conducted research (Chiu et al, 2001) Previously conducted research (Chiu et al, 2001) indicated that “late”/difficult” NHIS interviews were indicated that “late”/difficult” NHIS interviews were more likely to be partial completes.more likely to be partial completes.
Partially completed NHIS cases in the MEPS sample Partially completed NHIS cases in the MEPS sample observed to: observed to:
require more field effort require more field effort
have lower response rates compared to the NHIS complete have lower response rates compared to the NHIS complete casescases
Research questionsResearch questions Do the NHIS partially completed cases as included in the MEPSDo the NHIS partially completed cases as included in the MEPS
– Have lower response propensity at Round 1 and subsequent rounds?Have lower response propensity at Round 1 and subsequent rounds?
– Adversely affect data collection burden?Adversely affect data collection burden?
Are there differences in the demographic and socioeconomic Are there differences in the demographic and socioeconomic characteristics of the MEPS respondents when stratified by their characteristics of the MEPS respondents when stratified by their NHIS interview status (partial versus complete)?NHIS interview status (partial versus complete)?
Do the NHIS partially completed cases as carried over to MEPS Do the NHIS partially completed cases as carried over to MEPS affect survey data quality?affect survey data quality?
– Do they have higher item nonresponse rates on MEPS variables?Do they have higher item nonresponse rates on MEPS variables?
– Do MEPS survey estimates differ when stratified by partial vs. complete Do MEPS survey estimates differ when stratified by partial vs. complete NHIS interview status?NHIS interview status?
Source of Data Source of Data
MEPS MEPS
– Historical data for examining response rate trendsHistorical data for examining response rate trends
– Panels 11 & 12 for detailed analyses Panels 11 & 12 for detailed analyses
– Paradata (survey burden assessment)Paradata (survey burden assessment)
– Survey data (item nonresponse and weighted Survey data (item nonresponse and weighted survey estimates)survey estimates)
NHISNHIS
– Paradata (NHIS interview status and other data)Paradata (NHIS interview status and other data)
– Survey data (response propensity modelingSurvey data (response propensity modeling) )
Percentage of MEPS reporting units Percentage of MEPS reporting units with a previous NHIS partially with a previous NHIS partially completed interview: MEPS Panels 3-14completed interview: MEPS Panels 3-14
Year MEPS Year MEPS Panel StartedPanel Started
PanelPanel NHIS “partially NHIS “partially completed” completed”
interview (%)interview (%)19981998 33 101019991999 44 212120002000 55 242420012001 66 222220022002 77 171720032003 88 202020042004 99 191920052005 1010 161620062006 1111 232320072007 1212 191920082008 1313 252520092009 1414 2626
0102030405060708090
100
2004 2005 2006 2007 2008 2009
Year
(%)
un
wei
gh
ted
res
po
nse
Completes
Partials
MEPS Round 1 response rates MEPS Round 1 response rates (reporting unit level) by NHIS interview (reporting unit level) by NHIS interview completion status: 2004-2009completion status: 2004-2009
Percent refused MEPS interview (at the Percent refused MEPS interview (at the RU level) by round and NHIS interview RU level) by round and NHIS interview status, MEPS Panel 12status, MEPS Panel 12
RoundRound NHIS PartialNHIS Partial
(%)(%)
NHIS CompleteNHIS Complete
(%)(%)
11 28.7*28.7* 15.915.9
22 10.3*10.3* 5.55.5
33 4.74.7 3.63.6
44 3.23.2 2.62.6
55 1.81.8 1.11.1
*p<.001*p<.001
0
5
10
15
20
25
30
35
40
R1* R2* R3* R4 R5
Round
Per
cen
t
Partials
Completes
Percent ever refused (reluctant respondent or final Percent ever refused (reluctant respondent or final refusal) by Round and NHIS interview completion refusal) by Round and NHIS interview completion status: RU level MEPS Panel 12status: RU level MEPS Panel 12
Percent of noncontacts and true contacts by Percent of noncontacts and true contacts by NHIS interview status: MEPS Panel 12, Round 1NHIS interview status: MEPS Panel 12, Round 1
ParadataParadata
NHISNHIS
partialpartialNHIS NHIS
completecomplete SignifSignif
Round 1 noncontactsRound 1 noncontacts
4+4+ 34.734.7 26.926.9 p<.001p<.001
Round 1 “true” contacts Round 1 “true” contacts
11
2-32-3
4-54-5
6-106-10
11-1411-14
15+15+
11.111.1
42.142.1
21.521.5
18.518.5
3.73.7
3.03.0
13.313.3
51.251.2
17.517.5
13.813.8
2.52.5
1.61.6
p<.001p<.001
Other paradata measures by NHIS Other paradata measures by NHIS interview status: MEPS Panel 12, Round 1interview status: MEPS Panel 12, Round 1
ParadataParadata NHIS NHIS partialpartial
NHIS NHIS completecomplete
SignifSignif
Reluctant respondent (%)Reluctant respondent (%) 14.314.3 8.48.4 p<.001p<.001
Not located (%)Not located (%) 6.16.1 3.33.3 p<.001p<.001
MEPS interview typeMEPS interview type
In person (%)In person (%)
Phone (%)Phone (%)90.290.2
9.89.8
93.893.8
6.26.2
p<.001p<.001
Mean interview time Mean interview time (minutes)(minutes)
110.3110.3 107.3107.3 p=.232p=.232
Any break-offs during the Any break-offs during the interview (%)interview (%)
10.710.7 9.29.2 p=.006p=.006
Bivariate analysis of R1 respondent Bivariate analysis of R1 respondent characteristics (reference person) by NHIS characteristics (reference person) by NHIS interview completion status: MEPS Panels 11 & interview completion status: MEPS Panels 11 & 12 combined12 combined
CharacteristicCharacteristic Overall (%)Overall (%) Partial (%)Partial (%) Complete(%)Complete(%)
Age of Reference person*Age of Reference person* 65+65+ 18.118.1 13.013.0 19.219.2
Race/ethnicity *Race/ethnicity * HispanicHispanic Non-Hispanic BlackNon-Hispanic Black Non-Hispanic AsianNon-Hispanic Asian Non-Hispanic OtherNon-Hispanic Other
19.719.717.417.44.64.6
58.358.3
26.526.517.917.9 6.76.748.948.9
18.218.217.217.2 4.24.260.460.4
Marital Status*Marital Status* MarriedMarried Widowed/separated/divorcedWidowed/separated/divorced Never marriedNever married
49.849.828.328.321.821.8
56.956.923.423.419.619.6
48.248.229.429.422.322.3
Year 1 Poverty Status*Year 1 Poverty Status* In/near povertyIn/near poverty Low incomeLow income Middle incomeMiddle income High incomeHigh income MissingMissing
23.523.514.214.225.125.126.226.211.011.0
22.822.813.113.124.324.324.524.515.315.3
23.723.714.514.525.325.326.626.610.010.0
**significant at alpha = 0.05significant at alpha = 0.05
Bivariate analysis (cont.) of R1 respondent characteristics Bivariate analysis (cont.) of R1 respondent characteristics (MEPS reference person) by NHIS interview completion (MEPS reference person) by NHIS interview completion status: MEPS Panels 11 & 12 combined status: MEPS Panels 11 & 12 combined (* = significant at alpha = .05) (* = significant at alpha = .05)
CharacteristicCharacteristic Overall (%)Overall (%) Partial (%)Partial (%) Complete (%)Complete (%)
Size of RU*Size of RU* 11 22 33 44 5+5+
28.928.928.528.515.815.814.314.312.412.4
19.119.125.425.419.219.218.518.517.817.8
31.131.129.229.215.115.113.413.411.211.2
Employment status*Employment status* Employed Employed 65.365.3 69.469.4 64.464.4
Region*Region* NortheastNortheast MidwestMidwest SouthSouth WestWest
16.316.321.221.238.038.024.524.5
17.317.318.118.135.835.828.828.8
16.016.021.921.938.538.523.623.6
MSA status*MSA status* MSAMSA Non MSANon MSA
83.783.716.316.3
87.987.912.112.1
82.782.717.317.3
Logistic regression analysis of Round 1 (RU) Logistic regression analysis of Round 1 (RU) respondent (reference person charac) being a respondent (reference person charac) being a prior NHIS partial complete: MEPS Panels 11 & prior NHIS partial complete: MEPS Panels 11 & 1212
EffectEffect DFDF Wald XWald X22 Pr > Pr > XX22
Race/ethnicityRace/ethnicity 33 52.152.1 <.0001<.0001Yr1 poverty statusYr1 poverty status 55 41.941.9 <.0001<.0001No. of people in RUNo. of people in RU 44 21.821.8 .0002 .0002Family structureFamily structure 55 28.528.5 <.0001<.0001Employment statusEmployment status 22 15.015.0 .0006 .0006RegionRegion 33 10.210.2
.0167 .0167MSA statusMSA status 11 15.315.3 <.0001<.0001
Odds ratios of logistic model predicting a Odds ratios of logistic model predicting a “NHIS Partial Complete” respondent at “NHIS Partial Complete” respondent at MEPS Round 1, Panels 11 & 12MEPS Round 1, Panels 11 & 12
Race/ethnicityRace/ethnicity MSA MSA AsianAsian 1.61* 1.61* MSA MSA 1.31*1.31* BlackBlack 1.31*1.31* Non-MSA Non-MSA 1.001.00 HispanicHispanic 1.45*1.45* White/OtherWhite/Other 1.001.00
Reporting Unit SizeReporting Unit Size Poverty StatusPoverty Status 11 0.26*0.26* In poverty In poverty 1.011.01 22 0.57*0.57* Low income Low income 0.950.95 33 0.77*0.77* Middle income Middle income 1.011.01
44 0.900.90 Missing income Missing income 1.52* 1.52* 5+5+ 1.001.00 Near poverty Near poverty 1.101.10
High incomeHigh income 1.001.00RegionRegion MidwestMidwest 0.84*0.84* Employment StatusEmployment Status NortheastNortheast 0.950.95 Employed Employed 1.14*1.14* SouthSouth 0.85*0.85* Missing/<16 yr Missing/<16 yr 2.42*2.42* WestWest 1.001.00 Unemployed Unemployed 1.001.00
Predicting Round 1 dwelling unit level response Predicting Round 1 dwelling unit level response propensity -- 29 potential (NHIS) covariates as propensity -- 29 potential (NHIS) covariates as used in MEPS weights productionused in MEPS weights production
DemographicDemographic Household Household CharacteristicsCharacteristics
Socio-Socio-Economic Economic StatusStatus
GeographicGeographic Health-Health-related related
Age ref. personAge ref. person DU sizeDU size Poverty statusPoverty status Census regionCensus region Health Health statusstatus
Race/ethnicityRace/ethnicity Has phoneHas phone EducationEducation MSA sizeMSA size Need helpNeed help
Marital statusMarital status Working or not Working or not IncomeIncome MSA/nonMSAMSA/nonMSA # nts. in # nts. in hospitalhospital
GenderGender Type of PSUType of PSU Employment Employment statusstatus
Urban/RuralUrban/Rural Healthcare Healthcare coveragecoverage
Any AsianAny Asian Type of home – Type of home – house, apt., etc.house, apt., etc.
Home Home ownershipownership
Medical Medical expenses expenses categorycategory
Any BlackAny Black Time w/ no phoneTime w/ no phone
Interview Interview languagelanguage
U.S. citizenU.S. citizen
U.S. bornU.S. born
Additional NHIS para data included in logit Additional NHIS para data included in logit regression (predicting round 1 response regression (predicting round 1 response propensity) -- * available for MEPS panel 12 onlypropensity) -- * available for MEPS panel 12 only
NHIS interview completion status (partial vs. complete)NHIS interview completion status (partial vs. complete)
– Panels 11 and 12Panels 11 and 12
Household cooperativeness*Household cooperativeness*
How likely respond to later linked survey*How likely respond to later linked survey*
# of contacts and # of non-contacts*# of contacts and # of non-contacts*
Language problem*Language problem*
Health problem*Health problem*
Time constraints*Time constraints*
Content/privacy concerns*Content/privacy concerns*
Hostility mentioned*Hostility mentioned*
Results of logistic regression predicting round 1 Results of logistic regression predicting round 1 DU level response propensity -- MEPS Panel 11DU level response propensity -- MEPS Panel 11
EffectEffect DFDF Wald X Wald X22 Pr > XPr > X22
Predicted povertyPredicted poverty 11 12.6 12.6 .0004 .0004AgeAge 44 10.4 10.4 .0338 .0338Race/ethnicity Race/ethnicity 33 24.6 24.6 <.0001<.0001Marital statusMarital status 11 6.3 6.3 .0121 .0121IncomeIncome 44 48.3 48.3 <.0001<.0001DU sizeDU size 44 36.5 36.5 <.0001<.0001MSA statusMSA status 22 21.0 21.0 <.0001<.0001RegionRegion 33 18.7 18.7 .0003 .0003Has phoneHas phone 33 27.0 27.0 <.0001<.0001Home typeHome type 11 7.8 7.8 .0053 .0053Interview languageInterview language 22 6.9 6.9 .0325 .0325U.S. born U.S. born 22 11.8 11.8 .0028 .0028NHIS interview completion statusNHIS interview completion status 11 105.4105.4 <.0001<.0001
Results of logistic regression predicting round 1 Results of logistic regression predicting round 1 response propensity -- MEPS Panel 12response propensity -- MEPS Panel 12(additional NHIS paradata available)(additional NHIS paradata available)
EffectEffect DFDF Wald XWald X22 Pr > XPr > X22
Race/ethnicity Race/ethnicity 33 33.9 <.000133.9 <.0001Marital statusMarital status 11 4.2 .0405 4.2 .0405IncomeIncome 44 15.3 .004115.3 .0041DU sizeDU size 44 21.3 .000321.3 .0003MSA statusMSA status 22 6.0 .0496 6.0 .0496RegionRegion 33 21.0 .000121.0 .0001Has phoneHas phone 33 19.6 .000219.6 .0002PSU typePSU type 11 4.5 .0340 4.5 .0340Interview languageInterview language 22 12.3 .002112.3 .0021Health statusHealth status 22 11.2 .003711.2 .0037NHIS interview completion statusNHIS interview completion status 11 3.9 .0500 3.9 .0500Med expend categoryMed expend category 44 1.4 .0343 1.4 .0343HH cooperativenessHH cooperativeness 44 28.3 <.000128.3 <.0001Likely to respond to later surveyLikely to respond to later survey 11 10.6 .001110.6 .0011# contacts w/ sample unit# contacts w/ sample unit 66 35.5 <.000135.5 <.0001# noncontacts# noncontacts 55 30.7 <.000130.7 <.0001Privacy concernsPrivacy concerns 11 20.6 <.000120.6 <.0001Hostility mentionedHostility mentioned 11 5.5 .0194 5.5 .0194
RU level item nonresponse rates, MEPS Panel 12RU level item nonresponse rates, MEPS Panel 12(if any respondent in the RU had a missing value (if any respondent in the RU had a missing value in year 1) in year 1)
VariableVariable NHIS NHIS
Partial (%)Partial (%)
NHIS NHIS Complete (%)Complete (%)
SignifSignif
Yr1 poverty statusYr1 poverty status 15.815.8 10.310.3 p<.001p<.001
EducationEducation 3.93.9 2.12.1 p=.002p=.002
High blood pressure (>17)High blood pressure (>17) 2.42.4 0.90.9 p<.001p<.001
High cholesterol (>17)High cholesterol (>17) 2.32.3 1.21.2 p=.025p=.025
Diabetes diagnosisDiabetes diagnosis 1.51.5 0.80.8 p=.059p=.059
How often dental check upHow often dental check up 5.35.3 2.52.5 p<.001p<.001
How long last routine check up How long last routine check up (>17)(>17)
10.710.7 6.46.4 p<.001p<.001
How long last flu shot (>17)How long last flu shot (>17) 9.69.6 4.94.9 p<.001p<.001
How long since mammogram (>29)How long since mammogram (>29) 8.68.6 4.54.5 p<.001p<.001
How long since last PSA (>39, M)How long since last PSA (>39, M) 17.017.0 10.510.5 p<.001p<.001
Usual source of careUsual source of care 5.25.2 2.22.2 p<.001p<.001
Employment statusEmployment status 3.73.7 2.32.3 p=.014p=.014
Mental health statusMental health status 2.12.1 1.11.1 p=.014p=.014
Health statusHealth status 1.61.6 0.90.9 p=.059p=.059
Comparison of selected Year 1 estimates Comparison of selected Year 1 estimates (percents) according to NHIS interview completion (percents) according to NHIS interview completion status: MEPS Panels 11 & 12 status: MEPS Panels 11 & 12 (* = signif p <.05)(* = signif p <.05)
Person level Person level healthhealth
Panel 11Panel 11 Panel 12Panel 12
measuremeasure Partial Partial CompleteComplete PartialPartial CompleteComplete
Insurance (<65)Insurance (<65)
Any privateAny private 68.368.3 71.4*71.4* 65.065.0 68.968.9
Public onlyPublic only 15.215.2 15.315.3 17.417.4 15.915.9
UninsuredUninsured 16.516.5 13.313.3 17.617.6 15.215.2
Any activity Any activity limitation*limitation*
7.37.3 10.410.4 6.16.1 9.59.5
High cholesterol High cholesterol dx (>17)*dx (>17)*
20.720.7 25.525.5 24.424.4 30.530.5
Office based Office based provider visit*provider visit*
68.068.0 75.275.2 65.765.7 72.672.6
Rx (including Rx (including refills)*refills)*
58.658.6 65.265.2 55.155.1 63.463.4
Total mean Total mean expenditures*expenditures*
$2,760$2,760 $3,815$3,815 $3,171$3,171 $3,943$3,943
5+ contacts5+ contacts $2,484$2,484 $3,390*$3,390* $3,021$3,021 $3,823$3,823
MEPS Year 1 estimates (in percent) for All MEPS MEPS Year 1 estimates (in percent) for All MEPS respondents versus excluding NHIS partial cases respondents versus excluding NHIS partial cases (person weights for NHIS completes re-calculated treating partials (person weights for NHIS completes re-calculated treating partials as nonrespondents) as nonrespondents) (* = signif p<.05)(* = signif p<.05)
Person level Person level healthhealth
Panel 11Panel 11 Panel 12Panel 12
measuremeasure AllAll CompletesCompletes
Only (rewt)Only (rewt)
AllAll Completes Completes Only (rewt)Only (rewt)
Insurance (<65)Insurance (<65)
Any privateAny private 70.770.7 71.171.1 68.168.1 68.668.6
Public onlyPublic only 15.315.3 15.515.5 16.216.2 16.016.0
UninsuredUninsured 14.014.0 13.513.5 15.715.7 15.315.3
Any activity Any activity limitationlimitation
9.89.8 10.0*10.0* 8.98.9 9.19.1
High cholesterol High cholesterol dx (>17)*dx (>17)*
24.524.5 25.125.1 29.529.5 30.030.0
Office based Office based provider visit*provider visit*
73.773.7 74.774.7 71.471.4 72.172.1
Rx (including Rx (including refills)*refills)*
63.863.8 64.464.4 61.961.9 62.662.6
Total mean Total mean expendituresexpenditures
$3,593$3,593 $3,723*$3,723* $3,802$3,802 $3,836$3,836
5+ contacts5+ contacts $3,162$3,162 $3,313*$3,313* $3,647$3,647 $3,702$3,702
SummarySummary
We examined the impact of the carry-over of two types We examined the impact of the carry-over of two types of prior interview cases in the MEPS as a result of its of prior interview cases in the MEPS as a result of its integration with the NHIS.integration with the NHIS.
In particular, we wanted to examine if the partially In particular, we wanted to examine if the partially completed NHIS cases may bias MEPS survey completed NHIS cases may bias MEPS survey estimates and impact survey burden.estimates and impact survey burden.
NHIS partial cases had significantly higher ever refused NHIS partial cases had significantly higher ever refused rates, higher contact rates, lower response rates at rates, higher contact rates, lower response rates at MEPS Round 1, and higher attrition rates.MEPS Round 1, and higher attrition rates.
Partial versus complete was a significant predictor of Partial versus complete was a significant predictor of MEPS Round 1 response propensity controlling for MEPS Round 1 response propensity controlling for other variables.other variables.
Summary (cont.)Summary (cont.)
Item nonresponse rates were higher for the Item nonresponse rates were higher for the partially completed cases relative to the NHIS partially completed cases relative to the NHIS completes for a number of MEPS key variables.completes for a number of MEPS key variables.
Estimates for several selected health items were Estimates for several selected health items were different between the NHIS partials and different between the NHIS partials and completes as carried over in the MEPS sample.completes as carried over in the MEPS sample.
Excluding the NHIS partial cases from the MEPS Excluding the NHIS partial cases from the MEPS survey estimates (and re-weighting) resulted in survey estimates (and re-weighting) resulted in slightly higher estimates of selected conditions, slightly higher estimates of selected conditions, medical events, and expenditures.medical events, and expenditures.
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DiscussionDiscussion
Initial exploratory analysisInitial exploratory analysis
– What additional analyses can be carried out to What additional analyses can be carried out to assess potential nonresponse bias and assess potential nonresponse bias and measurement error bias related to the two types of measurement error bias related to the two types of interview cases in the MEPS?interview cases in the MEPS?
– What approaches could be explored to correct for What approaches could be explored to correct for nonresponse or measurement error bias?nonresponse or measurement error bias?
Should MEPS consider excluding or subsampling the Should MEPS consider excluding or subsampling the NHIS partials in future panels of the MEPS?NHIS partials in future panels of the MEPS?
Ideas/suggestions for future research?Ideas/suggestions for future research?
Logistic regression analysis of the insured (<65 years) Logistic regression analysis of the insured (<65 years) reference person: testing for NHIS interview status reference person: testing for NHIS interview status effect, MEPS, Panels 11 and 12 (RU level analysis)effect, MEPS, Panels 11 and 12 (RU level analysis)
Panel 11Panel 11 Panel 12Panel 12 Panel 11 + 12Panel 11 + 12
DFDF Wald FWald F p-valuep-value DFDF Wald FWald F P-valueP-value DFDF Wald FWald F p-valuep-value
AgeAge 33 9.139.13 .0276.0276 11 4.754.75 .0029.0029 33 21.8121.81 <.0001<.0001
SexSex 11 10.9210.92 .0009.0009 11 7.677.67 .0056.0056 11 18.6118.61 <.0001<.0001
Race/ethnicityRace/ethnicity 33 99.3999.39 <.0001<.0001 11 111.99111.99 <.0001<.0001 33 206.47206.47 <.0001<.0001
Highest year of Highest year of educationeducation 44 69.7869.78 <.0001<.0001 44 52.7552.75 <.0001<.0001 44 122.32122.32 <.0001<.0001
Poverty status (Y1)Poverty status (Y1) 55 237.16237.16 <.0001<.0001 55 174.76174.76 <.0001<.0001 55 406.38406.38 <.0001<.0001
RegionRegion 33 39.0139.01 <.0001<.0001 33 53.0253.02 <.0001<.0001 33 86.5186.51 <.0001<.0001
Total health careTotal health care
ExpendituresExpenditures 66 233.63233.63 <.0001<.0001 66 194.35194.35 <.0001<.0001 66 417.21417.21 <.0001<.0001
NHIS InterviewNHIS Interview
Completion StatusCompletion Status 11 0.360.36 .5477.5477 11 4.754.75 .0293.0293 11 2.932.93 .0868.0868
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