Statistical Brief #38 

Health Care Expenditures and Percentage Uninsured in 10 Large 

Metropolitan Areas, 2000 

By Steven R. Machlin, MS, Alice J. Nixon, MA, and John P. Sommers, PhD 

Introduction 

The Medical Expenditure Panel Survey–Household Component (MEPS-HC) is designed to 

produce estimates of the health care use, expenditures, sources of payment, and insurance 

coverage among the U.S. civilian noninstitutionalized (community) population. While MEPS 

was designed to ensure reliable estimates at the national and regional level for a large variety of 

population subgroups, estimates with acceptable precision can also be produced for several large 

metropolitan areas. 

Many factors can influence the level of health care expenses in a particular area, including the 

demographic, socioeconomic, and health status characteristics of the population. Further, the 

extent to which persons in an area have health insurance coverage can impact both access to care 

and the average level of expenditures. 

Based on data from the 2000 MEPS-HC, this report compares estimates of health care expenses 

and uninsured rates for the community population under 65 years of age in 10 large metropolitan 

areas to national averages. These 10 areas are defined by metropolitan statistical areas (MSA) 

and include Chicago, Dallas, Detroit, Houston, Los Angeles, Miami, New York City, 

Philadelphia, San Francisco, and Washington, D.C. All differences discussed in this Statistical 

Brief are statistically significant at the 0.05 level, and standard errors associated with the 

estimates are available at http://www.meps.ahrq.gov/mepsweb/survey_comp/standard_errors.jsp. 

Highlights 

• In comparison to the national average, the proportion of persons under 65 years of age 

that incurred some health care expenses in 2000 was lower in Houston, Miami, Los 

Angeles, and Dallas, but higher in Detroit and Washington, D.C. 

• For the majority of the 10 MSAs examined, differences from national averages in average 

expenses and uninsured rates for the population less than 65 years of age were not 

statistically significant. 

• The populations under 65 years of age in the Houston, Miami, and Los Angeles 

metropolitan areas were more likely to be uninsured throughout the year in 2000 and also 

had lower median expenses (among those with expenses) relative to the national average. 

• Median expenses in Detroit were higher than the national average, while the uninsured 

rate in Chicago was lower than the national average. 
Findings 

An estimated 81.8 percent of persons under 65 years of age in the U.S. community population 

had some expenses for health care in 2000. The proportion with health care expenses was 

somewhat lower in four MSAs—Houston (70.2 percent), Miami (71.4 percent), Los Angeles 

(74.3 percent), and Dallas (74.3 percent)—when compared to the national estimate (figure 1). In 

contrast, the proportion of non-elderly with health care expenses was higher than the national 

average in the Detroit (87.8 percent) and Washington, D.C. (88.3 percent) metropolitan areas. 

Among persons under 65 in the U.S. community population with some health care expenses in 

2000, the estimated mean expense per person was $2,127 (figure 2). Mean expenses per person 

only differed from the national average for the Houston metropolitan area, where the estimated 

mean was about 25 percent lower ($1,603). While the estimate for Detroit ($3,653) appears high 

relative to the national average, the difference was not statistically significant. 

Median health care expenses tend to be substantially lower than mean expenses because a small 

percentage of people incur a disproportionately large share of total medical expenses. The 

median expense for the overall U.S. civilian noninstitutionalized population under 65 years of 

age was $586 (figure 3), about one-fourth the mean expenditure level of $2,127 (as shown in 

figure 2). Median expenses were lower than the national average in three large MSAs—Houston 

($352), Los Angeles ($365), and Miami ($399). In contrast, the estimated median expense per 

person in Detroit ($835) was higher than the national average. 

Houston, Miami, and Los Angeles, the three MSAs with lower median expenses than the 

national average for the population under 65 years of age (as shown in figure 3), also had higher 

proportions that were uninsured for the full year (figure 4). The uninsured rates for persons under 

65 in these MSAs were 27.8, 26.0, and 19.3 percent, respectively, compared to a national rate of 

13.3 percent. Among the other MSAs, only Chicago had a lower uninsured rate (9.0 percent) 

than the national average. 

Definitions 

Metropolitan statistical area: Areas designated by the U.S. Office of Management and Budget 

that are composed of a large population nucleus combined with adjacent communities that have a 

high degree of economic and social integration with the nucleus. Each MSA has one or more 

central counties containing the area’s main population concentration. 

Expenditures: Total payments from all sources to hospitals, physicians, other health care 

providers (including dental care), and pharmacies for services reported by respondents in the 

MEPS-HC. Sources include direct payments from individuals, private insurance, Medicare, 

Medicaid, and miscellaneous other sources. 

Uninsured: Persons not covered by Medicare, Tricare, Medicaid, other public hospital/physician 

programs, or private hospital/physician insurance at any time during the year or period of 

eligibility for the survey. Individuals covered only by noncomprehensive State-specific programs 

(e.g., Maryland Kidney Disease Program, Colorado Child Health Plan) or private single-service 
plans (e.g., coverage for dental or vision care only, coverage for accidents or specific diseases) 

are not considered to be insured. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on 

health care utilization and expenditures, health insurance, and health status, as well as a wide 

variety of social, demographic, and economic characteristics for the civilian noninstitutionalized 

population. It is cosponsored by the Agency for Healthcare Research and Quality and the 

National Center for Health Statistics. 

References 

For a detailed description of the MEPS-HC survey design, sample design, and methods used to 

minimize sources on nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. 

MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for 

Health Care Policy and Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. 

MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for 

Health Care Policy and Research, 1997. 

More information about MEPS is available on the MEPS Web site: http://www.meps.ahrq.gov/. 
Source: Center for Financing, Access,

Figure 1: Percentage of persons under 65 

with health care expenses, 2000 

Percent 

71.4 74.3 77.8 80.3 82.3 83.6 87.8 88.3 

81.8 

70.2 74.3 

0 

20 

40 

60 

80 

100 

U.S. 

Houston 

Miami 

Dallas

Los Angeles 

New York 

Chicago

San Francisco

Philadelphia 

Detroit

Washington DC 

U.S. Lower than U.S. Difference from U.S. not significant Higher than U.S. 

 and Cost Trends, AHRQ, Medical Expenditure 

Panel Survey–Household Component, 2000 
Source: Center for Financing, Access,

Figure 2: Mean health care expenses for 

persons under 65 with health care expenses, 2000 

1,644 1,728 1,730 1,806 2,009 2,085 2,096 2,263 

3,653 

2,127 

1,603 

0 

1,000 

2,000 

3,000 

4,000 

U.S. 

Houston 

Dallas

San Francisco

Los Angeles 

Miami

Washington DC 

Philadelphia 

Chicago 

New York 

Detroit 

U.S. Lower than U.S. Difference from U.S. not significant 

Dollars 

 and Cost Trends, AHRQ, Medical Expenditure 

Panel Survey–Household Component, 2000 
Source: Center for Financing, Access,

Figure 3: Median health care expenses for 

persons under 65 with health care expenses, 2000 

365 399 

490 521 574 580 609 615 

835 

586 

353 

0 

200 

400 

600 

800 

1,000 

U.S. 

Houston

Los Angeles 

Miami 

Chicago 

Dallas 

New York

San Francisco

Washington DC

Philadelphia 

Detroit 

U.S. Lower than U.S. Difference from U.S. not significant Higher than U.S. 

Dollars 

 and Cost Trends, AHRQ, Medical Expenditure 

Panel Survey–Household Component, 2000 
Source: Center for Financing, Access,

Figure 4: Percentage of persons under 65 

without health insurance the entire year, 2000 

9.2 10.8 12.6 12.6 13.8 

18.1 19.3 

26.0 27.8 

13.3 

9.0 

0 

5 

10 

15 

20 

25 

30 

U.S. 

Chicago 

Detroit

Philadelphia

Washington DC

San Francisco 

New York 

Dallas

Los Angeles 

Miami 

Houston 

U.S. Lower than U.S. Difference from U.S. not significant Higher than U.S. 

Percent 

 and Cost Trends, AHRQ, Medical Expenditure 

Panel Survey–Household Component, 2000