U.S. Department of Health and Human Services 

Public Health Service

Agency for Healthcare Research and Quality

Health Care Expenses for Injuries:

Estimates from the 1997 MEPS

Research 

 Findings

Research 

 Findings #19
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Research and Quality uses data from the 1997 Medical

Expenditure Panel Survey (MEPS) Household

Component to examine the health care costs of injuryAbstract

This report from the Agency for Healthcareyyyyy

related conditions. An estimated $57.9 billion was spent

on injury-related conditions for the U.S. civilian

noninstitutionalized population. Approximately 62

million people were reported to have had an injuryrelated condition. Seventy percent of the people with an

injury-related condition (43 million people) had a

medical expense related to that condition. This report

gives estimates of injury-related expenses for inpatient

hospital services and ambulatory medical care services

by age, sex, race, health insurance, and poverty level.

Injury-related expenses as a proportion of total medical

expenses, and mean and median expenses are also

discussed. The proportion of expenses for injury and 

The estimates in this report are based on the most

recent data available at the time the report was written.

However, selected elements of MEPS data may be

revised on the basis of additional analyses, which could

result in slightly different estimates from those shown

here. Please check the MEPS Web site for the most

current file releases.

noninjury medical care paid by various sources,

including out-of-pocket, Medicare, Medicaid, private

insurance, and Workers’ Compensation, are also

compared. 

Suggested citation

Krauss NA, Machlin SR,Adams GA. Health care expenses for

injuries: estimates from the 1997 MEPS. Rockville (MD):Agency for

Healthcare Research and Quality; 2003. MEPS Research Findings No.

19.AHRQ Pub. No. 04-0005.

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Research 

 Findings

Research 

 Findings

U.S. Department of Health and Human Services 

Public Health Service

Agency for Healthcare Research and Quality

AHRQ Pub. No. 04-0005

December 2003

Health Care Expenses for Injuries:

Estimates from the 1997 MEPS

#19
The Medical Expenditure Panel

Survey (MEPS)

Background

The Medical Expenditure Panel Survey (MEPS) is

conducted to provide 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), formerly the Agency for Health Care Policy

and Research, and the National Center for Health

Statistics (NCHS).

MEPS comprises three component surveys: the

Household Component (HC), the Medical Provider

Component (MPC), and the Insurance Component (IC).

The HC is the core survey, and it forms the basis for the

MPC sample and part of the IC sample. 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) was

conducted in 1977, the National Medical Expenditure

Survey (NMES) in 1987. Beginning in 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

accommodate these goals, new MEPS design features

include linkage with the National Health Interview

Survey (NHIS), 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.

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

21/2-year period. Using computer-assisted personal

interviewing (CAPI) technology, data on medical

expenditures and use for 2 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, conducted by NCHS. NHIS

provides a nationally representative sample of the U.S.

civilian noninstitutionalized population, with

oversampling of Hispanics and blacks.

Medical Provider Component

The MEPS MPC supplements and validates

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 hospitals, hospital physicians,

home health agencies, and pharmacies reported in the

HC. Also included in the MPC are all office-based

physicians: 

• Providing care for HC respondents receiving

Medicaid.

• Associated with a 75-percent sample of households

receiving care through an HMO (health maintenance

organization) or managed care plan.

II
• Associated with a 25-percent sample of the

remaining households.

Data are collected on medical and financial

characteristics of medical and pharmacy events reported

by HC respondents, including:

• Diagnoses coded according to ICD-9 (9th Revision,

International Classification of Diseases) and DSMIV (Fourth Edition, Diagnostic and Statistical

Manual of Mental Disorders).

• Physician procedure codes classified by CPT-4

(Current Procedural Terminology, Version 4).

• Inpatient stay codes classified by DRG (diagnosisrelated group).

• Prescriptions coded by national drug code (NDC),

medication names, strength, and quantity dispensed.

• Charges, payments, and the reasons for any

difference between charges and payments.

The MPC is conducted through telephone

interviews and mailed survey materials.

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, 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 the Bureau of the

Census.

To provide an integrated picture of health insurance,

data collected from the first sampling frame (employers

and other insurance providers) are linked back to data

provided by the MEPS HC respondents. Data from the

other three sampling frames are collected to provide

annual national and State estimates of the supply of

private health insurance available to American workers

and to evaluate policy issues pertaining to health

insurance. Since 2000, the Bureau of Economic

Analysis has used national estimates of employer

contributions to group health insurance from the MEPS

IC in the computation of Gross Domestic Product

(GDP).

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 followup for

nonrespondents.

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 and

microdata files. Summary reports are released as printed

documents and electronic files. Microdata files are

released on CD-ROM and/or as electronic files.

Printed documents and CD-ROMs 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)

To order online, send an e-mail to: 

ahrqpubs@ahrq.gov.

Be sure to specify the AHRQ number of the

document or CD-ROM you are requesting. Selected

electronic files are available through the Internet on the

MEPS Web site: 

http://www.meps.ahrq.gov/

For more information, visit the MEPS Web site or 

e-mail mepspd@ahrq.gov.

III
V

Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Definitions of Injury and Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Population Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Total Expenses for Injury-Related Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Ambulatory Care Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Inpatient Hospital Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Source of Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Figures showing percent distributions of expenses:

1. For injury-related conditions by type of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2. For non-injury-related conditions by type of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

3. For injury-related conditions by source of payment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

4. For non-injury-related conditions by source of payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Tables showing information on injury-related conditions:

1. Percent with conditions and percent incurring expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2. Total medical expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

3. Ambulatory medical expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

4. Inpatient medical expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Technical Appendix

Survey Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Definitions of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Significance Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Rounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Standard Error Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Introduction

Injuries are the fifth leading cause of death in the

United States (Hoyert, Arias, Smith, et al., 2001) and

the leading cause of death for people ages 1-44

(Department of Health and Human Services (U.S.),

2000). The risk of injury is so great that most people

sustain a significant injury at some time during their

lives (Department of Health and Human Services

(U.S.), 2000). It is not surprising that injuries impose a

large burden on national health care costs, exceeded

only by heart disease and cancer (Cohen and Krauss,

2003). 

This report presents estimates from the 1997

Medical Expenditure Panel Survey Household

Component (MEPS HC) of spending for direct medical

care provided for conditions caused by injuries among

the U.S. civilian noninstitutionalized population.

Because direct medical costs do not include reduced or

lost productivity in the working-age population or the

nonmonetary cost of the disability and emotional stress

caused by injuries, this report does not analyze the total

economic burden attributable to injuries. Emphasis is

placed on injury-related expenses for ambulatory care

and inpatient hospital care. 

Specific comparisons are made by age, sex,

race/ethnicity, health insurance status, and poverty

status. The overall distribution of expenses is shown by

type of care and source of payment for injury- and noninjury-related conditions. 

The estimates are representative of the civilian

noninstitutionalized population of the United States

during calendar year 1997. A technical appendix at the

end of this report provides definitions of the variables

used in this report. It also gives a detailed description of

the MEPS HC, including data collection methods,

sample size, variable construction, and statistical

procedures used to derive estimates. The standard

errors for the tables and figures discussed in the text of

this report are also shown in the appendix. Only

differences between estimates that are statistically

significant at the 0.05 level are discussed in this report. 

Definitions of Injury and Expenses

The standard definition of injury is the occurrence

of sudden external forces resulting in trauma.

Furthermore an injury may be unintentional (an

accident) or intentional (violence or abuse). A single

injury episode may result in several injuries or

conditions. For example, a person may fall (the injury

episode) and receive a concussion and a broken hip (the

conditions related to the injury episode). This report

examines 1997 expenses for medical treatment of

conditions resulting from

an injury episode

regardless of whether the

episode occurred in 1997

or prior to 1997.

Approximately 41 percent

of the injuries for which

households reported

receiving treatment during

1997 actually occurred in

a prior year (data not

shown). 

The household

respondent identified the

date of the injury and the resulting conditions in the

Condition Enumeration section of the MEPS HC

Questionnaire and identified the number and type of

provider visits in the Medical Event Sections. (See

www.meps.ahrq.gov for details regarding the

questionnaire.) This report contains estimates of the

percent of the population reported to have an injuryrelated condition, not the percent with an injury per se.

If a person did not have a medical provider visit and did

not miss work or school because of an injury, such as a

pulled muscle, the injury may not have been reported

during the MEPS interview. 

This report focuses on overall expenses in 1997

associated with injuries, as well as on expenses for

ambulatory care and for inpatient hospital care, and

estimates injury-related expenses as a proportion of

total expenses for all care provided in these settings.

1

Health Care Expenses for Injuries: Estimates from the 1997 MEPS

by Nancy A. Krauss, M.S., Steven R. Machlin, M.S.,Agency for Healthcare Research and Quality; Gregory A.Adams,

M.A., Doctoral Candidate, University of Massachusetts

About 11 percent

of all health care

spending for the

U.S. civilian

noninstitutionalized

population in 1997

was for injuryrelated conditions.
Ambulatory visits to medical providers in office and

hospital settings, hospital inpatient care, home health

care, and prescribed medicines are included in total

expenses, but payments for over-the-counter-drugs,

alternative care services, and telephone contacts with

medical providers are not included. In contrast to other

reports containing MEPS expenditure estimates (e.g.,

Thorpe and Machlin, 2000), this report excludes

expenses for durable medical equipment and other

miscellaneous items (eyeglasses, contact lenses,

ambulance services, orthopedic items, hearing devices,

prostheses, bathroom aids, medical equipment,

disposable supplies, and other miscellaneous items or

services) because it was not possible to determine from

the survey questions which of these expenses were

associated with injuries.

Population Characteristics

Approximately 23 percent of the population (about

62 million persons) had a medical condition in 1997

that resulted from an injury (Table 1), and

approximately 70 percent of those people (about 43

million) had some medical expense for that condition.

About 16 percent of children under age 16 had at least

one injury-related condition, compared to about onequarter of people 16 years of age and over. People ages

16-24 were less likely to have an expense associated

with an injury-related condition than those under 16 or

45 and over.

Females (21.2 percent) were less likely than males

(25.0 percent) to have had an injury-related condition.

Males and females who had an injury-related condition

were equally likely to have a related medical expense.

Whites (25.4 percent) were more likely than blacks

(17.3 percent), Hispanics (17.5 percent), and others

(14.6 percent) to have an injury-related condition. The

probability of having an injury-related condition did not

vary by either insurance status or poverty status.

However, the uninsured population under age 65 were

the least likely to report an injury-related expense. 

Total Expenses for Injury-Related

Conditions

An estimated $57.9 billion was spent on injuryrelated conditions for the U.S. civilian

noninstitutionalized population in 1997 (Table 2). This

was 10.8 percent of all health care spending during that

year. For people with an injury-related expense, the

mean expense for injury-related conditions was $1,330

but the median expense was only $241.

As a proportion of total expenses for all health care

in 1997, injuries presented a greater burden for people

ages 16-24 (25.6 percent) than for those under 16 or 45

and over. The mean expense for injury-related

conditions was lowest for

children under age 16 ($467). 

An estimated $35.3 billion

was spent on health care for

injury-related conditions for

males, higher than the $22.6

billion spent for women. The

proportion of total expenses

associated with injuries was

about twice as high for males

(14.9 percent) as for females

(7.5 percent). Per capita

expenses were about 62 percent

higher for males ($266) than

for females ($163), and mean expenses for people with

injury-related conditions also were higher for males

($1,536) than for females ($1,101). Per capita injuryrelated expenses for whites were $246 in 1997, higher

than for blacks ($122) or Hispanics ($137).

Among those under age 65, the proportion of total

medical expenses attributable to injuries was

approximately twice as high for the uninsured (24.3

percent) as for people with private coverage (12.4

percent) and people with public insurance (11.0

percent). There were no statistically significant

differences among poverty status groups in the

proportion of total expenses attributable to injuries, per

capita expenses, or the mean or median expenses for

injury-related conditions.

Figures 1 and 2 summarize the distribution of

expenses for injury- and non-injury-related conditions,

respectively, by type of care received. Ambulatory care

accounted for a higher proportion of expenditures for

injuries (51.3 percent) than noninjury conditions (31.7

percent). The proportion of total expenses that went for

inpatient hospital care was similar for injury- and noninjury-related conditions (36.9 percent and 39.3 percent,

respectively). Dental care and prescribed medicines

made up a smaller proportion of expenses for injuryrelated conditions: dental care, 2.2 vs. 9.0 percent;

prescribed medicines, 4.4 vs. 14.6 percent.

2

About onequarter of all

health care

expenses for

the age group

16-24 were for

injury-related

conditions.
Ambulatory Care Expenses 

In 1997 expenses for injury-related care received by

the U.S. civilian noninstitutionalized population in

office-based settings and clinics, hospital outpatient

departments, emergency rooms, and clinics owned and

operated by hospitals amounted to approximately $29.7

billion, representing 16.4 percent of the ambulatory care

expenses for all conditions (Table 3). The per capita

expense for ambulatory care for injury-related

conditions was $109. For those with an injury-related

expense, the mean cost of ambulatory care for injuryrelated conditions was $787 and the median expense

was $234. Injury-related expenses for ambulatory visits

accounted for about one-quarter of all ambulatory

expenses for people ages 16-24 (26.4 percent) and 

25-44 (24.5 percent), a higher proportion than for the

other age groups. Per capita expenses for ambulatory

care were highest for people ages 25-44 ($146) and 45-

64 ($152). For persons with injury-related expenses,

mean injury-related ambulatory care expenses also were

highest for people ages 25-44 ($968) and 45-64 ($991).

Expenses for injury-related ambulatory care were

higher for males ($17.0 billion) than for females ($12.7

billion). The proportion of total ambulatory care

expenses associated with injuries was about 9

percentage points higher for males than for females

(21.6 vs. 12.3 percent). However, differences in mean

ambulatory care expenses for males and females were

not statistically significant. 

There were no statistically significant differences in

the proportion of total ambulatory expenses associated

with injuries by race/ethnicity. The mean injury-related

expense was not statistically significantly different for

blacks ($689) than for either whites or Hispanics, but it

was significantly higher for whites ($813) than for

Hispanics ($594). 

For the population under 65 years old, the

proportion of total ambulatory expenses attributed to

injuries was higher for uninsured people (29.7 percent)

than for those with private insurance (19.3 percent) or

3

Ambulatory

Inpatient 51.3%

36.9%

Prescribed

medicines

4.4%

Dental

2.2% Home health

5.2%

Source: Center for Financing, Access, and Cost Trends, Agency for

Healthcare Research and Quality: Medical Expenditure Panel

Survey Household Component, 1997.

Figure 1. Percent distribution of

expenses for injury-related conditions,

by type of care: United States, 1997

Figure 2. Percent distribution of expenses

for non-injury-related conditions, by type

of care: United States, 1997

Ambulatory

31.7%

Inpatient

39.3%

Prescribed

medicines

14.6%

Dental

9.0%

Home health

5.5%

Source: Center for Financing, Access, and Cost Trends, Agency for

Healthcare Research and Quality: Medical Expenditure Panel

Survey Household Component, 1997.

Injury-related conditions

Total = $57.9 billion

Non-injury-related conditions

Total = $478.8 billion
public insurance (16.1 percent). Differences in mean

expenses by insurance status for this age group were not

statistically significant. For people age 65 and over, the

proportion of total ambulatory care expenses attributed

to injuries was more than twice as high for those

covered by Medicare only (9.5 percent) as for people

covered by Medicare and other public insurance (4.3

percent). 

There were no statistically significant differences in

mean ambulatory care expenses for injury-related

conditions by poverty status. 

Inpatient Hospital Expenses

The inpatient expense estimates shown in Table 4

include room and board charges, all hospital diagnostic

and laboratory expenses associated with the basic

facility charge, payments for separately billed physician

inpatient services, and emergency room expenses

incurred immediately prior to inpatient stays for injuryrelated conditions. Estimated expenses for inpatient

services for injury-related conditions in 1997 were about

$21.4 billion, which constituted 10.2 percent of

expenditures for all inpatient care. The mean inpatient

expense per person for people with an injury-related

inpatient expense was $9,510, while the median expense

was $5,473. 

The amount spent on injury-related conditions for

people ages 16-24 ($4.6 billion) amounted to an

estimated 39.6 percent of all inpatient expenses for that

age group.1 This proportion is substantially higher than

the estimated proportions of total inpatient expenses for

any other age group (ranging from 6.7 to 12.5 percent). 

Males incurred about 72 percent of the total

expenses for injury-related inpatient care in 1997—

$15.3 billion, compared to only $6.1 billion for females.

The proportion of inpatient expenses spent on injuryrelated care was approximately three times as high for

males (15.4 percent) as for females (5.5 percent). Per

capita expenses for injury-related inpatient care were

nearly three times as high for males ($115) as for

females ($44). The mean injury-related expense for

those with an injury-related inpatient expense was about

$4,300 higher for males than for females ($11,194

compared to $6,891).

1 Relative standard errors of 30 percent or more.

The proportion of total inpatient expenses for

injury-related care did not vary by race/ethnicity.

However, per capita expenses for injury-related

inpatient care for the white population ($93) were more

than double expenses for the black population ($42), and

the mean cost for inpatient care for injury-related

conditions was substantially higher for whites than for

blacks ($10,084 vs. $5,936). 

There were no statistically significant differences in

either the proportion of inpatient medical expenses

attributable to injuries or the mean inpatient care

expenses for injury-related conditions by either

insurance status or poverty status. 

Source of Payment

Figures 3 and 4 summarize the percent distribution

of expenses by source of payment for injury- and noninjury-related conditions in 1997. Workers’

Compensation covered 14.4 percent of injury-related

4

Figure 3. Percent distribution of expenses

for injury-related conditions, by source of

payment: United States, 1997

Private insurance

45.2%

Medicare

18.2%

Medicaid

5.6%

Workers’

Compensation

14.4%

Other

5.1%

Out of

pocket

11.5%

Source: Center for Financing, Access, and Cost Trends, Agency for

Healthcare Research and Quality: Medical Expenditure Panel

Survey Household Component, 1997.

Injury-related conditions

Total = $57.9 billion
expenses. The proportion paid out of pocket was

smaller for injury-related conditions than for non-injuryrelated conditions (11.5 percent vs. 19.1 percent). In

contrast, the proportion of expenses paid by private

insurance was similar for both injuries (45.2 percent)

and noninjuries (44.0 percent), despite the noteworthy

proportion of expenses for injuries paid by Workers’

Compensation. 

Summary 

Approximately $57.9 billion was spent on injuryrelated care in 1997, constituting 10.8 percent of all

health care spending during that year. This amount does

not include payments for over-the-counter-drugs,

alternative care services, telephone contacts with

medical providers, or expenses for durable medical

equipment or other miscellaneous items such as

eyeglasses or ambulance services.

The average total expense for injury-related

conditions was lowest for children under 16 ($467 per

person with expense). However, as a proportion of total

health care expenditures in 1997, injuries imposed a

relatively high burden on people ages 16-24 years; about

one-quarter of their total health care costs were

attributed to injury-related conditions, a significantly

higher share than for most other age groups.

Furthermore, injury-related health care for this age

group accounted for about 40 percent of all inpatient

care expenses (about $4.6 billion),2 higher than for any

other age group. Injury prevention strategies targeted

toward this group of older teenagers and young adults

may well be cost effective. 

The proportion of total medical expenses associated

with injuries was about twice as high for males (14.9

percent) as for females (7.5 percent). Males also

incurred approximately 72 percent of all inpatient health

care expenses for injury-related conditions ($15.3

billion). About 15.4 percent of all inpatient expenses for

males were for injury-related conditions, approximately

three times the proportion for females (5.5 percent).

Injury-related conditions also accounted for

approximately one-fifth (21.6 percent) of ambulatory

care expenses for males compared to only 12.3 percent

for females. 

The impact of injuries on national health care

expenditures raises important public policy issues. The

extent of expenses for injury-related care is particularly

significant when one considers that, unlike many major

conditions, injuries often can be prevented or avoided by

relatively inexpensive

intervention programs

(Bernstein and Schur, 1990). In

Healthy People 2010

(Department of Health and

Human Services (U.S.), 2000),

the reduction of unintentional

injuries, as well as violence and

abuse, was identified as a

priority area. Achievement of

these national goals requires

timely and accurate measures of

the incidence of injury and

expenses, including data on cause of injury and type of

injury sustained, to form the basis for planning, analysis,

and evaluation of injury control efforts (Miller and

Lestine, 1996). 

2Relative standard errors of 30 percent or more.

5

Figure 4. Percent distribution of expenses

for non-injury-related conditions, by source

of payment: United States, 1997

Private insurance

44.0%

Medicare

24.2%

Medicaid

7.9%

Other

4.8%

Out of

pocket

19.1%

Source: Center for Financing, Access, and Cost Trends, Agency for

Healthcare Research and Quality: Medical Expenditure Panel

Survey Household Component, 1997.

Workers’

Compensation

paid for about

14 percent of

injury-related

expenses in

1997.

Non-injury-related conditions

Total = $478.8 billion
References

Bernstein AB, Schur CL. Expenditures for unintentional

injuries among the elderly. J Aging Health 1990; 2:157-

78. 

Cohen JW, Krauss NA. Spending and service use among

people with the fifteen most costly medical conditions,

1997. Health Aff 2003 Mar./Apr.; 22(2):129-38.

Cohen SB. 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 SB. Sample design of the 1997 Medical

Expenditure Panel Survey Household Component.

Rockville (MD): Agency for Healthcare Research and

Quality; 2000. MEPS Methodology Report No.11.

AHRQ Pub. No. 01-0001. 

Department of Health and Human Services (U.S.).

Healthy People 2010. 2nd ed. With Understanding and

Improving Health and Objectives for Improving Health.

2 vols. Washington: U.S. Government Printing Office;

Nov. 2000. 

Hoyert DL, Arias E, Smith BL, et al. Deaths: final data

for 1999. Hyattsville (MD): National Center for Health

Statistics; 2001. National Vital Statistics Reports; Vol.

49, No. 8.

Miller TR, Lestine DC. Patterns of U.S. medical

expenditures and utilization for injury, 1987. Am J

Public Health 1996; 86:89-93.

Thorpe JM, Machlin SR. Health care expenses in the

U.S. civilian noninstitutionalized population, 1997.

Rockville (MD): Agency for Healthcare Research and

Quality; 2000. AHRQ Pub. No. 01-R086. 

6
7

Table 1. Injury-related conditions and expenses—Percent of population with

conditions and percent of those incurring expenses: United States, 1997

People with injury-related condition

Population characteristic Percent

Percent with

expensea

Total 271,279 23.0 69.7

Age in years

Under 16 63,621 16.1 72.9

16-24 33,470 24.8 63.8

25-44 83,707 25.7 67.8

45-64 56,295 25.8 71.2

65 and over 34,185 23.2 73.9

Sex

Male 132,605 25.0 69.4

Female 138,673 21.2 70.1

Race/ethnicity

Hispanic 31,111 17.5 67.7

Black 34,086 17.3 64.5

White 195,030 25.4 70.8

Other 11,052 14.6 61.9

Health insurance statusb

Under age 65:

Any private 176,046 23.9 70.8

Public only 27,743 20.6 69.2

Uninsured 33,304 20.5 58.4

Age 65 and over:

Medicare only 8,550 22.5 74.5

Medicare and private 22,028 23.9 74.1

Medicare and other public 3,434 21.5 71.1

Poverty statusc

Poor 36,415 21.3 67.6

Near-poor 12,233 23.9 68.8

Low income 38,723 21.1 66.1

Middle income 89,981 23.7 71.0

High income 93,926 23.7 70.6

aPercent of those with injury-related condition(s) who incurred some expense for their condition(s) during 1997.

bUninsured refers to persons uninsured during the entire year. Public and private health insurance categories refer to individuals with public or

private insurance at any time during the period. Individuals with both public and private insurance and those with CHAMPUS or CHAMPVA

(Armed-Forces-related coverage) are classified as having private insurance.

cPoor refers to incomes at or below the Federal poverty line; near-poor, over the poverty line through 125 percent of the poverty line; low

income, over 125 percent through 200 percent of the poverty line; middle income, over 200 percent to 400 percent of the poverty line; and

high income, over 400 percent of the poverty line.

Note: Restricted to civilian noninstitutionalized population.

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

1997.

Total population 

in thousands
8

Total $57,878,383 $213 10.8 $241 $1,330

Age in years

Under 16 3,487,397 55 7.7 152 467

16-24 7,994,397 239 25.6 239 1,508

25-44 18,611,425 222 16.0 269 1,279

45-64 15,157,523 269 9.6 297 1,468

65 and over 12,627,641 369 6.8 283 2,155

Sex

Male 35,258,474 266 14.9 248 1,536

Female 22,619,909 163 7.5 233 1,101

Race/ethnicity

Hispanic 4,271,511 137 10.7 237 1,160

Black 4,165,598 122 8.8 253 1,094

White 47,932,351 246 11.0 240 1,369

Other *1,508,922 *137 12.4 261 1,512

Health insurance statusc

Under age 65:

Any private 34,458,675 196 12.4 236 1,159

Public only 5,506,037 198 11.0 234 1,395

Uninsured *5,286,030 *159 24.3 235 1,329

Age 65 and over

Medicare only 2,304,123 269 5.7 251 1,608

Medicare and private 8,863,421 402 7.5 278 2,273

Medicare and other public 1,460,097 425 5.5 452 2,775

Poverty statusd

Poor 6,956,216 191 9.5 269 1,323

Near-poor 2,530,134 207 7.6 214 1,258

Low income 8,944,592 231 12.3 286 1,660

Middle income 19,789,792 220 11.1 250 1,309

High income 19,657,648 209 11.0 225 1,250

Table 2.Total medical expensesa for injury-related conditions: United States, 1997

Population characteristic Per capita Median

Total in 

thousands

Injury-related total expenses

Mean

Percent of

total expenses

due to injuryb

Expense per person 

with expense

aTotal medical expenses include inpatient hospital and physician services, ambulatory physician and nonphysician services, and prescribed

medicines purchased during the year. Expenses for over-the-counter medications, alternative care services, and telephone contacts are not

included. Expenses for durable medical equipment and other miscellaneous items are excluded because it was not possible to determine

which of those expenses were associated with injuries.

bNumerator is total expenses for injuries. Denominator is total medical expenses for both injury- and non-injury-related conditions.

cUninsured refers to persons uninsured during the entire year. Public and private health insurance categories refer to individuals with public or

private insurance at any time during the period. Individuals with both public and private insurance and those with CHAMPUS or CHAMPVA

(Armed-Forces-related coverage) are classified as having private insurance.

dPoor refers to family incomes at or below the Federal poverty line; near-poor, over the poverty line through 125 percent of the poverty line;

low income, over 125 percent through 200 percent of the poverty line; middle income, over 200 percent to 400 percent of the poverty line;

and high income, over 400 percent of the poverty line.

*Relative standard error equal to or greater than 30 percent.

Note: Restricted to civilian noninstitutionalized population.

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

1997.
9

Total $29,677,277 $109 16.4 $234 $787

Age in years

Under 16 2,494,470 39 13.3 154 366

16-24 3,175,994 95 26.4 230 654

25-44 12,234,467 146 24.5 271 968

45-64 8,565,435 152 15.7 285 991

65 and over 3,206,911 94 7.0 193 675

Sex

Male 17,023,157 128 21.6 236 851

Female 12,654,120 91 12.3 223 715

Race/ethnicity

Hispanic 1,881,957 60 15.1 200 594

Black 2,193,572 64 15.7 251 689

White 24,762,460 127 16.5 234 813

Other 839,288 76 19.8 265 942

Health insurance statusc

Under age 65: .

Any private 21,591,232 123 19.3 242 824

Public only 2,500,292 90 16.1 205 740

Uninsured 2,378,842 71 29.7 242 708

Age 65 and over:

Medicare only 893,041 104 9.5 147 774

Medicare and private 2,121,752 96 6.7 210 657

Medicare and other public 192,118 56 4.3 *244 522

Poverty statusd

Poor 2,724,914 75 13.3 251 616

Near-poor 1,299,641 106 14.9 196 762

Low income 4,250,933 110 17.9 252 919

Middle income 11,340,460 126 19.0 238 859

High income 10,061,330 107 14.7 215 732

Table 3.Ambulatory medical expensesa for injury-related conditions: United States,

1997

Population characteristic Per capita Median

Total in

thousands

Injury-related ambulatory

expenses

Mean

Percent of total

ambulatory expenses

due to injuryb

Expense per person 

with expense

aExpenses for visits to medical providers seen in office-based settings or clinics, hospital outpatient departments, emergency rooms (except

visits resulting in an overnight hospital stay), and clinics owned and operated by hospitals, as well as expenses for events reported as hospital

admissions without an overnight stay, are included.

bNumerator is ambulatory expenses for injuries. Denominator is total ambulatory expenses for both injury- and non-injury-related conditions.

cUninsured refers to persons uninsured during the entire year. Public and private health insurance categories refer to individuals with public or

private insurance at any time during the period. Individuals with both public and private insurance and those with CHAMPUS or CHAMPVA

(Armed-Forces-related coverage) are classified as having private insurance.

dPoor refers to family incomes at or below the Federal poverty line; near-poor, over the poverty line through 125 percent of the poverty line;

low income, over 125 percent through 200 percent of the poverty line; middle income, over 200 percent to 400 percent of the poverty line;

and high income, over 400 percent of the poverty line.

*Relative standard error equal to or greater than 30 percent.

Note: Restricted to civilian noninstitutionalized population.

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

1997.
10

Total $21,372,738 $79 10.2 $5,473 $9,510

Age in years

Under 16 *818,725 *13 *6.7 *2,363 *5,090

16-24 *4,564,514 *136 *39.6 9,316 *16,966

25-44 4,419,911 53 12.5 4,040 6,060

45-64 4,762,106 85 7.9 5,908 9,631

65 and over 6,807,482 *199 7.6 6,140 11,468

Sex

Male 15,313,375 115 *15.4 *5,596 11,194

Female 6,059,363 44 5.5 5,033 6,891

Race/ethnicity

Hispanic *1,569,956 *50 9.1 5,588 9,624

Black 1,425,844 42 6.9 4,628 5,936

White 18,081,799 93 10.8 5,525 10,084

Other *295,140 *27 *7.5 *1,251 *5,808

Health insurance statusc

Under age 65:

Any private 9,880,695 56 10.8 4,862 7,935

Public only 2,054,842 74 10.4 5,243 7,659

Uninsured *2,629,719 *79 *31.7 *8,791 *18,754

Age 65 and over:

Medicare only *755,467 *88 *3.8 4,539 7,026

Medicare and private *5,495,520 *249 *9.8 6,362 *13,199

Medicare and other public *556,496 *162 *4.3 6,124 7,979

Poverty statusd

Poor 2,874,196 79 8.9 5,203 7,712

Near-poor *916,122 *75 *5.2 *5,835 7,753

Low income 3,099,773 80 10.9 7,826 9,533

Middle income 6,505,736 72 8.9 4,937 8,035

High income *7,976,912 *85 13.9 5,420 12,833

Table 4. Inpatient medical expensesa for injury-related conditions: United States,

1997

Population characteristic Per capita Median

Total in 

thousands

Injury-related inpatient 

expenses Percent of total

inpatient expenses

due to injuryb

Expense per person 

with expense

a Room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, payments for separately billed

physician inpatient services, and emergency room expenses incurred immediately prior to inpatient stays are included. Expenses for hospital

discharges that did not involve an overnight stay, which are ambulatory expenses (Table 3), are excluded. Expenses for newborns who left the

hospital on the same day as the mother are included in the mother’s record.

b Numerator is inpatient expenses for injuries. Denominator is total inpatient expenses for both injury-and non-injury-related conditions.

c For health insurance status, uninsured refers to persons uninsured during the entire year. Public and private health insurance categories refer

to individuals with public or private insurance at any time during the period. Individuals with both public and private insurance and those with

CHAMPUS or CHAMPVA (Armed-Forces-related coverage) are classified as having private insurance.

d Poor refers to family incomes at or below the Federal poverty line; near-poor, over the poverty line through 125 percent of the 

poverty line; low income, over 125 percent through 200 percent of the poverty line; middle income, over 200 percent to 400 percent of the

poverty line; and high income, over 400 percent of the poverty line.

*Relative standard error equal to or greater than 30 percent.

Note: Restricted to civilian noninstitutionalized population.

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

1997.

Mean
11

Technical Appendix 

Data in this report are based on the combined

samples for the second year of the 1996 panel of the

Medical Expenditure Panel Survey Household

Component (MEPS HC) and the first year of the 1997

MEPS HC. MEPS is cosponsored by the Agency for

Healthcare Research and Quality (AHRQ) and the

National Center for Health Statistics (NCHS). The focus

of the MEPS HC is to collect detailed data on

demographic characteristics, health conditions, health

status, use of medical care services, charges and

payments for those services, access to care, health

insurance coverage, income, and employment of the U.S.

civilian noninstitutionalized population. In other

components of MEPS, data are collected on the use,

charges, and payments reported by providers (Medical

Provider Component) and the supply side of the

insurance market (Insurance Component).

Survey Design

The sample for the 1996 MEPS HC was selected

from respondents to the 1995 National Health Interview

Survey (NHIS), and the sample for the 1997 MEPS HC

was selected from the 1996 NHIS. NHIS, which is

conducted by NCHS, provides a nationally representative

sample of the U.S. civilian noninstitutionalized

population and reflects an oversampling of Hispanics and

blacks.

The MEPS HC collects data through an overlapping

panel design. In this design, data are collected through a

precontact interview that is followed by a series of five

rounds of interviews over a period of 21/

2 years.

Interviews are conducted with one member of each

family, who reports on the health care experiences of the

entire family. Two calendar years of medical expenditure

and utilization data are collected in each household and

captured using computer-assisted personal interviewing

(CAPI). This series of data collection rounds is launched

again each subsequent year on a new sample of

households to provide overlapping samples of survey

data that will provide continuous and current estimates of

health care expenditures. 

The estimates of total expenditures in Tables 1-4 are

based on 32,636 sample persons. They are weighted to

develop population estimates for a total of 271,278,585

persons who were in the U.S. civilian noninstitutionalized

population for part or all of 1997. For persons who were

in the target population for the full year, all expenditures

from January 1 through December 31, 1997, were

included in the estimates. People with part-year

information include newborns, people who died during

the year, and people who resided in an institution, were

in the military, or lived outside the country for part of the

year. Expenditures for deceased persons were measured

for the period from January 1 through the date of death,

while those for newborns were measured from the date

of birth through December 31. Expenses incurred during

periods of full-time active-duty military service,

institutionalization, or residency outside the country were

not included. 

This report provides estimates of expenditures in

1997 for the treatment of conditions that were reported to

be attributable to an injury. The estimates include

expenditures for conditions associated with injuries that

occurred in 1997 as well as in prior years. Expenditures

refer to payments for health care services, including outof-pocket payments and payments by private insurance,

Medicaid, Medicare, Workers’ Compensation, and other

sources. Ambulatory visits to medical providers in office

and hospital settings, hospital inpatient care, home health

care, and prescribed medicines are included in total

expenditures, while payments for over-the-counter drugs,

alternative care services, and telephone contacts with

medical providers are not included. In contrast to other

reports containing MEPS expenditure estimates,

expenses for durable medical equipment and other

miscellaneous items (eyeglasses, contact lenses,

ambulance services, orthopedic items, hearing devices,

prostheses, bathroom aids, medical equipment,

disposable supplies, and other miscellaneous items or

services) are also excluded because it was not possible to

determine from the survey questions which of these

expenses were associated with injuries.

The estimates were developed using information

collected in the conditions and medical events sections of

the MEPS questionnaire

(www.meps.ahrq.gov/survey.htm#hcsurveyinstrument).

In the conditions section, respondents were asked to

identify medical conditions that bothered sample persons

during the period covered by the interview and identify

conditions that were due to an injury. In the medical

events sections, which collect information about

ambulatory visits, inpatient hospitalizations, dental care,

home health care, and prescribed medicines, respondents

were asked to identify the conditions that were associated
12

with each reported medical event. This information was

used to link medical events to associated injury-related

conditions. Estimates of expenditures for these events

were based on a combination of data obtained from

sample persons’ medical providers in the MEPS Medical

Provider Component (used as first priority where

available), the medical events sections of the MEPS HC,

and imputation procedures for missing data. For detailed

information on the MEPS sample design for Panel 1, see

Cohen (1997). For detailed information on the MEPS

sample design for Panel 2, see Cohen (2000). For

information on response rates and estimation procedures

see the Documentation File for HC-020

(http://www.meps.ahrq.gov/pubdoc/h20doc.pdf). 

In the report, expenses are shown by selected

population characteristics, including age, sex,

race/ethnicity, health insurance status, and poverty status.

(Definitions of these terms are given below.) In addition

to total expenses by these characteristics, estimates on

per capita expenses and spending for persons with

expenses are provided. The per capita estimates were

computed as the total injury-related expenses for a

particular group divided by the total population of that

group. The average number of conditions per injury

episode was 1.04, indicating that the overwhelming

majority of injuries were associated with only one

condition. The standard errors for the estimates in this

report are shown in Tables A-F.

Definitions of Terms

Type of Service

The types of service shown in Figures 1 and 2 are:

• Hospital inpatient services—This category includes

room and board and all hospital diagnostic and

laboratory expenses associated with the basic facility

charge, payments for separately billed physician

inpatient services, and some emergency room

expenses incurred immediately prior to inpatient

stays. It excludes expenses for hospital discharges

that did not involve an overnight stay, which are

classified as ambulatory expenses.

• Ambulatory services—This category includes

expenses for visits to medical providers seen in

office-based settings or clinics, hospital outpatient

departments, emergency rooms (except some visits

resulting in an overnight hospital stay), and clinics

owned and operated by hospitals. It also includes

expenses for events reported as hospital admissions

without an overnight stay.

• Prescribed medicines—This category includes

expenses for all prescribed medications that were

initially purchased or refilled during 1997, as well as

expenses for diabetic supplies (some of which may

have been purchased without a prescription).

• Dental services—This category covers expenses for

any type of dental care provider, including general

dentists, dental hygienists, dental technicians, dental

surgeons, orthodontists, endodontists, and

periodontists.

• Home health services—This category includes

expenses for care provided by home health agencies

and independent home health providers. Agency

providers accounted for a large majority of the

expenses in this category.

Source of Payment

The sources of payment shown in Figures 3 and 4

are classified as follows:

• Out-of-pocket—These are expenses paid by the user

or other family member.

• Private insurance—This category includes payments

made by insurance plans covering hospital and

medical care (excluding payments from Medicare,

Medicaid, and other public sources). Payments from

Medigap plans or CHAMPUS and CHAMPVA

(Armed-Forces-related coverage) are included.

Payments from plans that provide coverage for a

single service only, such as dental or vision

coverage, are not included.

• Medicare—Medicare is a federally financed health

insurance plan for the elderly, persons receiving

Social Security disability payments, and most

persons with end-stage renal disease. Medicare Part

A, which provides hospital insurance, is

automatically given to those who are eligible for

Social Security. Medicare Part B provides

supplementary medical insurance that pays for

medical expenses and can be purchased for a

monthly premium.

• Medicaid—Medicaid is a means-tested government

program jointly financed by Federal and State funds

that provides health care to those who are eligible.

Program eligibility criteria vary significantly by

State, but the program is designed to provide health
13

coverage to families and individuals who are unable

to afford necessary medical care.

• Workers’ Compensation—Workers’ Compensation is

a system, required by law, of compensating workers

injured or disabled in connection with work. This

system establishes the liability of an employer for

injuries or sickness that arise over and in the course

of employment. The benefits under this system

generally include hospital and other medical

payments and compensation for loss of income. 

• Other sources—This category includes payments

from the Department of Veterans Affairs (except

CHAMPVA); other Federal sources (Indian Health

Service, military treatment facilities, and other care

provided by the Federal Government); various State

and local sources (community and neighborhood

clinics, State and local health departments, and State

programs other than Medicaid); various unclassified

sources (e.g., automobile, homeowner’s, or other

liability insurance, and other miscellaneous or

unknown sources); Medicaid payments reported for

people who were not reported as enrolled in the

Medicaid program at any time during the year; and

private insurance payments reported for people

without any reported private health insurance

coverage during the year.

Population Characteristics

In general, population characteristics are measured

as of December 31, 1997, or the last date that the sample

person was part of the civilian noninstitutionalized

population living in the United States prior to December

31, 1997.

Race/Ethnicity

Classification by race and ethnicity is based on

information reported in MEPS for each family member.

Respondents were asked if the race of the sample person

was best described as American Indian, Alaska Native,

Asian or Pacific Islander, black, white, or other. They

also were asked if the sample person’s main national

origin or ancestry was Puerto Rican; Cuban; Mexican,

Mexicano, Mexican American, or Chicano; other Latin

American; or other Spanish. All persons whose main

national origin or ancestry was reported in one of these

Hispanic groups, regardless of racial background, are

classified as Hispanic. The other race categories do not

include Hispanic persons.

Comparisons by race/ethnicity are based on the

following four race/ethnicity groups: white, black,

Hispanic, and other. 

Health Insurance Status

Individuals under age 65 were classified into the

following three insurance categories. 

• Any private health insurance—Individuals with

insurance that provides coverage for hospital and

physician care at any time during the year (other than

Medicare, Medicaid, or other public

hospital/physician coverage) are classified as having

private insurance. Persons with Armed-Forcesrelated coverage—CHAMPUS/CHAMPVA

(currently called TRICARE)—are also included

because the number of sample persons in this group

is small and this type of coverage is similar to private

insurance. Insurance that provides coverage for a

single service only, such as dental or vision

coverage, is not included.

• Public coverage only—Individuals are considered to

have public coverage only if they met both of the

following criteria:

✔ They were not covered by private insurance at

any time during the year.

✔ They were covered by one of the following

public programs at any point during the year:

Medicare, Medicaid, or other public

hospital/physician coverage. 

• Uninsured—The uninsured are defined as persons

not covered by Medicare, CHAMPUS/CHAMPVA,

Medicaid, other public hospital/physician programs,

or private hospital/physician insurance at any time

during 1997. 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.

Individuals age 65 and over were classified into the

following three insurance categories:

• Medicare only.

• Medicare and private insurance.

• Medicare and other public insurance.
14

Poverty Status

Each person was classified according to the total

1997 income of his or her family. Within a household, all

individuals related by blood, marriage, or adoption were

considered to be a family. Personal income from all

family members was summed to create family income.

Possible sources of income included annual earnings

from wages, salaries, bonuses, tips, and commissions;

business and farm gains and losses; unemployment and

Workers’ Compensation; interest and dividends; alimony,

child support, and other private cash transfers; private

pensions, individual retirement account (IRA)

withdrawals, Social Security, and veterans’ payments;

Supplemental Security Income and cash welfare

payments from public assistance, Aid to Families with

Dependent Children, and Aid to Dependent Children;

gains or losses from estates, trusts, partnerships, S

corporations, rent, and royalties; and a small amount of

other income. Poverty status is the ratio of family income

to the 1997 Federal poverty thresholds, which vary by

family size and age of the head of the family. The

categories are:

• Poor—This refers to persons in families with income

at or less than the poverty line.

• Near-poor—This refers to persons in families with

income over the poverty line through 125 percent of

the poverty line. 

• Low income—This category includes persons in

families with incomes over 125 percent through 200

percent of the poverty line.

• Middle income—This category includes persons in

families with income over 200 percent through 400

percent of the poverty line.

• High income—This category includes persons in

families with income over 400 percent of the poverty

line.

Significance Testing

Tests of statistical significance were used to

determine whether the differences between populations

exist at specified levels of confidence or whether they

occurred by chance. Differences were tested using Zscores having asymptotic normal properties at the 0.05

level of significance. However, each individual

significance test was conducted at the 0.05 level, which

does not control the overall Type I error level at 0.05. 

Rounding

Estimates presented in the tables are rounded as

follows:

• Percentages are rounded to the nearest 0.1

percentage point. 

• Mean and median expenditures are rounded to the

nearest dollar.

• Total expenditures are rounded to the nearest million

dollar unit. 

Some of the estimates for population totals of

subgroups presented in the tables will not add exactly to

the overall estimated population total as a consequence

of rounding.
15

Table A. Standard errors for injury-related conditions and expenses—Percent of

population with conditions and percent of those incurring expenses: United States,

1997

Corresponds to Table 1

Population characteristic Percent with expensea Percent with injury-related condition

Standard error

Total 0.35 0.70

Age in years

Under 16 0.61 1.59

16-24 0.96 1.92

25-44 0.59 1.23

45-64 0.72 1.27

65 and over 0.92 1.71

Sex

Male 0.50 0.94

Female 0.44 0.94

Race/ethnicity

Hispanic 0.63 1.80

Black 0.75 2.18

White 0.43 0.80

Other 1.44 4.92

Health insurance statusb

Under age 65:

Any private 0.43 0.90

Public only 0.92 1.96

Uninsured 0.78 2.26

Age 65 and over:

Medicare only 1.90 3.60

Medicare and private 1.13 2.15

Medicare and other public 2.17 5.12

Poverty statusc

Poor 0.85 1.81

Near-poor 1.44 3.13

Low income 0.69 1.84

Middle income 0.56 1.20

High income 0.54 1.25

aPercent of those with injury-related condition(s) who incurred some expense for their condition(s) during 1997.

bUninsured refers to persons uninsured during the entire year. Public and private health insurance categories refer to individuals with public

or private insurance at any time during the period. Individuals with both public and private insurance and those with CHAMPUS or

CHAMPVA (Armed-Forces-related coverage) are classified as having private insurance.

cPoor refers to incomes at or below the Federal poverty line; near-poor, over the poverty line through 125 percent of the poverty line; low

income, over 125 percent through 200 percent of the poverty line; middle income, over 200 percent to 400 percent of the poverty line; and

high income, over 400 percent of the poverty line.

Note: Restricted to civilian noninstitutionalized population.

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

1997.
16

Standard error

Total 4,095,234 15 0.7 10 90

Age in years

Under 16 401,437 6 0.9 11 52

16-24 2,013,786 60 5.1 30 347

25-44 2,286,031 27 1.7 18 148

45-64 1,469,478 26 1.0 25 130

65 and over 2,179,019 63 1.1 36 355

Sex

Male 3,695,705 28 1.5 13 158

Female 1,364,078 10 0.5 15 61

Race/ethnicity

Hispanic 718,390 23 1.7 27 196

Black 455,118 13 1.0 28 107

White 4,168,822 22 0.9 12 114

Other 471,449 42 3.5 55 412

Health insurance statusc

Under age 65:

Any private 2,945,704 17 1.0 11 97

Public only 783,826 28 1.4 28 196

Uninsured 1,764,058 53 6.4 28 440

Age 65 and over:

Medicare only 456,719 52 1.1 74 267

Medicare and private 2,126,987 96 1.7 45 526

Medicare and other public 281,653 79 1.1 137 409

Poverty statusd

Poor 914,882 24 1.1 21 152

Near-poor 504,705 40 1.6 40 230

Low income 1,071,229 28 1.4 28 190

Middle income 1,841,138 21 1.2 19 129

High income 2,835,149 30 1.4 15 167

Table B. Standard errors for total medical expensesa for injury-related conditions:

United States, 1997

Corresponds to Table 2

Population characteristic Total in thousands Per capita Median

Injury-related total expenses Percent of total

expenses due to

injuryb

Average total expense per

injury episode

Mean

aTotal medical expenses include inpatient hospital and physician services, ambulatory physician and nonphysician services, and prescribed

medicines purchased during the year. Expenses for over-the-counter medications, alternative care services, and telephone contacts are not

included. Expenses for durable medical equipment and other miscellaneous items are excluded because it was not possible to determine

which of those expenses were associated with injuries.

bNumerator is total expenses for injuries. Denominator is total medical expenses for both injury- and non-injury-related conditions.

cUninsured refers to persons uninsured during the entire year. Public and private health insurance categories refer to individuals with public or

private insurance at any time during the period. Individuals with both public and private insurance and those with CHAMPUS or CHAMPVA

(Armed-Forces-related coverage) are classified as having private insurance.

dPoor refers to family incomes at or below the Federal poverty line; near-poor, over the poverty line through 125 percent of the poverty line;

low income, over 125 percent through 200 percent of the poverty line; middle income, over 200 percent to 400 percent of the poverty line;

and high income, over 400 percent of the poverty line.

Note: Restricted to civilian noninstitutionalized population.

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

1997.
17

Standard error

Total 1,876,730 6.9 0.9 8 48

Age in years

Under 16 230,738 3.5 1.4 11 29

16-24 392,746 11.5 2.6 26 69

25-44 1,597,652 19.2 2.4 14 119

45-64 943,243 16.6 1.5 24 98

65 and over 422,764 12.2 0.9 26 75

Sex

Male 1,619,700 12.5 1.8 11 83

Female 745,358 5.2 0.7 13 37

Race/ethnicity

Hispanic 194,750 6.0 1.6 21 54

Black 240,351 6.9 1.6 22 61

White 1,807,884 9.4 1.1 10 58

Other 230,470 20.1 3.9 55 201

Health insurance statusc

Under age 65:

Any private 1,722,207 10.0 1.3 10 64

Public only 334,918 11.3 1.8 21 84

Uninsured 352,055 10.8 3.4 31 104

Age 65 and over:

Medicare only 241,217 27.5 2.3 35 178

Medicare and private 367,871 16.3 1.1 35 100

Medicare and other public 45,023 13.1 1.2 75 115

Poverty status

Poor 303,521 7.6 1.2 20 51

Near-poor 363,914 28.8 4.0 28 203

Low income 753,914 20.1 2.8 25 160

Middle income 1,307,478 15.0 1.9 15 105

High income 827,082 8.3 1.1 16 52

Table C. Standard errors for ambulatory medical expensesa for injury-related

conditions: United States, 1997 

Corresponds to Table 3

Population characteristic Total in thousands Per capita Median

Injury-related ambulatory expenses

Percent of total

ambulatory

expenses due to

injuryb

Expense per person with

expense

Mean

aExpenses for visits to medical providers seen in office-based settings or clinics, hospital outpatient departments, emergency rooms (except

visits resulting in an overnight hospital stay), and clinics owned and operated by hospitals, as well as expenses for events reported as hospital

admissions without an overnight stay, are included.

bNumerator is total expenses for injuries. Denominator is total medical expenses for both injury- and non-injury-related conditions.

cUninsured refers to persons uninsured during the entire year. Public and private health insurance categories refer to individuals with public

or private insurance at any time during the period. Individuals with both public and private insurance and those with CHAMPUS or

CHAMPVA (Armed-Forces-related coverage) are classified as having private insurance.

dPoor refers to family incomes at or below the Federal poverty line; near-poor, over the poverty line through 125 percent of the poverty line;

low income, over 125 percent through 200 percent of the poverty line; middle income, over 200 percent to 400 percent of the poverty line;

and high income, over 400 percent of the poverty line.

Note: Restricted to civilian noninstitutionalized population.

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

1997.
18

Standard error

Total 3,074,015 11.4 1.4 361 1,195 

Age in years

Under 16 312,179 4.9 2.7 947 1,713 

16-24 1,890,607 56.3 11.8 1,596 5,748 

25-44 1,258,038 15.0 3.2 589 1,302 

45-64 854,142 15.3 1.7 878 1,290 

65 and over 2,055,873 60.1 2.2 870 2,843 

Sex

Male 2,886,688 21.9 2.8 636 1,909 

Female 904,081 6.5 0.9 587 758 

Race/ethnicity

Hispanic 479,768 15.5 2.8 2,028 1,945 

Black 330,467 9.7 1.7 792 956 

White 3,213,791 16.6 1.8 472 1,544 

Other 167,005 15.1 4.5 — 2,539 

Health insurance statusc

Under age 65:

Any private 1,974,686 11.3 2.1 700 1,273 

Public only 513,717 18.8 2.5 658 1,583 

Uninsured 1,722,535 51.9 15.1 3,483 9,812 

Age 65 and over:

Medicare only 257,915 29.9 1.3 1,140 1,281 

Medicare and private 2,039,382 92.2 3.4 1,828 3,924 

Medicare and other public 176,455 50.1 1.4 1,107 1,208 

Poverty statusd

Poor 718,637 19.5 2.1 833 1,648 

Near-poor 290,564 24.0 2.0 2,932 1,785 

Low income 670,616 17.3 2.3 687 1,377 

Middle income 1,005,163 11.3 1.6 544 971 

High income 2,594,223 27.5 4.0 1,218 3,689 

Table D. Standard errors for inpatient medical expensesa for injury-related

conditions, United States, 1997

Corresponds to Table 4 

Population characteristic Total in thousands Per capita Median

Injury-related inpatient expenses Percent of total

inpatient expenses

due to injuryb

Expense per patient with

expense

Mean

aRoom and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, payments for separately

billed physician inpatient services, and emergency room expenses incurred immediately prior to inpatient stays are included. Expenses for

hospital discharges that did not involve an overnight stay, which are ambulatory expenses (Table 3), are excluded. Expenses for newborns

who left the hospital on the same day as the mother are included in the mother’s record.

bNumerator is inpatient expenses for injuries. Denominator is total medical expenses for both injury- and non-injury-related conditions.

cUninsured refers to persons uninsured during the entire year. Public and private health insurance categories refer to individuals with public

or private insurance at any time during the period. Individuals with both public and private insurance and those with CHAMPUS or

CHAMPVA (Armed-Forces-related coverage) are classified as having private insurance.

dPoor refers to family incomes at or below the Federal poverty line; near-poor, over the poverty line through 125 percent of the poverty line;

low income, over 125 percent through 200 percent of the poverty line; middle income, over 200 percent to 400 percent of the poverty line;

and high income, over 400 percent of the poverty line.

Note: Restricted to civilian noninstitutionalized population.

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

1997.
19

Standard error

Injury-related 2.74 3.19 0.43 0.36 0.90

Non-injury-related 0.87 1.36 0.39 0.34 0.42

Table E. Standard errors for percent distributions of expenses for injury-related and

non-injury-related conditions by type of care: United States, 1997

Corresponds to Figures 1 and 2

Type of condition Ambulatory Inpatient Dental

Type of care

Prescribed

medicines

Home

health

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

Household Component, 1997.

Standard error

Injury-related 0.81 3.38 2.98 0.66 2.3 0.95

Non-injury-related 0.59 1.07 1.02 0.44 — 0.68

Table F. Standard errors for percent distributions of expenses for injury-related and

non-injury related conditions by source of payment: United States, 1997

Corresponds to Figures 3 and 4

Type of 

condition

Out of 

pocket

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

Household Component, 1997.

Private 

insurance Medicare Medicaid

Workers’

Compensation Other
AHRQ Pub. No. 04-0005

December 2003

ISBN 1-58763-094-X

ISSN 1531-5665

U.S. Department of Health 

and Human Services

Public Health Service

Agency for Healthcare

Research and Quality

540 Gaither Road

Rockville, MD 20850