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Design and Methods of the 

Medical Expenditure Panel Survey 

Household Component 

Methodolo

Report 1

Methodology 

U.S. Department of Health and Human Services

Public Health Service

Agency for Health Care Policy and Research

Agency for Health Care Policy and Research
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Health Care Information 

and Electronic Ordering 

Through the AHCPR Web Site

The Agency for Health Care Policy and Research’s Web

site—http://www.ahcpr.gov/—makes practical, science-based

health care information available in one convenient place.

Six buttons correspond to major categories of available

holdings on the Web site: Offices/Centers, News &

Resources, Research Portfolio, Data & Methods, Guidelines

& Medical Outcomes, and Consumer Health.

The Web site features an Electronic Catalog to the more than

450 information products generated by AHCPR, with

information on how to obtain these resources. Many

information products have an electronic ordering form and

are mailed free of charge from the AHCPR Clearinghouse

within 5 working days.

http://www.ahcpr.gov/
i

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 also includes a

nationally representative survey of nursing homes and

their residents. MEPS is cosponsored by the Agency for

Health Care Policy and Research (AHCPR) and the

National Center for Health Statistics (NCHS).

MEPS comprises four component surveys: the

Household Component (HC), the Medical Provider

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

the Nursing Home Component (NHC). The HC is the

core survey, and it forms the basis for the MPC sample

and part of the IC sample. The separate NHC sample

supplements the other MEPS components. 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 AHCPR 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 six rounds of interviews over a 

2 1/2-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. A subsample of

10,500 households was drawn from the NHIS sampling

frame for the initial 1996 MEPS HC panel. Every 5 years the HC sample size is increased. Beginning with







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|||| {{{{ Suggested citation

Cohen J. Design and methods of the Medical Expenditure

Panel Survey Household Component. Rockville (MD):

Agency for Health Care Policy and Research; 1997. MEPS

Methodology Report No.1. AHCPR Pub. No. 97-0026.

The Medical Expenditure Panel

Survey (MEPS)
ii

the 1997 panel, policy-relevant population subgroups

are oversampled. The subgroups initially targeted

include adults with functional impairments, children

with functional limitations in their activities, individuals

aged 18-64 who are predicted to have high levels of

medical expenditures, and individuals with family

income less than 200 percent of the poverty level.

Medical Provider Component

The MEPS MPC supplements and validates

information on medical care events reported in the

MEPS HC by contacting medical providers 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. 

• Associated with a 25-percent sample of the

remaining households.

The 1996 sample is projected to provide data from

approximately 2,700 hospitals, 12,400 office-based

physicians, 7,000 separately billing hospital physicians,

and 500 home health providers.

Data are collected on medical and financial

characteristics of medical 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 DRGs (diagnosisrelated groups).

• 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 employers, unions, and other

sources of private health insurance. Data obtained in the

IC include the number and types of private insurance

plans offered, benefits associated with these plans,

premiums, contributions by employers and employees,

eligibility requirements, and employer characteristics.

Establishments participating in the MEPS IC are

selected through four 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.

• An Internal Revenue Service list of the selfemployed.

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.

The MEPS IC is an annual panel survey. For the

survey conducted in 1997, the sample includes

approximately 7,000 establishments identified through

the MEPS HC, 27,000 identified through the business

establishments list frame, 1,900 from the Census of

Governments, and 1,000 identified through the list of

the self-employed. Data are collected from the selected

organizations through a prescreening telephone

interview, a mailed questionnaire, and a telephone

followup for nonrespondents.






























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Nursing Home Component

The 1996 MEPS NHC is a survey of nursing

homes and persons residing in or admitted to nursing

homes at any time during calendar year 1996. The

NHC gathers information on the demographic

characteristics, residence history, health and functional

status, use of services, use of prescription medications,

and health care expenditures of nursing home

residents. Nursing home administrators and designated

staff also provide information on facility size,

ownership, certification status, services provided,

revenues and expenses, and other facility

characteristics. Data on the income, assets, family

relationships, and care-giving services for sampled

nursing home residents are obtained from next-of-kin

or other knowledgeable persons in the community. In

keeping with the DHHS Survey Integration Plan, the

NHC is designed to be conducted every 5 years.

The 1996 MEPS NHC sample was selected using

a two-stage stratified probability design. In the first

stage, facilities were selected; in the second stage,

facility residents were sampled, selecting both persons

in residence on January 1, 1996, and those admitted

during the period January 1 through December 31. 

The sample frame for facilities was derived from

the National Health Provider Inventory, which is

updated periodically by NCHS. The MEPS NHC data

are collected in person in three rounds of data

collection over a 1 1/2-year period using the CAPI

system. Community data are collected by telephone

using computer-assisted telephone interviewing (CATI)

technology. At the end of data collection, the sample

will consist of approximately 800 responding facilities,

3,100 residents in the facility on January 1, and

approximately 2,200 eligible residents admitted 

during 1996. 

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.

Data collection is conducted under contract by

Westat, Inc., Rockville, MD, and the National Opinion

Research Center at the University of Chicago, as well

as through an interagency agreement with Bureau of

the Census. Technical consultation is provided by

Medstat, Inc., Boston, MA. Data processing support is

provided under contract by Social & Scientific

Systems, Inc., Bethesda, MD.

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 AHCPR Publications Clearinghouse. Write

or call:

AHCPR Publications Clearinghouse

Attn: (publication number)

P.O. Box 8547

Silver Spring, MD 20907

800/358-9295

410/381-3150 (callers outside the 

United States only)

888/586-6340 (toll-free TDD service; 

hearing impaired only)

Be sure to specify the AHCPR number of the

document or CD-ROM you are requesting. Selected

electronic files are available on the Internet in the

MEPS section of the AHCPR home page: 

http://www.ahcpr.gov/

Additional information on MEPS is available from

the MEPS project manager or the MEPS public use

data manager at the Center for Cost and Financing

Studies, Agency for Health Care Policy and Research,

2101 East Jefferson Street, Suite 500, Rockville, MD

20852 (301/594-1406).

iii
Table of Contents

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

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Household Component . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Preliminary Contact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 

Core Rounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Uses of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Tables

1. Panel design for the MEPS Household Component, 1996 and 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2. Design features of the MEPS Household Component, 1996 panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

iv
1

Introduction

The Medical Expenditure Panel Survey (MEPS) is

the third in a series of nationally representative surveys

of medical care use and expenditures sponsored by the

Agency for Health Care Policy and Research (formerly

the National Center for Health Services Research). The

first of these surveys, called the National Medical Care

Expenditure Survey (NMCES), was conducted in 1977,

and the second, called the National Medical Expenditure

Survey (NMES), in 1987. The 1996 MEPS, which is

cosponsored by the National Center for Health Statistics

(NCHS), will update the 1987 data to reflect the

dramatic changes that have occurred in the U.S. health

care system over the last decade.

Background

Major changes have taken place in the Nation’s

health care delivery system since NMES was conducted

almost 10 years ago. The most notable is the rapid

expansion of managed care arrangements such as HMOs

(health maintenance organizations), PPOs (preferred

provider organizations), and other provider networks that

seek to minimize increases in health care costs. New

hybrid forms of health insurance coverage also have

appeared. Changes such as these have affected both the

private and public sectors. The new MEPS provides

information about the current state of the health care

system in the United States and the changes that have

taken place since the last national survey of medical

expenditures was conducted in 1987. The information

collected by MEPS also provides valuable baseline data

for use in evaluating future changes in the system.

The MEPS study design was developed to enhance

the capabilities to study changes in health care delivery

and the effects of new health policies. These are

important objectives in view of the various health reform

initiatives being implemented by States and the Federal

Government. The MEPS design allows for the

production of annual estimates for 2 calendar years. It

also permits the tracking of changes in employment,

income, health status, and medical care use and

expenditures over the 2 consecutive years during which

households will be interviewed. In addition, National

Health Interview Survey (NHIS) baseline data are

available for persons in the MEPS panels, thereby adding

another data point for comparisons of change over time.

MEPS extends the NMES series of studies on

medical expenditures and health insurance and provides,

for the first time, data suitable for detailed analysis of

trends and changes in these areas. The survey is a

unique resource for a number of reasons, including:

• Scope. MEPS provides information on a broad

spectrum of the population. The survey sample base

represents the civilian noninstitutionalized population

and, in a separate component, the population

institutionalized in nursing homes. MEPS also

provides information on many types of health care

services, expenditures, and sources of payment for

both individuals and families.

• Population basis. Because MEPS is a survey of

persons, population groups that are or may become of

special policy concern can be identified and

analyzed. This is especially important for analyzing

the effect of particular eligibility requirements on the

enrollment and budgets of public programs and on

those who are not eligible for such programs. 

• Cost-effectiveness. MEPS will collect data needed

by groups that might otherwise either sponsor

separate or overlapping surveys, or do without crucial

information needed for important decisions.

Experience has demonstrated that broad-based data

on use, expenses, and financing of health care

Design and Methods of the Medical Expenditure Panel Survey

Household Component

by Joel Cohen, Ph.D.,

Agency for Health Care Policy and Research
collected from a nationally representative sample can

meet the data needs of a wide variety of users in a

cost-effective manner.

Household Component

The sample design of the NMES household surveys

has been revised for MEPS. The MEPS sample is not

defined through an initial screening round. Instead, it is

selected as a nationally representative subsample of

households that participated in NHIS. The 1996 MEPS

sample (based on the 1995 NHIS) is being carried

forward into 1997 and combined with a new subsample

of households responding to the 1996 NHIS. These two

panel samples (the 1996 MEPS sample and the new

MEPS selections from the 1996 NHIS) will jointly

define the sample base for the 1997 MEPS Household

Component. Table 1 shows the study design of the

1996 and 1997 MEPS Household Components. Table 2

summarizes various features of the study design of the

Household Component.

In 1996, the MEPS sample linked to the 1995 NHIS

was selected. It was drawn from a nationally

representative NHIS subsample that included 195

primary sampling units and approximately 1,700

segments, yielding approximately 10,500 responding

NHIS households. These households were recontacted

in MEPS. This NHIS subsample reflects an oversample

of Hispanics and blacks. Other groups with high public

policy relevance in the areas of health care use and

financing are oversampled as part of the MEPS 1997

panel to improve the precision of the estimates for those

groups.

Households selected for participation in the 1996 or

1997 MEPS Household Components are interviewed in

person five times (Rounds 1-5) and a last time during a

brief telephone interview (Round 6). The rounds of data

collection are spaced approximately 4 months apart.

The interviews take place with a family respondent who

reports for himself or herself and for other family

members.

Preliminary Contact 

Mail and telephone contacts take place prior to the

first MEPS interview with the NHIS participating

households selected for each MEPS panel (Round 1).

The purpose of the preliminary contact is to enlist the

household respondent into MEPS and plan for the

delivery of record-keeping materials before the study

observation period begins on January 1st of the survey

year. In December, an advance letter announcing MEPS

is mailed to the family respondent at the address where

the NHIS interview was conducted. An interviewer

follows up on the letter with a telephone call to confirm

its arrival, verify the identity of the household, identify

the MEPS family respondent (if different from the NHIS

respondent), and announce the future mailing of a study

calendar and record file. These materials are sent, along

with $5 to compensate respondents for the time and

effort devoted to keeping records in preparation for the

Round 1 interview. An interviewer telephones a second

time to confirm the arrival of these materials and

arrange for a convenient time to conduct the Round 1

interview.

Households that do not have a telephone or cannot

be reached using the telephone number from NHIS are

contacted by mail and asked to return a postcard

identifying a telephone number where they can be

contacted (e.g., the number at work or a neighbor's

house).

Core Rounds 

Data collection for the MEPS Household

Component takes place using a computer-assisted

personal interview (CAPI) system. A core instrument is

administered in each of the first five rounds of data

collection, with periodic supplements added in selected

rounds to deal with specific topics in greater depth.

Dependent interviewing methods, in which respondents

are asked to confirm or revise data provided in earlier

interviews, is used to update information in several of

the core questionnaires, such as employment and health

insurance, after the initial interview.

2
3

Core Instrument

The core instrument is used to collect data about all

persons in sampled households. It includes

questionnaires on demographics, health status and

conditions, use, charges and payments, prescribed and

over-the-counter medicines purchased, employment, and

health insurance.

Periodic Supplements

Supplements scheduled for inclusion in the survey

include questionnaires on access to and satisfaction with

care, income and assets, long-term care, and alternative

care (which includes approaches to health care that are

different from those typically practiced by medical

doctors in the United States, such as acupuncture and

homeopathic treatments).

Self-Administered Questionnaire

All adults in sample households are asked to

complete a self-administered questionnaire in Round 2.

This questionnaire collects information about health

behaviors and opinions that would be difficult, if not

impossible, to collect on a proxy basis from the family

respondent. Similar information is collected for children

as part of the regular interview with the household

survey respondent, usually the mother.

Medical Provider Permission Forms

Signed permission forms are requested in Round 1,

much earlier than in past NMES studies, in order to

expedite the timetable for the later Medical Provider

Component of the survey, which collects data about

specific medical events directly from providers. Results

from a previous methodological study suggested that

early requests for signed permission forms involving

office-based physicians have a modest negative effect on

survey cooperation rates in later rounds. Therefore, the

requests for signed permission forms in Round 1 are

limited to events taking place in hospitals. In Round 2

and subsequent rounds, requests for signed permission

forms apply to all types of providers included in the

Medical Provider Component of MEPS (that is,

hospitals, physicians, and home health agencies),

including those associated with use reported in Round 1.

Health Insurance Permission Forms

Signed permission forms are needed to contact

sources of employment and private health insurance

coverage in the Insurance Component of the survey,

which collects data directly from individuals’sources of

health insurance (typically their employers). These

requests are initiated in Round 2 and apply to the

insurance sources associated with plans held at the time

of the Round 1 interview. 

Health Insurance Policy Booklet

Requests

Following procedures tested successfully in a

previous methodological study, MEPS interviewers ask

respondents to provide health insurance booklets or other

summary materials that describe the characteristics of

private plans held by family members at the time of the

Round 1 interview. The requests for policy information

include all sources of private insurance coverage, not just

employment-related coverage. Respondents are

reimbursed $15 for the time and effort involved in

procuring policy booklets.

Provider Directories

To assist in the identification of medical providers

and the preparation of an unduplicated list of medical

providers, interviewers use a computerized database

(directory) of health providers that has been loaded into

the CAPI laptop computer. With search software loaded

into the laptops, interviewers can query the database of

providers in the course of the MEPS interview. If a

match is found in the database for the provider specified

by the household respondent, the matched directory

record is associated with the household member.

Directory records include the following information for

each provider: a unique provider identification number;

the provider’s name, address, and telephone number; and

the provider’s specialty (for individual office-based

physicians).
4

Uses of Data

At the most basic level, the objective of the MEPS

Household Component is to collect data that can be used

to produce annual estimates for a variety of measures

related to the characteristics of individuals; their health

insurance coverage; and their health care use,

expenditures, and sources of payment. The data can also

be used to support behavioral analyses that inform

researchers and policymakers about how the

characteristics of individuals and families, including their

health insurance, affect medical care use and spending.

Data obtained in this study will be used to produce

the following national estimates for calendar years 1996

and 1997:

• Annual estimates of health care use and expenditures

for persons and families.

• Annual estimates of sources of payment for health

care expenses, including amounts paid by public

programs, such as Medicare and Medicaid, and by

private insurance, as well as out-of-pocket payments.

• Annual estimates of health care use, expenditures,

and sources of payment for persons and families by

type of service, including inpatient hospital stays,

ambulatory care, home health care, dental care, and

purchases of prescribed and over-the-counter

medicines.

• The number and characteristics of the population

eligible for each of the public programs, including the

use of services and expenditures of the population

eligible for benefits under Medicare, Medicaid,

CHAMPUS and CHAMPVA (Civilian Health and

Medical Program for the Uniformed Services and

Civilian Health and Medical Program, Veterans’

Affairs), and the Department of Veterans’Affairs.

• The number, characteristics, use of services,

expenditures, and benefits of persons and families

with individual or group coverage; commercial or

nonprofit coverage; and coverage through HMOs or

other managed care arrangements.

In addition to national estimates, data collected in

this longitudinal study will be used to study determinants

of the use of services and expenditures, and the effects of

individual characteristics and policy changes on medical

care use and expenses. These behavioral analyses will

include studies of:

• Social and demographic factors such as employment

and income.

• Methods of financing health care and health

insurance.

• Health habits, lifestyles, and behavioral patterns of

individuals and families.

• Health needs of specific subpopulation groups of

current or potential policy interest, such as the elderly

and members of racial or ethnic minorities.

Finally, data collected in this survey–in conjunction

with data from the 1977 NMCES and the 1987

NMES–will be used to study trends in the nature and

distribution of national health expenditures, sources of

care, and amounts and types of services used by the U.S.

noninstitutionalized population.
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5

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Table 1.

Panel design for the MEPS Household Component, 1996 and 1997

Item Calendar year Calendar year Cal

1996 1997 

1996 panel (from 1995 NHIS) Round 1 Round 2 Round 3 Round 4 Round 5 Field period 3/96-7/96 8/96-11/96 2/97-5/97 8/97-11/97 2/98-5/98 Responding households 9,500 9,000 8,800 8,500 8,300 1997 panel (from 1996 NHIS)

—

— Round 1 Round 2 Round 3 

Field period

—

— 3/97-7/97 8/97-11/97 2/98-5/98 

Responding households

—

— 5,800 5,500 5,400 

Total responding households 9,500 9,000 14,600 14,000 13,700 

Note: MEPS is Medical Expenditure Panel Survey. NHIS is National Health Interview Survey.

Table 2. Design features of the MEPS Household Component, 1996 panel

Featur

e 1995 1996 1997 

Data collection Preliminar

y Round 1 Round 2 Round 3 Round 4 Roun

contact

Reference period

—

1/1/96 to date Date of Round 1 Date of Round 2 Date of Round 3 Date of R

of Round 1 interview to date interview to date interview to date intervi

interview of Round 2 of Round 3 of Round 4 12/31

interview interview interview

Field period 12/95-1/96 3/96-7/96 8/96-11/96 2/97-5/97 8/97-11/97 2/98-

Interview mode Mail and In-person,

CAPI In-person,

CAPI In-person,

CAPI In-person,

CAPI In-perso

telephone

Note: CAPI is computer-assisted personal interview. MEPS is Medical Expenditure Panel Survey.

Source: Agency for Health Care Policy and Research, Center for Cost and Financing Studies
U.S. Department of Health and Human Services

Public Health Service

Agency for Health Care Policy and Research

2101 East Jefferson Street, Suite 501

Rockville, MD 20852

AHCPR Pub. No. 97-0026

July 1997