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Sample Design of the 1996 

Medical Expenditure Panel Survey 

Household Component 

Methodolo 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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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

The Medical Expenditure Panel

Survey (MEPS)









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Cohen S. 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.

i
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
iv

Table of Contents

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

DHHS Survey Integration Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Enhancements and Efficiencies Through Survey Integration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

MEPS Household Component . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Table

1. Expected number of responding reporting units and associated response rate 

for 1996 and 1997 MEPS Household Component . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1

Introduction

The Household Component of the 1996 Medical

Expenditure Panel Survey (MEPS) is designed to

produce national and regional estimates of the health

care use, expenditures, sources of payment, and

insurance coverage of the U.S. civilian

noninstitutionalized population. MEPS includes

surveys of medical providers, employers, and other

health insurance providers to supplement the data

provided by household respondents. The MEPS design

permits both person-based and family-level estimates.

Government agencies, legislative bodies, and health

professionals need comprehensive national estimates to

use in formulating and analyzing national health

policies. The scope and depth of this data collection

effort reflect this need. 

MEPS collects data on the specific health services

that Americans use, how frequently they use them, the

cost of these services, and how they are paid for, as well

as data on the cost, scope, and breadth of private health

insurance held by and available to the U.S. population.

MEPS is unparalleled for the degree of detail in its data.

In addition, through MEPS, the medical expenditures

and health insurance data of survey respondents can be

linked to other characteristics such as demographic

variables, employment status, economic status, health

status, and use of health services. Moreover, MEPS is

the only national survey that provides a foundation for

estimating the impact of changes in sources of payment

for health services and insurance coverage on different

economic groups or special populations of interest, such

as the poor, the elderly, veterans, the uninsured, and

racial and ethnic minorities.

In this report, the sample design of MEPS, initially

referred to as the National Medical Expenditure Survey

(NMES-3), is described. The 1995 National Health

Interview Survey (NHIS) is the sample frame for the

1996 MEPS. The redesigned MEPS reflects the first

stage of implementation of the Department of Health

and Human Services (DHHS) Survey Integration Plan,

which provides directives targeted to improve the

analytic capacity of programs, fill major data gaps, and

establish a framework in which DHHS data activities

are streamlined and rationalized. Through this effort,

specifically through a linkage to NHIS, MEPS has

achieved a number of significant design improvements

and analytic enhancements.

This report discusses the design efficiencies and

enhancements in analytic capacity that have been and

will be realized through the MEPS sample design

integration with NHIS. It includes a summary of sample

size specifications and precision targets for national

population estimates and health care expenditure

estimates for policy-relevant population subgroups. It

also discusses the modification of MEPS from a

periodic annual survey to an ongoing continuous data

collection effort with each expenditure panel of

households followed for 2 years. 

DHHS Survey Integration Plan 

As part of the Reinventing Government Part II

(REGO II) activities, DHHS targeted improvement of

the analytic capacity of its programs, filling of major

data gaps, and establishment of a survey consolidation

framework in which DHHS data activities are

streamlined and rationalized. A Survey Consolidation

Working Group was charged with developing a

consensus plan for meeting these objectives (Hunter,

Arnett, Cohen, et al., 1995; Arnett, Hunter, 

Cohen, et al., 1996). 

Sample Design of the 1996 Medical Expenditure Panel Survey

Household Component

by Steven B. Cohen, Ph.D.,

Agency for Health Care Policy and Research
2

A major concentration of the Survey Integration

Plan was the redesign of the health care expenditure and

insurance studies conducted by DHHS, which include

the National Medical Expenditure Survey (NMES), the

Medicare Current Beneficiary Survey (MCBS), the

National Employer Health Insurance Survey (NEHIS),

and NHIS. The proposed survey integration plan was

designed to achieve significant cost efficiencies by

eliminating duplicative efforts and reducing overall

respondent burden. Furthermore, the analytic capacities

of the component surveys are enhanced because their

design features are integrated. To improve survey

design capabilities, enhancements such as an ongoing

longitudinal survey effort and the capacity to derive

State-specific health care estimates were considered.

Consideration was also given to including a periodic

institutional component in the survey to provide national

use and expenditure estimates for the population

residing in nursing homes (Hunter, Arnett, 

Cohen, et al., 1995). 

Enhancements and Efficiencies

Through Survey Integration 

One attraction of the DHHS Survey Integration

Plan is the enhanced analytic capacity to be achieved by

linking the distinct surveys through design integration.

This could be realized by sample size expansions

through survey mergers, such as the planned integration

between MEPS and MCBS and the consolidation of

employer surveys conducted by DHHS. Also, use of

NHIS as a sample frame for MEPS increases the

analytic content of the resultant linked surveys. Through

design integration of DHHS surveys, inefficiencies

associated with duplicative survey efforts can be

significantly reduced. Another goal is to reduce survey

design costs by implementing a uniform framework for

DHHS-sponsored surveys that has overlapping analytic

focus with respect to questionnaire content, data editing,

imputation, estimation, database structure, and

development of analytic files. Additional efficiencies in

survey operations in future years are anticipated as a

consequence of conducting an annual medical

expenditure survey rather than one every decade.

By moving to this integrated, annual household data

collection effort, DHHS expands and enhances its

analytic capabilities. The new format:

• Retains the design of the core NHIS household

interview. This core will provide cross-sectional

population statistics on health status and health care

use, with sufficient sample size to allow for analyses

based on detailed breakdowns by age, race, sex,

income, and other sociodemographic characteristics.

The core will also allow the use of data on a broad

range of topics currently covered by NHIS.

• Retains the analytic capacity to obtain annual and

quarterly population estimates of health care use and

the prevalence of health conditions, both for the

Nation and for policy-relevant population subgroups.

• Provides the ability to model individual and familylevel health status, access to care and use,

expenditures, and insurance behavior over the year

and examine the distribution of these measures

across individuals. The longitudinal feature of MEPS

(collecting data over multiple years) further enhances

the capacity to model behavior over time.

• Provides the ability to relate data from a detailed

sample (e.g., MEPS) to a larger sample (e.g., NHIS)

to enhance the utility of MEPS for national health

account estimation and microsimulation modeling,

including disaggregation by age group or geographic

area.

• Provides the potential to yield both national and

State-level estimates for marginal costs using the

enhanced sample design of the NHIS, which

includes 358 primary sampling units.

• Provides the following as a result of the longitudinal

aspect of the MEPS integrated data collection

effort—

- An increase in statistical power to examine 

change or make comparisons over time.

- The capacity to examine changes over time as 

well as changes in the relationships among 

measures of health status, access to care, health 

care use, expenditures, health insurance 

coverage, employment, functional limitations 

and disabilities, and demographic 

characteristics.
MEPS Household Component

The original NMES-3 sample design called for an

independent screening interview to identify a

nationally representative sample and facilitate

oversampling of policy-relevant population subgroups.

Data collection and training costs associated with this

independent screening interview were projected to

exceed $8 million. As part of the DHHS Survey

Integration Plan, this separate screening interview was

eliminated. Instead, NHIS was specified as the

sampling frame for MEPS. NHIS is an ongoing

annual household survey of approximately 42,000

households (109,000 individuals) conducted by the

National Center for Health Statistics (NCHS) to obtain

national estimates on health care use, health conditions,

health status, insurance coverage, and access for the

U.S. civilian noninstitutionalized population. In

addition to the cost savings achieved by substituting

NHIS as the MEPS sample frame, the design

modification will result in an enhanced analytic

capacity of the resultant survey data. Use of the 1995

NHIS data in concert with the 1996 MEPS data

provides an additional capacity for longitudinal

analyses not available in the original (NMES-3) design.

Furthermore, the greater number and dispersion of the

sample primary sampling units that comprise the

MEPS national sample should result in improvements

in precision over the original design specifications.

To fill major data gaps identified by DHHS,

MEPS is specified as a continuous survey with sample

peaks at 5-year intervals. The initial sample for the

1996 MEPS (10,597 NHIS dwelling units) is smaller

than originally planned but will now also permit

estimates for calendar year 1997 through an

overlapping panel design. The 1996 panel will be

followed for data collection through 1997. A new

nationally representative sample of 6,300 dwelling

units will be selected from the 1996 NHIS to

supplement the 1996 MEPS panel in order to meet the

original precision specifications for certain specified

policy-relevant population subgroups for calendar year

1997. As detailed in Cohen (1996), these policyrelevant population subgroups are:

• Adults (18 years and older) with functional

impairments.

• Children with limitations of activity.

• Individuals 18-64 years who are predicted to incur

high medical expenditures.

• Individuals predicted to have family income less

than 200 percent of the poverty level.

Before MEPS began, preliminary contact was

made with the NHIS responding households selected

for MEPS to announce the survey and introduce

record-keeping activities. The revised MEPS study

design includes several components. In addition to the

Nursing Home Component, it comprises: 

• The Household Component (HC), consisting of an

overlapping panel design in which any given

sample panel is interviewed a total of six times over

3 consecutive years to yield annual data for 2

calendar years.

• The Medical Provider Component (MPC), with a

sample of medical providers that treated HC

persons.

• The Insurance Component (IC), with a sample of

employers and other sources of health insurance of

HC persons.

The survey is cosponsored by the Agency for

Health Care Policy and Research (AHCPR) and

NCHS. Westat and the National Opinion Research

Center (NORC) are the data collection organizations

for the 1996 MEPS Household Component.

Sample Design

The 1996 MEPS Household Component sample

was selected from households that responded to the

1995 NHIS. NHIS is designed to permit the selection

of nationally representative subsamples from any one

of four panels. Furthermore, any combination of one

to four panels will provide a nationally representative

sample of households. Each NHIS panel subsample

for a given quarter of a calendar year is nationally

representative. The 1996 MEPS household sample was

selected from two of the four 1995 NHIS panels and

encompassed half of the households in the NHIS

sample during the second and third quarters of 1995.

3
4

The complete 1995 NHIS sample (panels 1-4)

consists of 358 primary sampling units, or PSUs (which

are counties or groups of contiguous counties), and

approximately 42,000 responding households. The

sample PSUs selected for NHIS were stratified by

geographic area (Census region and State), metropolitan

status, and sociodemographic measures (Judkins,

Marker, and Waksberg, 1994). Within sample PSUs, a

sample of blocks (segments) was selected after the

blocks were stratified by measures of minority

population density that allowed for an oversample of

areas with high population concentrations of blacks and

Hispanics. A nationally representative sample of

approximately 71,000 addresses within sampled blocks

was selected and targeted for further screening to

facilitate an oversample of blacks and Hispanics as part

of the 1995 NHIS interview.

The 1995 NHIS subsample selected for the 1996

MEPS consists of 195 PSUs. In the two targeted

quarters of 1995, these PSUs included 1,675 sample

segments (second-stage sampling units) and 10,597

responding households. This NHIS sample reflects

oversampling of households with Hispanics and blacks 

at a ratio of approximately 2.0:1 for Hispanics and 1.5:1

for blacks. This 1996 MEPS sample constitutes a panel

that will be surveyed to collect annual data for 2

consecutive years.

A new 1997 MEPS panel sample will be selected as

a nationally representative subsample of households

responding to the 1996 NHIS. More specifically, this

1997 MEPS sample will be selected from two of the four

NHIS panels. It will reflect additional disproportionate

sampling in order to satisfy the precision requirements

specified for the 1997 MEPS Household Component,

which generally coincide with the original plan for the

1996 survey (Cohen, 1996). As in 1995, the complete

1996 NHIS sample will consist of 358 PSUs with a

targeted sample of approximately 42,000 responding

households. A nationally representative subsample will

be reserved for the 1997 MEPS prior to additional

subsampling. This subsampling will come from the

same 195 PSUs selected for the 1996 MEPS household

sample and include approximately 21,000 responding

NHIS households. It reflects an oversample of

Hispanics and blacks at the same ratios as before

(Hispanics, 2.0:1; blacks, 1.5:1). A nationally

representative subsample of approximately 6,300 NHIS

responding households (6,480 reporting units) will be

selected for the new 1997 MEPS panel. This sample

will consist of an oversample of the following policyrelevant subgroups: functionally impaired adults,

children limited in activities, adults predicted to have

high medical expenditures, and persons predicted to have

family income less than 200 percent of the poverty level.

An oversample of the elderly who are not

functionally impaired was not planned for the 1997

survey. Such data will be available from the 1997

Medicare Current Beneficiary Survey, and consolidation

of MCBS and MEPS is planned. MCBS, an annual

person-based survey, obtains data for Medicare

beneficiaries. The same types of estimates of health care

use, expenditures, sources of payment, and health

insurance coverage can be derived from the two surveys.

The new 1997 MEPS panel will be fielded to collect

annual data for 2 consecutive years.

The 1997 MEPS Household Component sample will

consist of the new 1997 MEPS panel in combination

with the second year of the 1996 MEPS sample.

Overall, the 1997 MEPS household sample will consist

of approximately 13,700 reporting units that will

complete the full series of MEPS interviews, yielding

use and expenditure data for calendar year 1997. (The

number of reporting units is adjusted for Round 1 “splitoffs”—family member(s) who move apart from the

originally sampled household—but not for split-offs in

Rounds 2 and 3.) Sample selection procedures for the

1997 MEPS have been implemented in-house by

AHCPR staff, based on data keyed from the 1996 NHIS

interviews.

In 1998, a new MEPS sample of approximately

5,200 households (5,350 reporting units) will be selected

as a nationally representative subsample of households

that responded to the 1997 NHIS. In addition, the entire

1997 panel of 5,397 reporting units will be continued to

obtain calendar year 1998 data on health care use and

expenditures. The targeted response rate for Rounds 4

and 5 is 97 percent. Consequently, the 1998 MEPS

sample will consist of approximately 9,500 reporting

units (adjusted for split-offs in Round 1) completing

three core rounds of data collection to obtain calendar

year data (4,457 households from the new sample, 5,078

from the 1997 MEPS sample). In 1998, the 1996 MEPS

panel will be retired.
5

For 1998-2001, the survey will scale back to an

overall sample of approximately 9,500 reporting units

completing three core rounds of data collection to obtain

calendar year data on health care use and expenditures.

Each year, approximately 5,000 reporting units will

continue from the previous year. In 2002, the survey will

begin another 5-year cycle, with an increase to 13,700

reporting units (adjusted for Round 1 split-offs)

completing three core rounds of data collection to obtain

calendar year data. Coupled with data from MCBS, this

will provide DHHS with the same analytic capabilities

with respect to sample size that were first proposed for

the 1996 NMES-3. 

Sampling Unit Definitions and

Eligibility Criteria

The definitions for dwelling units and group

quarters in the MEPS Household Component are

generally consistent with the definitions employed for

NHIS. More specificially, a dwelling unit is a house,

apartment, group of rooms, or single room occupied as

separate civilian non-institutional living quarters or

vacant but intended for occupancy as separate living

quarters. Group quarters consist of a single civilian

noninstitutional dwelling or structure in which nine or

more unrelated persons reside and where inhabitants are

not considered a part of any other dwelling unit. A

reporting unit is a person or group of persons in the

sampled dwelling unit that are related by blood,

marriage, adoption, or other family associations, and are

to be interviewed at the same time in MEPS. Examples

of discrete reporting units follow.

• A married daughter and her husband living with her

parents in the same dwelling are considered one

reporting unit.

• A husband and wife and their unmarried daughter,

age 18, who is living away from home at college

constitute one family, but two reporting units.

• Three unrelated persons living in the same dwelling

unit would be three reporting units. 

College students under 24 years of age who usually

live in the sampled household but are currently living

away from home and going to school are treated as

separate reporting units for the purpose of data

collection. 

The 1996 MEPS sample consisted of households

(dwelling units) that responded to the 1995 NHIS in the

two panels reserved for MEPS, with the basic unit of

analysis defined as the person. Analysis is planned using

both the individual and the family as units. Through the

reenumeration section of the Round 1 questionnaire, the

status of each individual sampled at the time of the

NHIS interview is classified as “key” or “non-key,” “inscope” or “out-of-scope,” and “eligible” or “ineligible”

for MEPS data collection. For an individual to be inscope and eligible for person-level estimates derived

from the MEPS household survey, he or she must be a

member of the civilian noninstitutionalized population

for some period of time in the calendar year of analytic

interest. Because a person’s eligibility for the survey may

change after the NHIS interview, sampling

reenumeration takes place in each subsequent

reinterview for persons in all households selected into

the core survey. The keyness, in-scope, and eligibility

indicators, together, define the target sample to be used

for person-level national estimates. Only persons who

are key, in-scope, and eligible for data collection are

considered in the derivation of person-level national

estimates from MEPS.

Key Persons

Key survey participants are defined as all civilian

noninstitutionalized individuals who resided in

households that responded to the nationally

representative NHIS subsample reserved for MEPS (e.g.,

approximately 10,600 households from the 1995 NHIS),

with the exception of college students interviewed at

dormitories. Members of the Armed Forces who are on

full-time active duty are also defined as key persons if

they reside in responding NHIS households that include

other family members who are civilian

noninstitutionalized individuals. However, they are out of

scope for person-level estimates derived from the survey.

All individuals who join the NHIS reporting units

that define the 1996 MEPS household sample (in Round

1 or later MEPS rounds) and were not available for

selection during the time of the NHIS interview are also

considered key persons. These include newborn babies,
individuals who were in an institution or outside the

country, and military personnel previously residing on

military bases.

College students under 24 years of age interviewed

at dormitories in the 1995 NHIS are considered

ineligible for the 1996 MEPS sample. Furthermore, any

unmarried college student under 24 years of age who

responded to the 1995 NHIS interview while living

away at school (not in a dormitory) is excluded from the

sample if it is determined in the MEPS Round 1

interview that the person is unmarried, under 24 years of

age, and a student who has parents living elsewhere and

who resides at his or her current housing only during the

school year. If, on the other hand, the person’s status at

the time of the MEPS Round 1 interview is no longer

that of an unmarried student under 24 years of age living

away from home, then the person is retained as a key

person.

Additionally, during the MEPS Round 1 interview

with NHIS sample respondents, a determination is made

whether there are any related college students under 24

years of age who usually live in the sampled household

but are currently living away from home and going to

school. These college students are considered key

persons and are identified and interviewed at their

college address but linked to the sampled household for

family analyses. Some of these college students will

have been identified as living in the sampled household

at the time of the 1995 NHIS interview. The remainder

are identified at the time of the MEPS Round 1

interview.

Non-Key Persons

Persons who were not living in the original sampled

dwelling unit at the time of the 1995 NHIS interview

and who had a nonzero probability of selection for that

survey are considered non-key. If such persons happen

to be living in sampled households in Round 1 or later

rounds, MEPS data are collected for the period of time

they are part of the sampled unit to permit family

analyses. Non-key persons who leave any sampled

household are not recontacted for subsequent interviews.

Non-key individuals are not part of the target sample

used to obtain person-level national estimates.

A key person from the NHIS sampled household

selected for MEPS may move out in Round 1 or later

rounds and join or create another family. Data on all

members of this new household who are related by

blood, marriage, adoption, or foster care to the person

from the NHIS sampled household are obtained from

the time that the sampled person joined the household.

Similarly, data are collected in Round 1 and later rounds

on all related persons who join NHIS sampled

households selected into MEPS.

Persons in NHIS sampled households selected in

MEPS may subsequently enter an institution, thus no

longer qualifying as a member of the U.S. civilian

noninstitutionalized population. For those who enter

nursing homes, data collection continues during the

nursing home stay. For those who enter other

institutions, data collection is suspended while they are

instiutionalized, but their whereabouts are monitored

during the field period. If they rejoin the U.S. civilian

noninstitutionalized population, HC data collection

resumes. (This is also the procedure for those entering

military service away from home or moving out of the

United States.)

MEPS Data Collection Eligibility

In order for a MEPS reporting unit to be eligible for

data collection, it must include at least one individual

who is key and in-scope for some period of time during

the reference period for a given round of data collection.

If this condition holds, the persons who are key and inscope and all other individuals who are members of the

reporting unit (living together and related by blood,

marriage, adoption, or other family associations) are

eligible for data collection in a given round of MEPS.

Sample Size Targets and Precision

Requirements

The 1996 MEPS sample size targets require

approximately 9,000 reporting units yielding the complete

series of core interviews (Rounds 1-3) to obtain use and

expenditure data for calendar year 1996. The expected

yield at each stage of data collection for each new MEPS

sample linked to the NHIS (Table 1) is as follows:

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7

Table 1. Expected number of responding reporting units and associated

response rate for 1996 and 1997 MEPS Household Component

NHIS

Panel and response linked sample Calendar year 1996 Calendar year 1997 Calendar year 1998

1996 MEPS panel Round Round Round Round Round Round 

1A 2A 3A 4A 5A 6A

111,424 Responding reporting units 19,488 39,018 38,792 38,528 38,272 38,106 210,800

(Response rate) 94% 83% 95% 97.5% 97% 97% 98%

1997 MEPS panel Round Round Round Round 

1B 2B 3B 4B

16,857 Responding reporting units — — 15,828 35,536 35,397 35,235 26,480

(Response rate) 94% — — 85% 95% 97.5% 97%

1Includes “splits-offs” (family member(s) who move apart from the originally sampled household) in Round 1 of the 1996 and 1997 MEPS panels. 2Original sample of reporting units. 3Does not include split-offs after Round 1.

Note: The estimates of response rates shown here are for the original sample of responding NHIS reporting units, including split-offs in Round 1.

These rates are also expected to apply to split-offs in subsequent rounds (households that will be created in the course of the survey field period as

a result of key persons moving away from originally sampled NHIS households).

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

Source: Agency for Health Care and Policy Research, Center for Cost and Financing Studies. 1996 Medical Expenditure Panel Survey—

Household Component.

• An NHIS response rate of 94 percent at the

household level.

• A response rate of 85 percent (83 percent achieved

for the 1996 MEPS) among reporting units at Round

1 (conditional on a completed NHIS interview).

• A round-specific response rate of 95 percent among

reporting units at Round 2.

• A round-specific response rate of 97.5 percent

among reporting units at Round 3.

• A round-specific response rate of 97 percent among

reporting units at Rounds 4 and 5.

• A round-specific response rate among reporting

units of 98 percent at Round 6.

Consequently, the targeted response rate for

obtaining calendar year 1996 data on health care use

and expenditures from the 1996 MEPS sample is 77

percent, conditional on response to NHIS (interviews

for Rounds 1-3), or 72 percent overall.

The response rate target for the MEPS core

interviews for obtaining calendar year 1997 data on

health care use and expenditures from the new 1997

MEPS sample is 79 percent, conditional on response to

NHIS (interviews for Rounds 1-3), or 74 percent overall

(Table 1). 

The minimum acceptable response rate target for

the MEPS core interviews within a PSU is 65 percent

for calendar year 1997 data from the new MEPS panel,

conditional on NHIS response (interviews for Rounds 

1-3), and is 60 percent for calendar years 1996 and

1997 for the 1996 MEPS panel (interviews for Rounds

1-5, conditional on response to NHIS).






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8

The 1995 NHIS response rate achieved for MEPSeligible households was 94 percent. Of 10,639

responding NHIS dwelling units eligible for MEPS, 99.6

percent were identified with enough information to allow

MEPS data collection. Of the 11,424 eligible reporting

units targeted for interviews in Round 1, 9,488 (83.1

percent) responded. Overall, the joint NHIS-Round 1

response rate for the 1996 MEPS household survey was

77.7 percent (.939 x .996 x .831).

The sample size specifications were set to meet

precision requirements developed for MEPS. The

precision requirements for the first year of MEPS were

relaxed relative to the original design specifications of

NMES-3 because of major changes in the survey design

as a consequence of the DHHS Survey Integration Plan.

These changes included sample size constraints

(restricting the sample to the 195-PSU NHIS

subsample), and inclusion of the first quarter of the 1995

NHIS sample in a disability survey sponsored by the

Assistant Secretary of Planning and Evaluation, DHHS

(Cohen, 1996; DiGaetano, 1994). 

For the 1996 MEPS sample, the relative standard

error for a population estimate of 20 percent for the

overall population at the family level was specified to be

no more than 2.7 percent, and the relative standard error

for a population estimate of 20 percent for the overall

population at the person level was specified to be no

more than 1.7 percent. For example, if the estimate of

the percentage of the national population uninsured at

any time during 1996 were 20 percent, the standard error

of the estimate should not exceed 0.34 percent. That

would translate to a 95-percent confidence interval

(19.33 percent, 20.67 percent) for the insurance coverage

estimate characterizing the Nation at the person level.

The 1996 MEPS sample is selected from a nationally

representative 1995 NHIS subsample characterized by

195 PSUs, 1,675 segments, and approximately 9,000

responding households at the end of Round 3, with

disproportionate sampling rates ranging from 1.0 to 0.5.

Preliminary design work suggests that these conditions

should yield average design effects for MEPS survey

estimates of annual use and expenditures in the 

1.5-1.6 range.

The 1996 MEPS sample linked to NHIS was

designed to produce unbiased estimates for the four

Census regions, with oversampling of Hispanics and

blacks. The expected sample yield after three rounds of

data collection at the person level is approximately

22,000 overall, with 3,400 black non-Hispanic

individuals and 4,200 Hispanic individuals. The average

design effect target for survey estimates for the 1996

MEPS is 1.6. The sample design should satisfy the

following precision requirements for mean estimates of

the following measures of health care use and

expenditures at the person level: total health

expenditures, use, and expenditure for inpatient hospital

stays, physician visits, dental visits, and prescribed

medicines.

Demographic Persons at the Average relative

group end of Round 3 standard error

Black non-Hispanic 3,400 .065

Hispanic 4,200 .055

Overall population 22,000 .025

Procedures for Data Collection

The preliminary contact with households responding

to NHIS and subsampled as part of a MEPS panel is

described in Cohen (1997). Procedures in the rounds of

data collection are described below.

Rounds 1-5

Five interviews are conducted with each NHIS panel

selected for MEPS at 3- to 4-month intervals over an

approximately 24-month field period. The first three

rounds (Rounds 1A-3A) define the 1996 MEPS

Household Component and collect the main body of

annual use and expenditure data for calendar year 1996.

Rounds 3A-5A of the 1996 MEPS panel are combined

with Rounds 1B-3B of the 1997 MEPS panel to yield

the sample base for the 1997 MEPS Household

Component and the source of annual estimates for that

calendar year. All interviews are conducted in person

through a computer-assisted personal interview (CAPI).

Round 1 asks about the period from January 1 of the

MEPS year to the date of that interview; Round 2 will

ask about the time from the Round 1 interview through

the date of the Round 2 interview, and Round 3 asks
9

about the time from the date of the Round 2 interview

through the date of the Round 3 interview in 1997.

Questionnaires for these field rounds parallel those

used in the 1987 NMES but include some

modifications implemented for a 1992 feasibility study

and further changes stemming from the feasibility study

and the NMES-3 pretest. The instruments contain items

that are asked once in the life of the study, items that are

asked repeatedly in each round, and items that are

updated in later rounds. Questions asked only once

include basic sociodemographic characteristics. Core

questions asked repeatedly include health status, health

insurance coverage, employment status, days of

restricted activity due to health problems, medical use,

hospital admissions, and purchase of medicines. For

each health encounter identified, data are obtained on

the nature of health conditions, characteristics of the

provider, services provided, associated charges, and

sources and amounts of payment.

Permission forms for medical providers and for

sources of employment and private health insurance

coverage are collected in the field. Anyone who reports

being employed but not covered by private health

insurance is asked to sign a permission form that allows

contact with the employer. A sample of medical

providers identified by MEPS respondents is contacted

in the survey of medical providers, MPC, to verify and

supplement information provided by the family

respondent in the household interview. Employers and

other health insurance providers are contacted in the

survey of health insurance providers, IC, to verify

analogous insurance information and collect other

information on insurance characteristics that household

respondents would not typically know.

As a consequence of a successful test in the

feasibility study, copies of policies for the private

insurance coverage of sampled persons are collected

from household respondents. The requests for

insurance policies are initiated in Round 1 and followed

up in Round 2 for eligible individuals who did not

provide copies of their policies at the time of the first

request. A description of the type of documents to be

collected, a list of the policies identified by the

respondent, and request forms to be given to providers

are given to interviewing staff to assist in this effort.

Round 6

Round 6 is concerned with obtaining valuable

ancillary information before a MEPS panel is retired.

For the 1996 MEPS panel, it takes place after April 15,

1998, and asks for details on tax filing information.

The majority of Round 6 interviews are administered by

telephone from the interviewers’ homes. In-person

interviews are conducted for respondents without access

to a telephone or for whom telephone administration is

not feasible (e.g., respondents with hearing or

comprehension problems).

Summary

The benefits of the redesigns incorporated in MEPS

include significant cost savings, enhanced analytic

capacities, increased opportunities for longitudinal

analyses, reduction of major data gaps, and major

improvements in providing timely data access to the

research community at large. MEPS will provide

information to help understand how the dramatic

growth of managed care, changes in private health

insurance, and other dynamics of today’s market-driven

health care delivery system have affected, and are likely

to affect, the kinds, amounts, and costs of health care

that Americans use. The survey will also provide

necessary data for projecting who benefits from and

who bears the cost of changes to existing health policy

and the creation of new policies. 

The MEPS data will serve as the primary source of

information for research efforts examining how health

care use and expenditures vary among different sectors

of the population (such as the elderly, veterans, children,

disabled persons, minorities, the poor, and the

uninsured) and how the health insurance of households

varies by demographic characteristics, employment

status and characteristics, geographic locale, and other

factors. The MEPS data will provide answers to

questions about private health insurance costs and

coverage, such as how employers’ costs vary by region,

and help evaluate the growing impact of managed care

and of enrollment in different types of managed 

care plans.
10

The first MEPS data became available on public use

data tapes in spring 1997. MEPS data also will be used

in a series of studies to be published by AHCPR and by

AHCPR researchers and others publishing in the

scientific literature. As a consequence of the shift to a

continuous ongoing annual survey, additional

efficiencies in survey data collection, data editing, and

imputation tasks will be realized, as well as further

improvements in the timely release of MEPS data

products to the research community.

References

Arnett RA, Hunter E, Cohen S, et al. The

Department of Health and Human Services’ Survey

Integration Plan. In: Proceedings of the American

Statistical Association (ASA). Section on Government

Statistics. Chicago: 1996 Aug.

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.

Cohen SB. The redesign of the Medical Expenditure

Panel Survey, a component of the DHHS Survey

Integration Plan. Proceedings of the Council of

Professional Associations on Federal Statistics

(COPAFS) Seminar on Statistical Methodology in the

Public Service, Bethesda (MD); 1996 Nov.

DiGaetano R. Sample design of the Household

Component of the National Medical Expenditure Survey

(NMES-3). Unpublished report. Rockville (MD):

Westat, Inc.; 1994. Contract No. 282-94-200.

Hunter E, Arnett R, Cohen S, et al. HHS Survey

Integration Plan: Background materials. Agency for

Health Care Policy and Research, Rockville (MD), and

National Center for Health Statistics, Hyattsville 

(MD); 1995.

Judkins D, Marker D, Waksberg J. National Health

Interview Survey: research for the 1995 redesign.

Unpublished report. Prepared under contract for the

National Center for Health Statistics. Rockville (MD):

Westat, Inc.; 1994.
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. 97-0027

July 1997