Patterns of Response During Covid-19 in a National Survey of Businesses:A Look at the Medical Expenditure Panel Survey – Insurance Component (MEPS-IC)

David Kashihara

Agency for Healthcare Research and Quality

FCSM Research and Policy Conference – November 2021

Disclaimer

The views expressed in this presentation are those of the author and no official endorsement by the Department of Health and Human Services or the Agency for Healthcare Research and Quality is intended or should be inferred.

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Presentation Outline

Introduction to MEPS

Insurance Component (IC)

Background

Changes due to COVID-19

Survey Response

Response by survey characteristics

Summary

Moving Forward & Continuing Research

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Medical Expenditure Panel Survey (MEPS)

Household Component (HC)

Annual survey of households

Survey administered by Westat

Medical Provider Component (MPC)

Sample of providers of services to HC respondents

Physicians

Hospitals

Home health agencies

Pharmacies

Administered by RTI International

Insurance Component (IC)

Annual survey of

Business establishments

State & local governments

Survey administered by the U.S. Census Bureau

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Medical Expenditure Panel SurveyInsurance Component (MEPS-IC)

Annual sample

Over 42,000 business establishments

Over 3,300 State & local governments

This presentation will only cover private sector (businesses) operations

National & State-level estimates

% of employers offering health insurance

# of enrolled employees

Average health insurance premiums, copays & deductibles

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COVID and the MEPS-IC

Operations at time of Fed Gov’t Covid shutdown

Census Bureau’s National Processing Center (NPC) shut down on March 18, 2020

Sample being prepared

Research about to begin

Update contact information

Find contact within business to respond to the survey

Conducted by analysts at the NPC

Prescreener data collection operation ready

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2020 MEPS-IC Survey OperationsSummary of Covid Effects

Sample

Frame set in March

Sample drawn in April

No changes due to Covid

Research

Analysts update contact information for sampled businesses

Find best contact within the business to send the survey

Initially canceled; operation completed

Telephone Pre-screener

Determine if offer insurance.  If no - end of survey

Initially delayed; operation completed

Added collection of email address for future web contacts

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2020 MEPS-IC Survey OperationsSummary of Covid Effects

Mail & Web

Survey forms mailed if offer insurance or nonresponse to pre-screener (primary option)

Web response option given in introductory letter of mailed survey forms packet & on first page of mailed survey form

Mail:  canceled

Web:  only response option

Survey shifted to web response as primary option

Paper forms mailed to some businesses once NPC re-opened

Mail response: 24.1% in 2019 → 10.5% in 2020

Web response: 37.8% in 2019 → 50.0% in 2020

Personal Visit

Very few – only for the largest-size non-respondents

No personal visits in 2020

Telephone Follow-up

For establishments with no response via mail or web

Extended field period to increase response

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Covid and the IC: Issues & Concerns

Survey Operations

NPC shut down → no Research, Prescreener or Mailout operations

No contact information updates & no contact information for some businesses

Major data collection operations halted

Telephone interviewers not telework-ready

Telephone follow-up (TFU) operation may be overwhelmed (volume)

Skeleton staffing → capabilities & pace of operations compromised

Manual operations by Census NPC & HQ staffs

Survey Respondents 

Certain industries may be severely affected

Certain regions or areas may be severely affected

Temporary & permanent business closures

Changes in business structure → furloughs, telework, etc.

Survey Challenges

Identifying business closures vs non-response

High unit non-response

May vary by industry, firm size & location

Quality of State-level estimates

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MEPS-IC Private SectorOverall Response Rate

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Year

Response Rate (%)

Data Collection: Prescreener

Prescreener Operation

Brief telephone interview

Determine offer insurance status

Yes: receive full survey (web & mail response options)

No: ask business characteristics questions & end survey

June 2020 – August 2020

Phone centers closed

Interviewers worked remotely for the first time

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IC Prescreener Response Rates

Prescreener Response Rates

Decreasing, but relatively small change from 2018 to 2019

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| Year                | 2018   | 2019   | 2020   |
|---------------------|--------|--------|--------|
| Response Rate (%)   | 58.6   | 54.8   | 44.9   |
| # of Establishments | 39,487 | 39,315 | 39,426 |

IC Prescreener Response Rates

Prescreener Response Rates

2020 response rates decline in all NAICS-2 industries

Industries with lowest response rates include [NAICS-2]:

Agriculture, forestry, fishing, hunting [11]

Real estate [53]

Accommodation, food services [72]

Publishing, movies, broadcasting, telecommunications [51]

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| Year                | 2018   | 2019   | 2020   |
|---------------------|--------|--------|--------|
| Response Rate (%)   | 58.6   | 54.8   | 44.9   |
| # of Establishments | 39,487 | 39,315 | 39,426 |

2020 MEPS-IC Post-Prescreener Response

MEPS-IC private sector response 

Preliminary high-level examinations

By industry

By type of firm (single unit vs multiunit)

By firm size

Overall response rates close to previous years

Response rates fairly consistent across subgroups of respondents

Response bias analyses in progress

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MEPS-IC Response RateBy Industry (2-Digit NAICS)

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Survey Year

Response Rate (%)

MEPS-IC Response RateBy Type of Firm

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Survey Year

Response Rate (%)

MEPS-IC Response RateBy Firm Size

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Survey Year

Response Rate (%) 

Response by Mode

Initial push during COVID to move the IC from a mail & web survey to a web-only survey

Census Bureau currently moving economic surveys to web-only format

Effects of promoting web response over mail

Data quality?

Bias?

Certain industries prefer mail response

Smaller firms prefer mail response

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MEPS-ICResponse Percentages by Mode

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Response Percentage

2019 & 2020 MEPS-ICResponse Percentage by Mode & Firm Size

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2019

Firm Size

Response Percentage

2020

Firm Size

2019 & 2020 MEPS-ICResponse Percentages by Mail & Firm Size

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2019 & 2020 MEPS-ICResponse Percentages by Web & Firm Size

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2019 & 2020 MEPS-ICResponse Percentages by Phone & Firm Size

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2019 & 2020 MEPS-ICResponse Percentage by Mode & Firm Size

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Firm Size:  1 - 10 Employees

Mode by Year

Response Percentage

MEPS-ICMail vs Web Response

Before 2020

Mail becomes steadily less popular as firm size increases

Mail only more popular than web for the smallest firms (1-10 employees)

Web more popular than mail for all other firm sizes

Data quality (Kashihara, 2019)

Better quality likely due to automated edits in web instrument

Web reporting issues include:

Internet access

Some respondents not computer savvy

Paper surveys preferred by some

During 2020

Web response more prevalent in all firm size categories

Mail becomes steadily less popular as firm size increases

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Response Mode by Industry (NAICS-2)

Findings from an analysis of 2017 MEPS-IC data

Web response more popular than mail

Most industries

Mail response more popular than web

Agriculture, Forestry, Fishing & Hunting

Retail Trade

Warehousing & Storage

Other Services

Repair & Maintenance

Personal & Laundry Services

Etc.

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Summary

Covid-based MEPS-IC disruptions in 2020

Survey operations

Sampled businesses

Overall private sector response rate

2019:  59.2%

2020:  56.3%

Response rate by industry, type of firm, firm size

Generally followed annual trends

Response by mode noticeably altered

Shift in primary survey mode:  mail → web

Overall response rate relatively unchanged from 2019

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Moving Forward

2021 Survey Operations

Data collection operations will be similar to 2020

Initial Mail

2019:  letter & survey forms (paper response w/ web option)

2020:  letter only (web response)

2021:  letter only (web response)

Mail Follow-up

2019:  follow-up letter & survey forms

2020:  follow-up letter & survey forms

2021:

1st mail follow-up:  follow-up letter & fact sheet

2nd mail follow-up:  follow-up letter & survey forms

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Continuing Research

2021 Research Projects

COVID survey questions

2020 MEPS-IC data quality analysis

2020 MEPS-IC bias analysis

Independent pilot study

5,000 establishments

Remove costly & time-consuming operations

No Research, Prescreener or TFU

Examine effects on estimates, response & bias

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Contact Information

David Kashihara

Email:  David.Kashihara@ahrq.hhs.gov

Thank You!

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