Changes to the 2018 MEPS

AHRQ made several changes to the MEPS questionnaire in 2018. Below, we enumerate the omitted sections, new sections, and modified sections. We also describe changes to the Self-Administered Questionnaires, health care use and expenditure collection, and variables in further detail.

Medical Conditions, Illnesses, and Injuries

The MEPS Medical Conditions file only contains those conditions defined as "current." Prior to 2018, the following criteria defined a "current" condition: 1) a priority condition reported in the Priority Conditions Enumeration (PE) section that the person reported experiencing in the current calendar year in the Conditions Enumeration (CE) section, 2) a priority condition reported in the PE section that had an associated medical event in the current calendar year, or 3) a non-priority condition with an associated medical event in the current calendar year. According to the 2016 documentation, "certain conditions were a priori designated as 'priority conditions' due to their prevalence, expense, or relevance to policy. Some of these are long-term, life-threatening conditions, such as cancer, diabetes, emphysema, high cholesterol, hypertension, ischemic heart disease, and stroke. Others are chronic manageable conditions, including arthritis and asthma. The only mental health condition on the priority conditions list is attention deficit hyperactivity disorder/attention deficit disorder." In contrast, a respondent could report conditions such as a cold or headache in the CE section.

The CE section was eliminated in 2018, alongside the introduction of a changed definition for a "current" condition: 1) a priority condition reported in the PE section with an associated medical event during the current calendar year or 2) a non-priority condition reported as the reason for a medical event during the current calendar year. Therefore, beginning in 2018, a priority condition will only be included in the conditions file if there is an associated medical event in the year.

The PE section was modified to replace the omitted CE section. The PE section first collects two summary assessment measures of each person's physical and mental health, then collects information about priority conditions. While the two questions about a person's general physical and mental health continue to be collected every round, the questions about priority conditions follow a different skip pattern. They are asked in their entirety in Round 1 for all current RU members and again in their entirety in Rounds 2 and 4, but for new RU members only. In Round 3, current RU members are asked about conditions that were not reported in an earlier round and all persons ages 18 and older are asked questions about joint pain and chronic bronchitis. The question about whether current RU members had ever been diagnosed with diabetes is now asked of persons of all ages instead of only those 18 and older. AHRQ also added follow-up questions about asthma attacks and use of asthma medication for those who reported an asthma diagnosis.

Medical Events

To reduce underreporting of visits and expenditures associated with lab tests and hospital stays to give birth, the Event Follow-Up (EF) section was added in 2018. The EF section is administered when a household member reports receiving a lab test to determine "whether the tests were performed at the medical provider's office or during a separate health care event at a lab." The EF is also administered when "a household member reports a hospital stay for a woman who has given birth to a baby to ensure hospital stay events were collected for both mother and child."

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Provider Information

To reduce interview time and respondent burden, AHRQ modified the Provider Probes (PP) section by collecting all relevant identifying information about a provider only once in this section. Additionally, the Provider Directory section was eliminated and replaced with a provider lookup tool that links the provider's information to the provider's National Provider Identity ID. Similarly, information about a provider is only collected the first time a visit to that provider is reported in the Outpatient Visits (OP) and Medical Provider Visits (MV).

Reorganization of Questions Covering PReventive Care and Health Behaviors

The Additional Health Questions (AH) section and the Preventive Self-Administered Questionnaire were introduced in 2018. The AH section content focuses on the impact of physical illness, injury, or mental/emotional health on household members' attendance at work; smoking; and vigorous exercise. It includes questions from the eliminated Disability Days, Accidents/Injuries and Conditions, and Preventive Care sections and from the modified Priority Condition Enumeration section. The AH section includes two questions from the retired Preventive Care section: one asking whether the person lost all natural (permanent) teeth and one asking whether the person currently spends half an hour or more in moderate to vigorous physical activity at least five times per week. Two questions from the retired Disability Days section pertaining to missing work due to illness or injury or due to caring for someone else were also moved to the AH section and the AH section now includes a question asking whether a reported condition is due to an accident or injury, which was previously asked in the Accidents/Injuries and Conditions section. The AH section also now asks a question about how often the person smokes cigarettes.

While the PSAQ, which collects information on preventive care measures taken by the respondent, retains questions about when the person last had a blood stool test, a colonoscopy, and a sigmoidoscopy, the questions asking for the reason for each of these procedures were dropped. The question about how long it has been since the respondent had a breast exam was dropped, and now there is only a question indicating whether they received a mammogram in the last two years.

Several questions asked in the now-retired Preventive Care and Disability Days sections were eliminated from the MEPS questionnaire entirely. The questions about frequency of dental check-ups, receipt of doctor advice to eat less high fat food, receipt of doctor advice to exercise more, whether the person takes aspirin frequently, and whether the person wears a seat belt in the car previously included in the Preventive Care section are no longer asked. The question pertaining to the number of days of school missed due to illness or injury previously asked in the Disability Days section was also dropped.

Health Status and Functional Limitations

Beginning in 2018, the Health Status section is now only collected in Rounds 1-4 instead of all five rounds. Questions about limitations in activities of daily living (ADLs), instrumental activities of daily living (IADLs), and functional and activity limitations are asked in Rounds 1 and 3. Prior to 2018, they were also asked in Round 5. Questions about hearing and vision problems and disability status are asked in Rounds 2 and 4. AHRQ omitted the questions indicating whether the person is blind, whether the person uses a hearing aid, and whether the person wears eyeglasses or contacts. Additionally, the questions pertaining to missing work due to illness or injury or due to caring for someone else were moved to the new Additional Healthcare Questions (AH) section.

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Self-Administered Questionnaires

Moving forward, the Self-Administered Questionnaire (SAQ) and the new Preventive SAQ are administered in Rounds 2 and 4 in alternating years such that the SAQ will now be collected every odd year and the PSAQ will be collected in every even year. The SAQ contains questions pertaining to satisfaction with health care (Consumer Assessment of Healthcare Providers and Systems, or CAHPS), health status (Veterans RAND-12, or VR-12), non-specific psychological distress (Kessler Psychological Distress Scale, or K6), and the Patient Health Questionnaire (Patient Health Questionnaire, or PHQ-2). The PSAQ, with one version for females and one for males, collects information about preventive care and contains many questions from the omitted Preventive Care section. The PSAQ retains the VR-12, K6, and PHQ-2 questions, such that those measures are still collected twice per panel. The female version of the PSAQ contains additional questions about birth control, receipt of a hysterectomy, mammogram, or Pap or HPV test, cervical and breast cancer history, and osteoporosis. The male version asks about colon and prostate cancer history and receipt of a PSA test to detect prostate cancer.

Access to Care

The questions in the Access to Care section about delays in receiving care were changed so that they now only ask about delays due to affordability or cost. Previously, respondents could indicate they delayed care because they could not afford it, because the insurance company wouldn't approve the care, because the doctor did not accept the family's insurance plan, because they had problems getting to doctor's office, because they spoke a different language, because they could not get time off work, because they did not know where to go to get care, because they were refused services, because they could not get child care, or because they did not have time. As with other sections, information about any provider reported in this section is only collected the first time the provider is reported.

The questionnaire changes introduced in 2018 included changes to the collection of health insurance information. The new Verification Series is administered if at least one household member is without any public or private health insurance during the entire reference period to verify the correct information. There were minor changes to the Health Insurance Detail section to streamline the question flow and the new single-screen grid in the Time Period Covered Detail section helps interviewers and respondents more easily identify similar coverage periods for different household members. The single-screen grid in the Old Employment and Private Related section is designed to reduce cognitive burden and simplify reporting. Finally, some questions in the Public Insurance section were reworded to eliminate confusion.

Child Health Supplement

The Child Health Supplement (CS) section covers four content areas: 1) Special health care needs, 2) Child preventive care, 3) the Columbia Impairment Scale (CIS), and 4) Consumer Assessment of Healthcare Providers and Systems (CAHPS). The CS is administered in Rounds 2 and 4 and, prior to 2018, all four content areas were covered in each year. Beginning in 2018, AHRQ introduced an alternating schedule for these content areas. The special health care needs questions will be asked every year, the child preventive care questions will be asked in even years only, and the CIS and CAHPS questions will be collected in odd years only. As a result, not every measure will be available every year, but each measure will be collected once per panel.

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Income and Assets

The Income (IN) and Assets (AS) sections have been slightly modified. The Income section now uses previously reported information about marital status and the ages of household members to skip questions about alimony and unemployment compensation which are not relevant to the respondent. Additionally, the Assets section now only asks about the two assets most applicable to the national sample, home ownership and retirement accounts.

Medical Events and Expenditures

There were several slight changes to the collection of information about medical events. First, to reduce respondent burden, details about an event are now collected only for the first visit in a repeat visit group. Details about an event are collected only for the first event in a repeat visit group. Beginning in 2018, only two linked events are required to constitute a "repeat" visit group, compared to three linked events prior to 2018. Second, the Dental Visits (DN) section now reorganizes seven dental services groupings into five major groupings and there is a new response category to more easily identify flat fees for orthodontia. Third, the Home Health Care (HH) section offers simplified provider type categories and encourages grouping visits. Fourth, the Prescribed Medications (PM) section utilizes a new lookup function to reduce manual pharmacy address input. Fifth, in the Other Medical Expenses (OME) section, expenses are asked each round compared to only once a year before 2018. This change is intended to reduce the recall period for respondents. Finally, the Charge Payment (CP) section no longer includes questions about reimbursements or expected payments.

New Person-Level Identifiers and Missing Code

Beginning in 2018, the person identifier DUPERSID was expanded to include the two-digit panel number at the beginning. DUPERSID now uniquely identifies persons across panels, similar to the IPUMS-generated identifier MEPSID. Additionally, the missing code "-9 NOT ASCERTAINED" was retired in 2018 and the missing code "-15 CANNOT BE COMPUTED" was introduced. For more information on the use of missing codes in MEPS data and handling by IPUMS, please see the the user note on missing data codes.

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