Using the MEPS for Cost-Effectiveness Analysis

The MEPS is used for cost-effectiveness analysis because it is the richest source of nationally representative, health utilization and expenditure data, and it also contains information suitable to estimating QALYs. These advantages are described below.

6.4.1 QALY Information in the MEPS

The MEPS collects two measures of health status on all respondents, the Short-Form 12 and the EuroQol 5-D (Fleishman, 2005). These are two of the more widely used health status metrics. Each relates to QALY measurements, with the latter enabling direct QALY calculations (Gold et al., 1996). Accordingly, QALY information can be directly integrated into the individual evaluations that depend on MEPS cost and

utilization data. Table 6-1 gives the means of the EuroQol 5-D broken down by whether the individual falls into the transportation-disadvantaged target population, and according to insurance status.

Table 6-1: EuroQol 5 D Results from the MEPS

Transportation UNINSURED EuroQoL 5-D

Status ALL OF 2001 N Population Mean

Non-Target Population Yes 3,045 22,456,521 0.8548

Non-Target Population No 17,087 164,035,341 0.8195

Target Population Yes 76 526,597 0.7421

Target Population No 210 1,769,281 0.5601

N/A N/A 11,704 95,459,587 N/A

Total 32,122 284,247,327

6.4.2 Using the Richness of the MEPS for Cost and Benefit Analysis The initial analytical plan involved linking the NHIS data to the MEPS so that the NHIS’s detailed condition information would be supplemented with the MEPS’s rich expenditure data. Special linkage disks were obtained via a data user’s agreement with the U.S. Agency for Healthcare Research and Quality. Unfortunately, after reviewing the preliminary linked data, it was discovered that the final sample of MEPS respondents would be effectively cut in half (from about 32,000 to 15,000), because only an NHIS sub-sample contains the crucial transportation question that carries through to the linked MEPS data.

Given the other virtues of the MEPS data, including its own

transportation-disadvantaged designation and the close agreement between this measure and the one in NHIS, we determined that it could stand on its own for the subsequent

cost-effectiveness analyses. The MEPS is the preeminent, nationally representative healthcare cost and utilization dataset in the United States, and it includes extensive encounter and cost data broken down into five categories:

1. Inpatient stays 2. Outpatient visits 3. ER visits

4. Office-based visits 5. Pharmacy costs.

The MEPS data provide significant information on transportation-disadvantaged persons and their use of health services. The study population – those who miss healthcare visits due to a transportation barrier – is described in detail, and contrasted with the rest of the U.S. population, in Table 6-2. The weighted frequencies project the survey sampling onto the entire U.S. population using sophisticated statistical procedures.

6.4.2.1 Demographic Information

Comparing those who we believe to have missed healthcare due to transportation factors, with all others in the survey, Table 6-2 shows that the former group has more older adults, includes more females and minorities, and its members are more likely to have come from households with yearly income under $20,000 (this figure is low due to the focus on individuals, hence children, in the MEPS v. families or

households).

Table 6-2: Demographic Review of the Target Population and Rest of the U.S.

Weighted Frequencies Weighted Percentages

Age Rest of U.S.

Population Target

Population Rest of U.S.

Population Target Population 0-15 63,940,806 848,675 22.8% 24.6%

16-24 34,529,988 419,293 12.3% 12.2%

25-39 59,061,624 683,714 21.0% 19.8%

40-64 86,959,976 985,529 31.0% 28.6%

65+ 36,308,457 509,266 12.9% 14.8%

Totals 280,800,851 3,446,477 100.0% 100.0%

Sex

MALE 137,147,041 1,483,896 48.8% 43.1%

FEMALE 143,653,809 1,962,580 51.2% 56.9%

Totals 280,800,850 3,446,476 100.0% 100.0%

Race

AMERICAN INDIAN 2,558,716 51,171 0.9% 1.5%

ALEUT, ESKIMO 99,946

ASIAN OR PACIFIC 11,513,628 142,118 4.1% 4.1%

BLACK 35,483,711 464,591 12.6% 13.5%

WHITE 231,144,849 2,788,595 82.3% 80.9%

Totals 280,800,850 3,446,475 100.0% 100.0%

Personal Income

$20,000 or more 110,680,755 489,435 39.4% 14.2%

Less than $20,000 170,120,095 2,957,041 60.6% 85.8%

Totals 280,800,850 3,446,476 100.0% 100.0%

Source: 2001 MEPS Data

6.4.2.2 Insurance Status of the Target Population

Transportation-disadvantaged persons who miss healthcare due to a lack of access to NEMT are more likely to be uninsured than those who do not miss healthcare for transportation-related reasons. Of the target population, 22 percent were uninsured for all of 2001, while only 12 percent of the others were uninsured for the entire year.

Table 6-3 shows the proportion of people in each of the insured categories.

Table 6-3: Insurance Status of the Target Population

6.4.2.3 Utilization of Healthcare Services

The target population is much more likely to have an inpatient stay and emergency room visit as well as have more prescriptions written for them. Table 6-4 shows that for each of these indicators of utilization, the target population was about twice as likely to use these services. This finding confirms earlier analysis that indicates the target population suffers from diseases at a higher rate and also experiences multiple, chronic conditions.

Table 6-4: Utilization of Services

Inpatient Stays

6.4.2.4 Per Capita Expenditures by Category

While the median per capita costs of healthcare for the target population is significantly higher than the cost for the rest of the U.S. population, the cost categories that appear to drive the total per capita cost are home health and

prescription costs. Table 6-5 shows the weighted per capita cost for each of the cost categories included in the MEPS database.

It is not surprising that the per capita costs for outpatient care are less for the target population. This further demonstrates how difficult it is for

transportation-disadvantaged persons who miss medical care due to a lack of access to transportation to obtain care.

Table 6-5: Weighted Median Per Capita Healthcare Costs by Category

Unweighted Sample

Total Healthcare

Expenses Inpatient Out

patient ER Rx

Office-Based Medical

Provider Dental Home

Health Other

Target

Population 454 $1,874 $4,862 $310 $336 $644 $446 $184 $2,156 $141 Rest of U.S. 31,668 $1,095 $5,281 $547 $357 $312 $307 $178 $928 $157

% Difference 71% -8% -43% -6% 107% 45% 3% 132% -10%