Validating household reports of health care use in the medical expenditure panel survey

Health Serv Res. 2009 Oct;44(5 Pt 1):1679-700. doi: 10.1111/j.1475-6773.2009.00995.x. Epub 2009 Jul 13.


Background: The Medical Expenditure Panel Survey (MEPS) is a widely used nationally representative survey of health care use and expenditures. Numerous studies raise concerns that use is underreported in household surveys.

Objective: To assess the quality of household reports in the MEPS and the impact of misreporting on descriptive and behavioral analyses.

Research design: Participants in MEPS with Medicare coverage during 2001-2003 were matched to their Medicare enrollment and claims data (4,045 person-year observations). Household reports of Medicare-covered services for the matched sample were validated against Medicare claims. Standard models of the determinants of health care utilization were estimated with both MEPS and claims-based utilization measures.

Measures: In-person interviews with household informants obtained data on hospital inpatient, emergency department (ED), and office-based visits. Comparable measures were created from the claims.

Results: In the validation sample, households accurately reported inpatient stays (agreement rate=0.96, kappa=0.89) and number of nights (Lin's concordance statistic=0.88). Households underreported ED visits by one-third (Lin's concordance statistic=0.51) and office visits by 19 percent (Lin's concordance statistic=0.67).

Conclusions: Household respondents in the validation sample accurately report inpatient hospitalizations but underreport ED and office visits. Behavioral analyses are largely unaffected because underreporting cuts across all sociodemographic groups.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cognition
  • Data Collection / methods*
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Services / economics*
  • Health Services / statistics & numerical data*
  • Health Status
  • Humans
  • Insurance Claim Review / statistics & numerical data*
  • Interviews as Topic*
  • Male
  • Medicare / statistics & numerical data
  • Office Visits / economics
  • Office Visits / statistics & numerical data
  • Patient Admission / economics
  • Patient Admission / statistics & numerical data
  • Reproducibility of Results
  • Socioeconomic Factors
  • United States