Validating Household Reports of Health Care Use in the Medical Expenditure Panel Survey

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.