H. Patient Incurred Cost

4. How do I obtain the cost of acute hospital care from AHRQ web site?

The Agency for Healthcare Research and Quality (AHRQ) provides a number of various databases from which to access information to obtain acute hospital care cost.

The Medical Expenditure Panel Survey (MEPS)

MEPS is the third part of a set of national surveys gathering information since 1996 on health care services used, frequency of use, cost of services, sources of payment, and insurance coverage. MEPS is co-sponsored by the Agency for Healthcare Research and Quality (AHRQ) and the National Center for Health Statistics (NCHS).

Data from various components have been collected through a combination of computer-assisted in-person interviews, telephone interviews, and mailed surveys.

• Household Component (HC) provides information on an individual and household level including demographics, health conditions, health status, use of medical care services, charges and payments, access to medical care, satisfaction with care, health insurance coverage, income, and employment.
• Medical Provider Component (MPC) contains information from medical providers identified by household data.
• Health Insurance Component (IC) consists of information on employer, union, and private health insurance plans.
• Nursing Home Component (NHC) contains information from a national survey of nursing homes, providing information on characteristics, health care use, and expenditures of nursing home residents and facilities.

The HC, MPC, and IC can be linked to provide comprehensive data that can estimate the level and distribution of healthcare use and expenditures.

These data can be used to:

• make estimates of medical utilization and expenditures; and
• identify costs, including consumers' out-of-pocket costs.

Note - Data are unable to be used to estimate the frequency of treatment or costs associated with particular treatments.

Advantage of new MEPS:

• It is unique in being able to link data with individuals and households (demographics, health status, employment, income, etc.) to health care use, expenditures, sources of payment, health insurance status, etc.
• Longitudinal analyses - ongoing longitudinal survey allows study of behavior-modeling, health care use, and expenses over time.
• It is the only national survey that provides a foundation for estimating the impact of changes in payment sources and insurance coverage on different economic groups or populations of particular interest.

Other questions that can be answered on MEPS:

• How many veterans are covered by private insurance?
• Where do veterans get their medical care?
• What are their out-of-pocket costs for health care?

The Healthcare Cost and Utilization Project (HCUP)

HCUP consists of 2 database sources. The State Inpatient Database (SID) contains information from all hospitals and all discharges from 22 states. The Nationwide Inpatient Sample (NIS), contains information from a sample of hospitals selected from states in the SID. It includes all discharges from the sampled hospitals.

Data consist of 3 types of data elements:

1. Measures of health care use and expenditures among the elderly, poor, children, minorities, unemployed, uninsured, and nursing homes.
2. Hospital characteristics - identifiers that can be linked to AHAAS, characteristics of hospitals used for sample AHA data
3. Weights to produce national, regional, and state estimates.

NIS contains information on over 100 clinical and non-clinical variables about hospital stays:

• 1st degree and 2nd degree diagnosis
• 1st degree and 2nd degree procedures
• admission & discharge status
• patient demographics
• expected payment source
• total charges
• length of stay
• hospital characteristics(ownership, size, teaching status)

The database promotes comparative studies of health care services including:

• use and cost of hospital services
• medical practice variation
• health care cost inflation
• hospital finance distress
• analyses of states and communities
• medical treatment effectiveness
• length of stay
• quality of care
• impact of health policy changes
• access to care
• diffusion of medical technology
• utilization of health services by special population

NIS:

• Is an unique and powerful database of hospital input stays.
• Can be used to identify, track, and analyze national trends in health care utilization, access, charges, quality and outcomes.
• Is the largest all-payer inpatient care database in the U.S.
• Is the only national hospital database with charge information on all patients - regardless of payer, including those covered by Medicare, Medicaid, private insurance, and the uninsured.

NIS information can be used to determine:

• The association between patient outcomes and volume-specific high-tech hospital procedures.
• How to do alternative cardiac procedures compared in terms of patient costs and outcomes.
• Racial differences in utilization, outcome, or cost experience of hospital health plans compared with national trends.

The NIS is available as a CD-ROM in ASCII format for use with SAS & SPSS.

HIV Cost & Services Utilization Study (HCSUS)

HCSUS is the first major research effort to collect information on a nationally representative sample of people in care for HIV infection. HSCUS examines costs of care, utilization of health care services, access to health care, quality of health care, quality of life, unmet needs for medical and non-medical services, social support, satisfaction with medical care, and knowledge of HIV therapies.

HCSUS will examine:

• cost, use, and quality of care
• access to care
• unmet need for care
• QOL (Quality of Life)
• Social Support
• Knowledge of HIV
• Clinical Outcomes
• Mental Health
• Relationship of these variables to provider type and patient characteristics