Design strategies and innovations in the medical expenditure panel survey.

Background: Recent efforts to provide an annual profile of the health care quality of the nation's health care delivery system and to identify health care disparities in the population's access to and use of health care services have served to stimulate design innovations and content enhancements to the Medical Expenditure Panel Survey (MEPS).

Objectives: To present a summary of the analytical objectives, design, and core content of the MEPS, and to provide an overview of the new and innovative design features that add capacity for health status and quality of care measurement and improve data quality.

Summary: The MEPS questionnaire has been expanded to include content taken from the Consumer Assessment of Health Plans Study (CAHPS) to facilitate assessments of patient experiences with health care at the national level. The survey now includes the series of questions from the SF-12 and the EuroQol 5D to improve the survey's capacity to measure health status. Additional condition-specific questions for diabetes, asthma, high blood pressure, and heart disease were added to identify the health care services received for treatment and to determine whether the care received was consistent with practice guidelines. Sample design modifications are presented, with particular emphasis given to a summary of the recent sample size increase and resultant improvements in the precision of resultant survey estimates. Attention is also given to changes in survey design, estimation, and data collection strategies that improve data quality.