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.