Federal statistics on healthcare benefits and cost trends: an overview: federal government statistical agencies provide a variety of healthcare information on diverse aspects of the nation's healthcare picture

Monthly Labor Review, Nov, 2004 by John E. Buckley, Robert W. Van Giezen

There are various Federal statistical surveys that attempt to shed light on a major national topic--healthcare availability and costs. Federal agencies--such as the Bureau of Labor Statistics, the Bureau of the Census, the Bureau of Economic Analysis, the National Center for Health Statistics, and the Centers for Medicare and Medicaid Services--collect, analyze, and publish data that address different aspects of the healthcare picture. Some statistical programs such as those conducted by the Bureau of Labor Statistics have as their primary mission the dissemination of statistics. Other agencies, such as the Centers for Medicare and Medicaid Services, publish data in conjunction with their primary mission to provide services and enforce regulations. This article summarizes major Federal healthcare statistical surveys and identifies selected benefit provisions, including incidence of coverage and employer and employee costs. Two types of surveys are examined separately--surveys of establishments (employers) and household surveys. In addition, Federal accounting structures that provide a measurement of aggregate medical costs are reviewed.

Establishment surveys

The two major establishment-type surveys are the Bureau of Labor Statistics' National Compensation Survey (NCS) and the Medical Expenditure Panel Survey Insurance Component (MEPS-IC) conducted by the Agency for Healthcare Research and Quality. Both establishment surveys are conducted annually. Data for the NCS are collected by personal visit initially and updated by mail and telephone; the MEPS'S data are collected primarily by mail. Both survey types obtain some detailed provisions from benefit plan documents rather than directly from respondents. Tables 1 through 4 present examples of selected published data from the NCS and the MEPS-IC. (2)

While both establishment surveys collect health insurance data, the focus of each is considerably different. (Note that the NCS reference to "medical care" is comparable to the MEPS' "health care" term.) The NCS is designed to get broad estimates of several types of employee compensation, including wages and salaries, overtime pay, sick leave, vacation benefits, health and retirement benefits, and so forth. The following is a sample of the medical insurance details available from the NCS:

* Incidence of coverage of selected medical services

* Amount of plan deductibles

* Coinsurance rates

* Out-of-pocket expense provisions

* Mental health and substance abuse treatment provisions

* Types of prescription drug coverage

* Brand name drug provisions

* Type of medical plan and financial intermediary

* Cost containment provisions

* Dollar plan maximums

* Employee share of total premiums and average monthly contributions (see table 2) The MEPS is designed specifically for in-depth analysis of healthcare benefits. (3) It provides, for example, cost of premiums and employees' contributions by private-sector (non-government) data, by industry groupings, and by such characteristics as ownership type and age of firm. (See table 4.) The following is a sample of some other health insurance details available from the MEPS:

* Private-sector data by firm size and selected characteristics

* Private-sector data by firm size and State

* Public-sector data by government type, government size, and census division

* National totals for enrollees and cost of health insurance coverage for the private and public sectors

* Private-sector data by proportion of employees who are full time or low wage and State

* Private-sector data by average wage quartiles and State.

Within each of these categories, tables are subsequently grouped by:

* Establishment-level tables

* Employee-level tables

* Premiums, employee contributions, and enrollment tables for single coverage plans

* Premiums, employee contributions, and enrollment tables for family coverage plans

* Premiums, employee contributions, and enrollment tables for employee-plus-one coverage plans.

Household surveys

There are three major Federal household surveys that collect data on healthcare benefits:

* The Current Population Survey (CPS)

* The Survey of Income and Program Participation (SIPP)

* The Medical Expenditure Panel Survey Household Component (MEPS-HC).

The Current Population Survey is a monthly household survey jointly conducted by the Bureau of Labor Statistics and the Bureau of the Census. Data are collected by personal and telephone interviews. The CPS (4) is the primary source of information on the labor force characteristics of the U.S. population. Supplemental questions are often added to the regular CPS questionnaire to produce estimates on a variety of topics, including health and employee benefits. Table 5 presents selected demographic information related to health insurance coverage.

The Survey of Income and Program Participation (5) is conducted by the Bureau of the Census and provides information on the source and amount of income, labor force information, program participation and eligibility data, and general demographic characteristics to measure the effectiveness of existing Federal, State, and local programs. Data are collected by personal interviews with telephone follow-ups. Data are used to estimate future costs and coverage for government programs, such as food stamps, and to provide improved statistics on the distribution of income in the country. The survey design is a continuous series of national panels, with a sample of household interviews lasting about 2 1/2 to 4 years. Table 6 presents selected published data from the SIPP.