Table 1.

A Framework of Health Plan Factors and Available MEPS Measures

Perspective	General Factors	MEPS Measures
Enrollee	Choice of providers/Existence of network	• Whether a defined network of providers
	Out-of-network coverage	• Whether coverage for care is restricted to a network
	Use of gatekeepers	• Whether plan requires enrollee to sign up with a primary care gatekeeper
	Cost-sharing	• Copayment amount
		• Deductible amount
		• Coinsurance rate
	Benefit coverage	• Breadth of plan's benefit coverage (coverage of medical, dental, vision, and prescription drug services)
Provider	Basic compensation arrangement to provider	§
	Nature of risk or rewards to providers	§
	Contractual exclusivity	§
Medical Group	Basic compensation to medical group	§
	Nature of risk or rewards to medical group	§
	Practice arrangements	§
Plan	Administrative and management strategies (“utilization management”)	• Level of cost containment used by plan (use of utilization review, preadmission certification, etc.)
	Provider networks	§
	Ownership/Governance	§

^§Data not available in the1996 MEPS HC or MEPS HIPA data files.