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[p.238]

U.S. Department of Commerce
Bureau of the Census
Acting as Collecting Agent for the
U.S. Public Health Service
Centers for Disease Control
National Center for Health Statistics

NATIONAL HEALTH INTERVIEW
SURVEY

1995 Supplement Booklet

III. Family Resources
IV. Year 2000 Objectives
V. Aids Knowledge and Attitudes

1. RO

____

2. Sample - Suffix

____ ____

3. Week

____

4. Book ______ of

______ books

5. Control number
PSU

____

Segment

____

Suffix

____

Serial

____

Suffix

____

Check digit

____

6. Family number

____

7. Field representative's name

____

Code

____

8. Beginning time

_____
1[] a.m.
2[] p.m.

9. Ending time

_____
1[] a.m.
2[] p.m.

Sample Person List

ITEM IV1
Are there are any nondeleted persons 18+ years old in this family?
[] Yes (List by age, oldest to youngest)
[] No (Section III)

Line No.

1
2
3
4
5
6
7
8
9

Person No.

____

Age

____

Sex

1[] M
2[] F

Last name

_____

First name

_____

1[]

List No.

Refer to the 18+ part of the sample selection label and circle as applicable. Mark (X) the "SP" box in the column above for the selected sample person in 18+. Then, go to Section III.

[p.239]

Section III - Family Resources

Part A - Access to Care

(The next questions are about medical care)

1a. Is there one doctor, person or place that -- USUALLY goes to when--is sick or needs advice about--health?

1[] Yes (NP or A1)
2[] No (NP or A1)
3[] There is more than one (1b)
9[] DK (NP or A1)

b. Is there ONE of those places that -- goes to MOST OFTEN when -- is sick or needs advice about -- health?

1[] Yes (NP or A1)
2[] No (NP or A1)
9[] DK (NP or A1)

ITEM A1

Refer to questions 1a and 1b above

1[] Yes in 1a or 1b (5 on page 4)
2[] DK in 1a (4 on page 4)
8[] Other (2)

Hand Card FA1: Read categories if telephone interview.
CARD FA1

1. Two or more usual doctors/places
2. Doesn't need a doctor
3. Doesn't like/trust/believe in doctors
4. Doesn't know where to go
5. Previous doctor is not available/moved
6. No insurance/Can't afford it
7. Speak a different language
8. No care available/Care too far away, not convenient
9. Changed residence
98. Other (specify)

2. Which of these is the MAIN reason --does not have a usual source of medical care?
(mark (x) only one).

01[] Two or more usual doctors/places (A2)
02[] Doesn't need a doctor (4 on page 4)
03[] Doesn't like/trust/believe in doctors (4 on page 4)
04[] Doesn't know where to go (4 on page 4)
05[] Previous doctor is not available/moved (4 on page 4)
06[] No insurance/Can't afford it (4 on page 4)
07[] Speak a different language (4 on page 4)
08[] No care available/care too far away, not convenient (4 on page 4)
09[] Changed residence (4 on page 4)
98[] Other- Specify (4 on page 4)
________
99[] DK (4 on page 4)

ITEM A2
Refer to question 1a above.

1[] "No" in 1a (3a)
2[] "There is more than one" in 1a (3b)

3a. Is there one of those places that -- goes to MOST OFTEN when -- is sick or needs advice about -- health?

1[] Yes (5 on page 4)
2[] No (3b)
9[] DK (3b)

b. Is there a particular place -- USUALLY goes to when -- needs routine or preventive medical care, such as a general physical examination or check-up, a flu shot, or other immunizations?

1[] Yes (4 on page 4)
2[] No (4 on page 4)
9[] DK (4 on page 4)

[p.240]

Part A - Access to Care - Continued

4a. At ANY time in the past 12 months did -- have a place that -- went to for medical care?
1[] Yes (4b)

2[] No (A1 for NP, or 10 on page 6)
9[] DK (A1 for NP, or 10 on page 6)

b. What kind of place was it - a clinic, a health center, a hospital, a hospital emergency room, a doctor's office, or some other place?
Mark (x) only one

01[] Hospital emergency room
02[] Urgent care/walk-in clinic
03[] Doctor's office
04[] Clinic
05[] Health center
06[] Hospital outpatient clinic
07[] HMO (Health Maintenance Organization)/Prepaid group
08[] Military or VA health care facility
98[] Some other place- Specify
_______
99[] DK

c. If -- needed medical care NOW, would -- go to that (place in 4b)?

1[] Yes (A1 for NP, or 10 on page 6)
2[] No (4d)
9[] DK (A1 for NP, or 10 on page 6)

Hand Card FA2. Read Categories if telephone interview.
CARD FA2

1. Changed residence/moved
2. Changed jobs
3. Employer changed insurance coverage
4. Former usual source not available
5. Owed money to former usual source
6. Dissatisfied with former source/liked new source better
7. Medical care needs changed
8. Former usual source stopped taking insurance/coverage
98. Other (specify)

d. What is the MAIN reason -- would not use that place for medical care NOW?
Mark (x) only one

01[] Changed residence/moved (A1 for NP, or 10 on page 6)
02[] Changed jobs (A1 for NP, or 10 on page 6)
03[] Employer changed insurance coverage (A1 for NP, or 10 on page 6)
04[] Former usual source not available (A1 for NP, or 10 on page 6)
05[] Owed money to former usual source (A1 for NP, or 10 on page 6)
06[] Dissatisfied with former source/liked new source better (A1 for NP, or 10 on page 6)
07[] Medical care needs changed (A1 for NP, or 10 on page 6)
08[] Former usual source stopped taking insurance/coverage (A1 for NP, or 10 on page 6)
98[] Other-Specify (A1 for NP, or 10 on page 6)
______
99[] DK (A1 for NP, or 10 on page 6)

5a. What kind of place is it that -- goes to -- a clinic, a health center, a hospital, a hospital emergency room, a doctor's office, or some other place?
Mark (x) only one

01[] Hospital emergency room (7 on page 6)
02[] Urgent care/walk-in clinic (7 on page 6)
03[] Doctor's office (5b)
04[] Clinic (5b)
05[] Health center (5b)
06[] Hospital outpatient clinic (5b)
07[] HMO (Health Maintenance Organization)/Prepaid group (5b)
08[] Military or VA health care facility (5b)
98[] Some other place- Specify (5b)
________
99[] DK (5b)

b. Is there a particular person -- usually sees when -- goes there?

1[] Yes (6 on page 6)
2[] No (7 on page 6)
9[] DK (7 on page 6)

[p.241]

Part A - Access to Care - Continued

6a. Is that person a doctor or nurse or some other health professional?
Mark (x) only one

1[] Doctor (6b)
2[] Nurse (7)
3[] Nurse Practitioner (7)
4[] Physician's assistant (7)
5[] Chiropractor (7)
6[] Other-Specify (7)
_______
9[] DK (7)

b. Is this a doctor who treats a variety of illnesses and gives routine care, or a doctor who mainly treats just one type of health problem?
Mark (x) only one

1[] Family doctor/general practitioner/internist/pediatrician
2[] Obstetrician/gynecologist
3[] Other specialist
9[] DK

7. When was the last time -- went to the (place in 5a) for ANY kind of medical care? (This is the (place in 5a) that -- usually goes to for medical are).
Mark (x) only one

0[] Hasn't been there yet/Never
1[] Less than 3 months ago
2[] At least 3 months, but less than 6 months ago
3[] At least 6 months, but less than 1 year ago
4[] At least 1 year, but less than 2 years ago
5[] Two or more years ago
9[] DK

8. Is the (place in 5a) the place -- [usually goes/would go] to when -- needs routine or preventive medical care, such as a general physical examination or check-up, a flu shot, or other immunizations? (This is the (place in 5a) that -- usually goes to for medical care).

1[] Yes
2[] No
9[] DK

9. During the past 12 month, did -- go to any OTHER place for medical care?

1[] Yes (A1 for NP, or 10)
2[] No (A1 for NP, or 10)
9[] DK (A1 for NP, or 10)

10a. At any time in the past 12 months did anyone in the family CHANGE the place to which he or she USUALLY goes for medical care?

1[] Yes (10b)
2[] No (11 on page 8)
9[] DK (11 on page 8)

b. Who is this?
Mark (x) "Changed usual source" box in person's column

1[] Changed usual source

c. Anyone else?

[] Yes (reask 10b and c)
[] No (10d)

Hand card FA2. Read categories if telephone interview.
CARD FA2

Ask for each person with 10b marked.
d. The LAST time this happened, what was the MAIN reason -- changed -- USUAL source of care?
Mark (x) only one.

01[] Changed residence/moved (10d for NP with 10b, or 11 on page 8)
02[] Changed jobs (10d for NP with 10b, or 11 on page 8)
03[] Employer changed insurance coverage (10d for NP with 10b, or 11 on page 8)
04[] Former usual source not available (10d for NP with 10b, or 11 on page 8)
05[] Owed money to former usual source (10d for NP with 10b, or 11 on page 8)
06[] Dissatisfied with former source or liked new source better (10d for NP with 10b, or 11 on page 8)
07[] Medical care needs changed (10d for NP with 10b, or 11 on page 8)
08[] Former usual source stopped taking insurance/coverage (10d for NP with 10b, or 11 on page 8)
98[] Other-Specify (10d for NP with 10b, or 11 on page 8)
_______
99[] DK (10d for NP with 10b, or 11 on page 8)

[p.242]

Part A - Access to Care - Continued

11a. Sometimes people have difficulties in getting medical care when they need it. During the past 12 months, was there any time when someone in the family needed medical care or surgery, but did not get it?

1[] Yes (11b)
2[] No (12)
9[] DK (12)

b. Who didn't get needed care?
(Mark (x) "Didn't get care" box in person's column).

1[] Didn't get care.

c. Anyone else?

[] Yes (Reask 11b and c)
[] No

(Ask 11d and e for each person marked in 11b marked).
d. The LAST time -- did not get the care -- needed, what was the MAIN reason -- didn't get care? (Mark (x) only one).

01[] Could not afford it (11d for NP with 11b marked or 12)
02[] No insurance (11d for NP with 11b marked or 12)
03[] Doctor did not accept Medicaid/insurance plan (11d for NP with 11b marked or 12)
04[] Insurance didn't cover (11d for NP with 11b marked or 12)
05[] Not serious enough (11e)
06[] Wait too long in clinic/office (11e)
07[] Difficulty getting an appointment (11e)
08[] Doesn't like/trust/believe in doctors (11e)
09[] No doctor available (11e)
10[] Didn't know where to go (11e)
11[] No way to get there (11e)
12[] Hours not convenient (11e)
13[] Speak a different language (11e)
14[] Health of another family member interfered (11e)
15[] Clinic/office not accessible (11e)
98[] Other -Specify (11e)
_______
99[] DK (11e)

e. At ANY TIME during the past 12 months was lack of insurance or money A reason why -- did not get the medical care -- needed?

1[] Yes (11d for NP with 11b, or 12)
2[] No (11d for NP with 11b, or 12)
9[] DK (11d for NP with 11b, or 12)

12a. During the past 12 months, has anyone in the family delayed seeking medical care because of worry about the cost?

1[] Yes (12b)
2[] No (13)
9[] DK (13)

b. Who delayed getting needed care?
(Mark (x) " Delayed getting care" box in person's column)

1[] Delayed getting care

c. Anyone else?

[] Yes (Reask 12b and c)
[] No (13)

13a. During the past 12 months, was there any time when someone in the family needed dental care but could not get it?

1[] Yes (13b)
2[] No (14 on page 10)
9[] DK (14 on page 10)

b. Who is this?
(Mark (x) " Didn't get dental care" box in person's column)

1[] Didn't get dental care

c. Anyone else?

[] Yes (Reask 13b and c)
[] No (14 on page 10)

[p.243]

Part A - Access to Care - Continued

14a. During the past 12 months, was there any time when someone in the family needed prescription medicines but could not get them?

1[] Yes (14b)
2[] No (15)
9[] DK (15)

b. Who is this?
(Mark (x) " Didn't get prescription" box in person's column)

1[] Didn't get prescription

c. Anyone else?

[] Yes (Reask 14b and c)
[] No (15)

15a. During the past 12 months, was there any time when someone in the family needed eyeglasses but could not get them?

1[] Yes (15b)
2[] No (16)
9[] DK (16)

b. Who is this?
(Mark (x) "Didn't get eyeglasses" box in person's column)

1[] Didn't get eyeglasses

c. Anyone else?

[] Yes (Reask 15b and c)
[] No (16)

16a. During the past 12 months, was there any time when someone in the family needed mental health care but could not get it?

1[] Yes (16b)
2[] No (Item A3)
9[] DK (Item A3)

b. Who is this?
(Mark (x) "Didn't get mental health care" box in person's column)

1[] Didn't get mental health care

c. Anyone else?

[] Yes (Reask 16b and c)
[] No (item A3).

ITEM A3
About how often did the respondent appear to answer the questions in Part A accurately?

1[] All the time
2[] Most of the time
3[] Some of the time
4[] Rarely or never
9[] DK

ITEM A4
About how often did the respondent appear to answer the questions in Part A honestly?

1[] All the time
2[] Most of the time
3[] Some of the time
4[] Rarely or never
9[] DK

ITEM A5

Enter the person number of the respondent. If more than one, enter the person number of the one who answered the most questions.

______ Person number

Continue with Part B
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