[p.174]
Bureau of the Census
Acting as Collecting Agent for the
U.S. Department of Health and Human Services
Public Health Service
NATIONAL HEALTH INTERVIEW
SURVEY
A. Access to Care
B. Health Care Coverage
C. Private Plan and Coverage Detail
D. Income and Assets
4. Book ______ of
______ books
Segment
Suffix
Serial
Suffix
Check digit
7. Field representative's name
Code
1[] a.m.
2[] p.m.
1[] a.m.
2[] p.m.
COMPLTE FINAL STATUS ITEMS ON BACK COVER
[p.175]
Section II - 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?
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?
2[] No (NP or A1)
9[] DK (NP or A1)
ITEM A1
Refer to questions 1a and 1b above
2[] DK in 1a (4 on page 4)
8[] Other (2)
2. Which of these is the MAIN reason --does not have a usual source of medical care?
Hand Card FA1. Read categories if telephone interview.
CARD FA1
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)
Mark (x) only one.
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)
98[] Other- Specify (4 on page 4)
_____
99[] DK (4 on page 4)
ITEM A2
Refer to question 1a above.
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?
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?
2[] No (4 on page 4)
9[] DK (4 on page 4)
[p.176]
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?
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
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)?
2[] No (4d)
9[] DK (A1 for NP, or 10 on page 6)
d. What is the MAIN reason -- would not use that place for medical care now?
Hand Card FA2. Read Categories if telephone interview.
CARD FA2
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)
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
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?
2[] No (7 on page 6)
9[] DK (7 on page 6)
[p.177]
Part A - Access to Care - Continued
6a. Is that person a doctor or nurse or some other health professional?
Mark (x) only one
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
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 care).
Mark (x) only one
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).
2[] No
9[] DK
9.During the past 12 month, did -- go to any OTHER place for medical care?
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?
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
c. Anyone else?
[] No (10d)
Ask for each person with 10b marked.
Hand card FA2. Read categories if telephone interview.
CARD FA2
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. The LAST time this happened, what was the MAIN reason -- changed -- USUAL source of care?
Mark (x) only one.
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.178]
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?
2[] No (12)
9[] DK (12)
b. Who didn't get needed care?
Mark (x) "Didn't get care" box in person's column.
c. Anyone else?
[] 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.
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?
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?
2[] No (13)
9[] DK (13)
b. Who delayed getting needed care?
(Mark (x) " Delayed getting care" box in person's column)
c. Anyone else?
[] 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?
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.
c. Anyone else?
[] No (14 on page 10)
[p.179]
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?
2[] No (15)
9[] DK (15)
b. Who is this?
Mark (x) " Didn't get prescription" box in person's column
c. Anyone else?
[] No (15)
15a. During the past 12 months, was there any time when someone in the family needed eyeglasses but could not get them?
2[] No (16)
9[] DK (16)
b. Who is this?
Mark (x) "Didn't get eyeglasses" box in person's column
c. Anyone else?
[] 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?
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
c. Anyone else?
[] No (item A3).
ITEM A3
About how often did the respondent appear to answer the questions in Part A accurately?
2[] Most of the time
3[] Some of the time
4[] Rarely or never
9[] DK
About how often did the respondent appear to answer the questions in Part A honestly?
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.
CONTINUE WITH PART B