Survey Text

1980
1976
top
1980
Survey form view entire document:  text  image

For each person review 1,2, 3 and 6 for each plan and determine if "covered" by either Medicare or insurance, or "Not covered."

1 [] Cov. (NP)
2 [] Not cov. (NP)

Ask for each person "Not covered,"

Many people do not carry health insurance for various reasons. Hand card N
CARD N

1. Care received through Medicaid or Welfare.
2. Unemployed, or reasons related to unemployment.
3. Can't obtain insurance because of poor health, illness, or age.
4. Too expensive, can't afford health insurance.
5. Dissatisfied with previous insurance.
6. Don't believe in insurance.
7. Have been healthy, not much sickness in the family, haven't needed health insurance.
8. Military dependent, (CHAMPUS), veterans' benefits.
9. Some other reasons - Specify

7a. Which of those statements describes why -- is not covered by any health insurance plan? Any other reason?
Circle all reasons given

[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9 -- Specify ________

top
1976
Survey form view entire document:  text  image

For each person review 1, 2, and 5 for each plan and determine if "Covered" by either Medicare, Medicaid, or insurance, or "Not covered."

1 [] Covered (NP)
2 [] Not covered (NP)

Ask for each person "Not covered."

Many people do not carry health insurance for various reasons (Hand Card N)

CARD N
1. Care received through Social Security Medicare
2. Care received through Medicaid or Welfare
3. Unemployed, or reasons related to unemployment
4. Can't obtain insurance because of poor health, illness, or age
5. Too expensive, can't afford health insurance
6. Dissatisfied with previous insurance
7. Don't believe in insurance
8. Have been healthy, not much sickness in the family, haven't needed health insurance
9. Military dependent, (CHAMPUS), veteran's benefits
10. Some other reason

6a. Which of those statements describes why -- is not covered by any health insurance plan? Any other reason?

[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] Other (Specify) ____