Form VA Form 10-21034k VA Form 10-21034k Key Drivers Module 2

SURVEY OF VETERAN ENROLLEES' HEALTH AND RELIANCE UPON VA - KEY DRIVERS MODULE
	I. USAGE OF VA HEALTH CARE
	II. ENROLLMENT IN VA HEALTH CARE
	III. ATTITUDES SURROUNDING VA HEALTH CARE
	NOTE: QUESTIONS IN EACH SECTION WILL BE RANDOMIZED FOR INTERVIEWING.
	NOTE: Questions 1-21 are aimed at understanding how veterans use or might use VA health care.
I	USAGE OF VA HEALTH CARE
	Interviewer, for each question, read list.
1	DEPENDENCE	1		All of my health care needs
	I use VA to meet...	2		Most of my health care needs
		3		Some of my health care needs
		4		None of my health care needs
		5		I have no health care needs
		98		Don't Know
		99		Refused
2	SUMMARY USE	1		All of my health care needs
	I rely on VA for…	2		Most of my health care needs
		3		Some of my health care needs
		4		None of my health care needs
		5		I have no health care needs
		98		Don't Know
		99		Refused
PREQ3	USE TYPE I
	Now I am going to read you a list of different types of health care services. Given your current situation, if you needed to use these services of if you already do use them, please tell me if you would definitely go to VA, maybe go to VA, or would you definitely go somewhere else. Lets begin…
	Interviewer, for each question, read list.
3	Preventative Care Such as Physicals or Immunizations	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
4	Urgent Care, such as when you are sick and need to see a doctor within a day	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
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5	Routine or Necessary Care, such as to see your primary care physician for routine day to day care (for example, for a cold or the flu).	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
6	Prescriptions or Other Medical Supplies	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
7	Mental Health Care	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
8	X-Rays or Lab Tests	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
9	Inpatient Care	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
10	Vision Care	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
PREQ11	USE TYPE II
	Now, I am going to read you a list of common health problems, conditions, or services. If you now have or in the future developed the need to use related health care, please tell me if you would definitely go to VA, would maybe go to VA, or would definitely go somewhere else.
	Interviewer, for each question, read list.
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11	Arthritis	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
12	Heart Disease	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
13	Digestive Problems	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
14	Cancer	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
15	Stroke	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
16	Mental Health Problems	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
17	Substance Abuse Problems	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
18	Post-Traumatic Stress Disorder (PTSD)	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
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19	Service-Connected Conditions	1		Would definitely go to VA
		2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
20	Prosthetics	1		Would definitely go to VA
	Interviewer Note: This includes appliances, equipment and devices such as artificial limbs, orthopedic braces and shoes, wheelchairs, or crutches and canes - but NOT eyeglasses or hearing aids.	2		Would maybe go to VA
		3		Would definitely go somewhere else
		98		Don't Know
		99		Refused
21	Homemaker/Home Health Aide Services	1		Would definitely go to VA
	Interviewer Note: …such as when a nurse or aide comes into your home to assist you with nutrition and meals, medications, medical equipment, rehabilitation, etc.	2		Would maybe go to VA
		3		Would definitely somewhere else
		98		Don't Know
		99		Refused
NOTE: Questions 22- 33 are aimed at understanding perceptions of VA that are components of reliance.
	NOTE: SCREENER question for ENROLLMENT Questions 22 - 26 is in Health Insurance Module.
II	ENROLLMENT
PREQ22	I am now going to read you a series of statements that I would like you to tell me how much you agree with. For each statement tell me if you completely agree, agree, neither agree nor disagree, disagree, or completely disagree.
	Interviewer, for each question, read list.
22	I enrolled in VA health care to fill gaps in my coverage.	1		Completely agree
		2		Agree
		3		Neither agree nor disagree
		4		Disagree
		5		Completely disagree
		98		Don't Know
		99		Refused
23	I enrolled in VA health care to obtain services more cost-effectively to me.	1		Completely agree
		2		Agree
		3		Neither agree nor disagree
		4		Disagree
		5		Completely disagree
		98		Don't Know
		99		Refused
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24	I enrolled in VA health care in case I was to lose my health care coverage, that is as a safety net or backup.	1		Completely agree
		2		Agree
		3		Neither agree nor disagree
		4		Disagree
		5		Completely disagree
		98		Don't Know
		99		Refused
25	I enrolled in VA health care because I am entitled to the benefits/because I deserve them.	1		Completely agree
		2		Agree
		3		Neither agree nor disagree
		4		Disagree
		5		Completely disagree
		98		Don't Know
		99		Refused
26	I enrolled in VA health care because I had no other coverage.	1		Completely agree
		2		Agree
		3		Neither agree nor disagree
		4		Disagree
		5		Completely disagree
		98		Don't Know
		99		Refused
III	ATTITUDES
PREQ27	I am now going to read you a list of statements and I would like you to rate each statement on a (5/10) point scale, with 1 being the most true and (5/10) being the least true.
	Interviewer: In Qs 27-33, and for each individual item, enter numerical rating, or 98 for "Don't Know" or 99 for "Refused".
27	Overall Image
	1. VA serves people like me.
	2. Veterans like me are comfortable going to VA.
	3. Veterans like me like going to VA because you can talk to other veterans.
	4. Veterans like me hear or read good things about VA health care from other people.
28	Cost
	1. VA is the most cost-effective healthcare provider for veterans like me.
		2. VA provides health care at a cost veterans like me can afford.
	3. VA offers veterans like me the best value for our health care dollar.
	4. For veterans like me, some VA services are a better value than those you can get from other health care providers.
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29	Quality
	1. Veterans like me who go to VA are well taken care of.
	2. Veterans like me who use VA are satisfied with the health care they receive.
	3. Veterans like me are confident in the care they receive from VA.
	4. VA facilities have the most up to date medical technology.
	5. VA health care providers are experts in their fields.
	6. VA health care providers explain treatment/diagnoses in a way that patients can understand.
	7. VA health care providers treat their patients with respect.
	8. VA health care providers listen to their patients' concerns.
30	Convenience
	1. There is a VA health care facility close to where I live.
	2. Veterans like me can get in and out of an appointment at VA in a reasonable time.
	3. When veterans like me go to VA for an appointment, they do not wait a long time to see the doctor.
	4. Transportation to and from the VA facility is manageable for veterans like me.
	5. There is a VA provider in my area that offers all of the health care services that veterans like me need.
31	Accessibility
	1. It is easy for veterans like me to get around in the VA health care facility.
	2. Veterans like me can see many different doctors, specialists, etc., in one visit to VA.
	3. I feel I know what is available to me through my VA coverage.
	4. I understand how my VA health insurance coverage works.
32	Availability
	1. Patients can get an appointment at VA when they want or need one.
	2. It takes more than 30 days to get an appointment at VA.
	3. Patients can see specialists at VA when they need to.
	4. VA patients can see the doctor/health care provider that they want.
	5. There is plenty of parking at my local VA facility.
	6. It is easy to get to my local VA facility.
	7. My local VA facility has enough staff to meet the needs of veterans in this area.
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33	Other Factors
	1. My best friends include veterans met through military service or veterans groups.
	2. If the cost of health care to me increases, I will use VA more.
	3. I would only use VA if I did not have access to any other source of health care.
	4. I have a doctor outside VA who I really like and trust.
	5. My family has a health insurance plan that covers me and the rest of the family
	6. Veterans who can afford to use other sources of health care should leave the VA to those who really need it.
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