Not Assigned Family Access to Health Care and Utilization

Page 1 of 7

2007 NHIS Questionnaire - Family

Family Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: FAU.010_00.000 Instrument Variable Name: FDMED12M QuestionnaireFileName: Family

QuestionText: ? [F1]

The following questions are about the use of health care. Do not include dental care.

DURING THE PAST 12 MONTHS, [fill: have you delayed seeking medical care/has medical care been delayed for

anyone in the family] because of worry about the cost?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PDMED12M and goto FNMED12M; else, goto

PDMED12M]

<2,R,D> [goto FNMED12M]

Question ID: FAU.020_00.000 Instrument Variable Name: PDMED12M QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

For which family member was medical care delayed?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one had medical care delayed due to worry about the cost during

the past 12 months

SkipInstructions: goto FNMED12M

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FAU.030_00.000 Instrument Variable Name: FNMED12M QuestionnaireFileName: Family

QuestionText: ? [F1]

DURING THE PAST 12 MONTHS, was there any time when [fill1: you/someone in the family] needed medical care, but

did not get it because [fill2: you/the family] couldn't afford it?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PNMED12M and goto FHOSPYR; else, goto

PNMED12M]

<2,R,D> [goto FHOSPYR]

Page 2 of 7

2007 NHIS Questionnaire - Family

Family Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: FAU.040_00.000 Instrument Variable Name: PNMED12M QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who didn't get needed care?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one didn't get medical care due to cost during the past 12 months

SkipInstructions: goto FHOSPYR

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FAU.050_00.000 Instrument Variable Name: FHOSPYR QuestionnaireFileName: Family

QuestionText: ?[F1]

[fill1: were you/Including all infants born in a hospital, has anyone in the family] been hospitalized OVERNIGHT in the

past 12 months? Do not include an overnight stay in the emergency room.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PHOSPYR and goto HOSPNO; else, goto PHOSPYR]

<2,R,D> [goto FHCHM2W]

Question ID: FAU.060_00.000 Instrument Variable Name: PHOSPYR QuestionnaireFileName: Family

QuestionText: *Ask or verify. Enter applicable line number(s), separate with commas.

Who was in a hospital overnight?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one was a patient overnight during the past 12 months (excluding

ER)

SkipInstructions: goto HOSPNO

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Page 3 of 7

2007 NHIS Questionnaire - Family

Family Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: FAU.070_00.000 Instrument Variable Name: HOSPNO QuestionnaireFileName: Family

QuestionText: ? [F1]

How many different times did [fill: you/ALIAS] stay in any hospital overnight or longer DURING THE PAST 12

MONTHS?

001-365 1-365 times

997 Refused

999 Don't know

UniverseText: All persons who had an overnight hospital stay during the past 12 months (excluding ER)

SkipInstructions: <1-10> [goto HPNITE]

<11-365> [goto ERR_HOSPNO]

<R,D> [goto HPNITE]

Question ID: FAU.110_00.000 Instrument Variable Name: HPNITE QuestionnaireFileName: Family

QuestionText: ? [F1]

Altogether how many nights [fill: were you/was ALIAS] in the hospital DURING THE PAST 12 MONTHS?

001-365 1-365 nights

997 Refused

999 Don't know

UniverseText: All persons who had an overnight hospital stay during the past 12 months (excluding ER)

SkipInstructions: <1-50,R,D> [goto next person selected at PHOSPYR; if no more persons, goto FHCM2W]

<51-365> [goto ERR1_HPNITE]

if HOSPNO gt HPNITE, goto ERR2_HPNITE

Question ID: FAU.120_00.000 Instrument Variable Name: FHCHM2W QuestionnaireFileName: Family

QuestionText: ? [F1]

* Hand calendar card.

These next questions are about health care received during the 2 WEEKS outlined on that calendar. Include care from ALL

types of medical doctors, such as dermatologists, psychiatrists, ophthalmologists, and general practitioners. Also include

care from OTHER health professionals such as nurses, physical therapists, and chiropractors.

Do not include dental care. Do not include care while an overnight patient in a hospital.

During those 2 WEEKS, did [fill: you/anyone in the family] receive care AT HOME from a nurse or other health care

professional?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PHCHM2W and goto PHCHMN2W; else, goto

PHCHM2W]

<2,R,D> [goto FHCPH2W]

Page 4 of 7

2007 NHIS Questionnaire - Family

Family Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: FAU.130_00.000 Instrument Variable Name: PHCHM2W QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received care at home?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received care at home from a health care professional during

the past 2 weeks (excluding dental care)

SkipInstructions: goto PHCHMN2W

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FAU.140_00.000 Instrument Variable Name: PHCHMN2W QuestionnaireFileName: Family

QuestionText: How many home visits did [fill: you/ ALIAS] receive during those 2 WEEKS?

* Enter '50' for 50 or more visits.

01-50 1-50 home visits

97 Refused

99 Don't know

UniverseText: All persons who received care at home from a health care professional during the past 2 weeks (excluding dental care)

SkipInstructions: <1-14,R,D> [repeat for all eligible persons, then goto FHCPH2W]

<15-50> [goto ERR_PHCPHMN2W]

Question ID: FAU.150_00.000 Instrument Variable Name: FHCPH2W QuestionnaireFileName: Family

QuestionText: During those 2 WEEKS, did [fill: you/anyone in the family] get any medical advice or test results over the PHONE from a

doctor, nurse, or other health care professional?

Do not include phone calls to make appointments, for billing questions or for prescription refills.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PHCPH2W and goto PHCPHN2W; else, goto

PHCPH2W]

<2,R,D> [goto FHCDV2W]

Page 5 of 7

2007 NHIS Questionnaire - Family

Family Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: FAU.160_00.000 Instrument Variable Name: PHCPH2W QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who was the phone call about?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received medical advice or test results over the phone during

the past 2 weeks (excluding calls for appointments, billing questions, or prescription medicines)

SkipInstructions: goto PHCPHN2W

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FAU.170_00.000 Instrument Variable Name: PHCPHN2W QuestionnaireFileName: Family

QuestionText: During those 2 WEEKS, how many telephone calls [fill: did you make/were made about ALIAS]?

* Enter '50' for 50 or more phone calls.

01-50 1-50 calls

97 Refused

99 Don't know

UniverseText: All persons for whom medical advice or test results were received over the phone from a health care professional

during the past 2 weeks (excluding calls for appointments, billing questions, or prescription refills)

SkipInstructions: <1-14,R,D> [repeat for all eligible persons, then goto FHCDV2W]

<15-50> [goto ERR_PHCPHN2W]

Question ID: FAU.180_00.000 Instrument Variable Name: FHCDV2W QuestionnaireFileName: Family

QuestionText: During those 2 WEEKS, did [fill1: you/anyone in the family] see a doctor or other health care professional at a doctor's

OFFICE, a clinic, an emergency room, or some other place?

[fill2: Do not include times during an overnight hospital stay.]

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PHCDV2W and goto PHCDVN2W; else, goto

PHCDV2W]

<2,R,D> [goto F10DVYR]

Page 6 of 7

2007 NHIS Questionnaire - Family

Family Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: FAU.190_00.000 Instrument Variable Name: PHCDV2W QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received care?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one saw a health care professional in an office, clinic, emergency

room, or some other place during the past 2 weeks (excluding visits during overnight hospital stays)

SkipInstructions: goto PHCDVN2W

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FAU.200_00.000 Instrument Variable Name: PHCDVN2W QuestionnaireFileName: Family

QuestionText: How many times did [fill: you/ALIAS] visit a doctor or other health care professional during those 2 WEEKS?

* Enter '50' for 50 or more visits.

01-50 1-50 times

97 Refused

99 Don't know

UniverseText: All persons who visited a health care professional during the past 2 weeks (excluding overnight hospital stays)

SkipInstructions: <1-14,R,D> [repeat for all eligible persons, then goto F10DVYR]

<15-50> [goto ERR_PHCDVN2W]

Question ID: FAU.210_00.000 Instrument Variable Name: F10DVYR QuestionnaireFileName: Family

QuestionText: During the past 12 MONTHS did [fill: you/any member of the family] receive care from doctors or other health care

professionals 10 or more times? Do not include telephone calls.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in P10DVYR and goto FHICOV; else, goto P10DVYR]

<2,R,D> [goto FHICOV]

Page 7 of 7

2007 NHIS Questionnaire - Family

Family Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: FAU.220_00.000 Instrument Variable Name: P10DVYR QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received care 10 or more times?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received care 10 or more times from a health care professional

during the past 12 months (excluding telephone calls)

SkipInstructions: goto FHICOV

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.