Section 15, Part A - Medical and Health Expenditures - Screening Questions for Payments

Section 15, Part A collects out-of-pocket medical payments, including payments for medical services, prescription drug purchases, and rentals or purchases of medical supplies and equipment. IMPORTANT: The Census Bureau does not release to the Bureau of Labor Statistics any confidential information such as names and addresses. This information is only used during the course of the interview.

Now I am going to ask you some questions about medical payments and reimbursements. I will begin with your payments.

By payments I mean any expenses paid by any members of your CU directly to a medical provider by cash, check, credit card, or automatically deducted from your account for a medical service or item. Include all payments, even those for persons who are outside of your CU.

1. Enter 1 to continue



For definitions Information Booklet »

Since the first of the reference month, have you or any members of your CU made any payments for the following?
* Read each item on list

1. Eye examinations, treatment, or surgery
2. Purchase of eye glasses or contact lenses
3. Dental care
4. Hospital room or hospital services
5. Services by medical professionals other than physicians
6. Physician services
7. Lab tests or x-rays
8. Care in convalescent or nursing homes
9. Other medical care
10. Hearing aids
11. Prescribed medicines or prescribed drugs
12. Rental of supportive or convalescent equipment
13. Purchase of supportive or convalescent equipment
14. Rental of medical or surgical equipment for general use
15. Purchase of medical or surgical equipment for general use
99. None/No more

* Ask if not apparent

Describe the care/service/item.[enter text] _______________

* Ask if not apparent

Who was/were the "care/service/item" for?

1. Active member CU "number"
55. Non-CU member

* Enter name of person: [enter text] _____________

In what month was(were) the payment(s) made? [enter text] _____________
* Enter 13 for a continuous expense

What was the total amount paid in the above month?/ Enter monthly amount if continuous. [enter value] _____________

* Enter 'C' for a combined expense

1. C
2. Not combined expense

What is the "care/service/item" combined with?
* Enter all that apply

1. Eye examinations, treatment, or surgery
2. Purchase of eye glasses or contact lenses
3. Dental care
4. Hospital room or hospital services
5. Services by medical professionals other than physicians
6. Physician services
7. Lab tests or x-rays
8. Care in convalescent or nursing homes
9. Other medical care
10. Hearing aids
11. Prescribed medicines or prescribed drugs
12. Rental of supportive or convalescent equipment
13. Purchase of supportive or convalescent equipment
14. Rental of medical or surgical equipment for general use
15. Purchase of medical or surgical equipment for general use
77. Misc. combined (unable to specify/DK)

Did you or any members of your CU make any other payments for the "care/service/item"?

1. Yes
2. No

End of Section 15A

Go to Section 15 Part B - Screening Questions for Reimbursements »

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Last Modified Date: November 21, 2006