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Section 15, Part A - Medical and Health Expenditures - Screening Questions for PaymentsSection 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 some questions about medical payments and reimbursements. I will begin with your payments. By payments I mean any co-pays and out-of-pocket expenses. Include all payments, even those for persons who are outside of your household. Since the first of the reference month, have you or any members of your household made any
payments for the following?
For definitions Information Booklet » Have you or any members of your household made any payments for
For definitions Information Booklet » * Ask if not apparent Describe the care/service/item.[enter text] _______________ * Ask if not apparent Describe the care/service/item.[enter text] _______________ * Ask if not apparent Was this a purchase or rental? * Ask if not apparent Was/were the care/service/item for a member of your household or someone outside of your household? In what month was(were) the payment(s) made?
[enter text] _____________ What was the total amount paid in the above month?/ What is your monthly expense? [enter value] _____________ * Enter 'C' for a combined expense What is the "care/service/item"combined with?
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. Care for invalids, convalescents, handicapped, or elderly persons in the home 10. Adult day care centers 11. Other medical care and services 12. Hearing aids 13. Prescription drugs 14. Purchase or rental of supportive or rehabilitative equipment 15. Purchase or rental of medical or surgical equipment for general use 77. Misc. combined (unable to specify/DK) Did you or any members of your household make any other payments for the "care/service/item"? End of Section 15A Go to Section 15 Part B - Screening Questions for Reimbursements » Go to CE CAPI Survey Instrument Home Page »
Last Modified Date: April 7,2016 |