0990-Trends in the USAttachment D_KFF Instrument

Attachment D
Americans’ Perceptions of Racial Disparities in Health Care, 1999 Questionnaire
Prepared by Henry J. Kaiser Family Foundation and Princeton Survey Research Associates

Attachment D

AMERICANS' PERCEPTIONS OF RACIAL DISPARITIES IN HEALTH CARE, 1999 QUESTIONNAIRE

Questionnaire

Americans’ Perceptions
of Racial Disparities in Health Care,
Summer 1999
Prepared by Princeton Survey Research Associates
for the Henry J. Kaiser Family Foundation
7.9.1999

Hello, my name is _____ calling for Princeton Survey Research. We are conducting a
national opinion survey about some important health care issues. May I please speak with the
youngest male, age 18 or older, who is now at home? (If no male:) May I please speak with
the oldest female, age 18 or older, who is now at home?
Q1.

I have some questions about issues facing our country today. For each issue I read please tell
me if you think it is a major problem facing our country, a minor problem or not a problem at
all.
[Randomize items:]
a. unemployment
b. teen pregnancy
c. racism
d. decline in moral values
e. crime or violence
f. education
1
2
3
8
9

Major problem
Minor problem
Not a problem at all
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q2.

Now thinking specifically about health care, how would you rate the overall quality of our
health care system? If A means excellent, B means good, C average, D poor and F failing,
what letter grade would you give our health care system?
1
2
3
4
5
8
9

A, excellent
B, good
C, average
D, poor
F, failing
(Don’t know)
(Refused)

2

[Randomly assign to form A or B]
Q3.

Ask Q3 if form A:
How much of the time do you think you can trust (Insert) to do what is best for patients or
customers? Almost all of the time, most of the time, only some of the time or almost none of
the time?
a.

doctors and other health care providers

[Randomize b-f:]
b. hospitals
c. clinics or health centers
d. health insurance companies, including HMOs and other managed care plans
e. Medicaid, the government program that helps pay medical bills for people with low
incomes
f. Medicare, the government program that helps pay medical bills for people over age 65
and the disabled
1
2
3
4
8
9

Almost all of the time
Most of the time
Some of the time
Almost none of the time
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q4.

Ask Q4 if form B:
How much of the time do you think you can trust (Insert) to do what is right for you or your
community? Almost all of the time, most of the time, only some of the time or almost none
of the time?
[Randomize items:]
a. the police
b. the fire department
c. local schools
d. doctors and other health care providers
e. local elected officials
f. the courts
g. Congress or politicians in Washington
1
2
3
4
8
9

Q5.

3

Almost all of the time
Most of the time
Some of the time
Almost none of the time
(Don’t know)
(Refused)

[Ask all:]
Thinking about people like yourself, is (Insert) a major problem, a minor problem or not a
problem?
[Randomize a-b:]
a. being able to afford the cost of health insurance and necessary medical care
b. having enough doctors and other health providers near where you live
c. having difficulty getting care because of your race or ethnic background
1
2
3
8
9

Major problem
Minor problem
Not a problem
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q6.

Generally speaking, how often do you think our health care system treats people unfairly
based on (Insert)? Very often, somewhat often, not too often or never?
[Randomize items:]
a. what their race or ethnic background is
b. whether or not they have health insurance

4

Ask c-f if form A:
c. whether they are male or female
d. how well they speak English
e. whether or not they are physically disabled
f. how they are dressed or groomed
Ask g-j if form B:
g. how well-educated they are
h. whether or not they are overweight
i.
how much money they have
j. their sexual orientation—that is, if they are gay or lesbian
1
2
3
4
8
9
Q7.

Very often
Somewhat often
Not too often
Never
(Don’t know)
(Refused)

How often do you think a person’s race or ethnic background affects whether they can get
(Insert)? Very often, somewhat often, not too often or never?
a.
b.
c.

1
2
3
4
8
9

routine medical care when they need it
specialized treatments or surgery when they need it
health insurance to pay for medical care
Very often
Somewhat often
Not too often
Never
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q8.

As I mention some different areas of our society, please tell me if you think racism—that is,
people being treated worse than others because of their race or ethnicity—is a major problem,
a minor problem or not a problem at all in this area of society. Is racism a major problem, a
minor problem or not a problem at all in (Insert)?
[Randomize items:]
a. education
b. the workplace
c. health care
d. housing
1
2
3
8
9

Q9.

Major problem
Minor problem
Not a problem
(Don’t know)
(Refused)

Thinking again about health care, how often do you think racism occurs when a patient and
doctor are of different racial or ethnic backgrounds? Very often, somewhat often, not too
often or never?
1
2
3
4
8
9

Q10.

5

Very often
Somewhat often
Not too often
Never
(Don’t know)
(Refused)

And what about if the patient and doctor are of the same racial or ethnic background? Does
racism occur very often, somewhat often, not too often or never?
1
2
3
4
8
9

Very often
Somewhat often
Not too often
Never
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q11.

For the next few questions I would like you to think about African Americans in our country
today. Do you think the average African American is better off, worse off or just as well off
as the average white person in terms of (Insert)?
[Randomize items:]
a. getting needed health care
b. infant mortality—that is, a baby’s chance of surviving after birth
c. life expectancy—that is, how long someone can expect to live
Ask d-e if form A:
d. housing
e. education
Ask f-g if form B:
f. employment
g. income
1
2
3
8
9

Q12.

Ask Q12-Q13 if form A:
When going to a doctor or health clinic for health care services, do you think most African
Americans receive the same quality of health care as whites, higher quality of care or lower
quality of health care as most whites?
1
2
3
8
9

Q13.

Better off
Worse off
Just as well off
(Don’t know)
(Refused)

Same quality
Higher quality
Lower quality
(Don’t know)
(Refused)

How big a problem do you think (Insert) is for the average African American? Is this a major
problem, a minor problem or not a problem at all for the average African American?
[Randomize a-b:]
a. being able to afford the cost of health insurance and necessary medical care
b. having enough doctors and other health providers near where they live
c. having difficulty getting care because of their race or ethnic background
1
2
3
8
9

Major problem
Minor problem
Not a problem at all
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

6

Q15.

[Ask all:]
Do you think the average African American is better off, worse off or just as well off as the
average white person in terms of (Insert)?
a.
b.
c.
d.

1
2
3
8
9
Q16.

how healthy they are
getting routine medical care when they need it
getting specialized treatments or surgery when they need it
having health insurance
Better off
Worse off
Just as well off
(Don’t know)
(Refused)

Now thinking about Latinos in our country today, do you think the average Latino is better
off, worse off or just as well off as the average white person in terms of (Insert)?
[Randomize items:]
a. getting needed health care
b. infant mortality—that is, a baby’s chance of surviving after birth
c. life expectancy—that is, how many years, on average, they live
Ask d-e if form A:
d. housing
e. education
Ask f-g if form B:
f. employment
g. income
1
2
3
8
9

Q17.

Better off
Worse off
Just as well off
(Don’t know)
(Refused)

Ask Q17-Q18 if form B:
When going to a doctor or health clinic for health care services, do you think most Latinos
receive the same quality of health care as whites, higher quality of care or lower quality of
health care as most whites?
1
2
3
8
9

Same quality
Higher quality
Lower quality
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

7

Q18.

How big a problem do you think (Insert) is for the average Latino? Is this a major problem, a
minor problem or not a problem at all for the average Latino?
[Randomize a-b:]
a. being able to afford the cost of health insurance and necessary medical care
b. having enough doctors and other health providers near where they live
c. having difficulty getting care because of their race or ethnic background
1
2
3
8
9

Q20.

[Ask all:]
Do you think the average Latino is better off, worse off or just as well off as the average
white person in terms of (Insert)?
a.
b.
c.
d.

1
2
3
8
9
Q21.

Major problem
Minor problem
Not a problem at all
(Don’t know)
(Refused)

how healthy they are
getting routine medical care when they need it
getting specialized treatments or surgery when they need it
having health insurance
Better off
Worse off
Just as well off
(Don’t know)
(Refused)

Now I am going to read you some statements. Pease tell me whether you think each
statement is true or false.
[Randomize items:]
African Americans with heart disease are just as likely as whites who have heart disease
to get specialized medical procedures and surgery. (False)
b. Whites with HIV or AIDS are more likely than African Americans with HIV or AIDS to
get the newest medicines and treatments. (True)
a.

1
2
8
9

True
False
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

8

Q22.

Ask Q22 if think health care system treats people unfairly based on race or ethnicity
[Q6a = 1-3]:
Earlier you expressed the view that the health care system treats people unfairly based on
their race or ethnicity. I am going to read you a series of possible reasons why this is so. For
each please tell me whether you think it is a major reason, a minor reason, or not a reason for
why the system treats people unfairly based on their race or ethnicity.
[Randomize items:]
Ask a-c if form A:
a. Most doctors are white, and many do not understand the health care needs and how to
treat the illnesses of African Americans, Latinos and other minority groups.
b. Most doctors assume that African Americans, Latinos and other minority groups do not
have enough insurance or money to pay for the care they get.
c. Most doctors do not think African Americans, Latinos and other minority groups do
enough to take care of their own health.
Ask d-f if form B:
d. Many African Americans, Latinos and other minority groups live in areas where there are
fewer doctors or other health providers.
e. African Americans, Latinos and members of other minority groups prefer different health
care treatments than whites.
f. Medical researchers do not pay enough attention to how health conditions affect racial or
ethnic minority groups.
1
2
3
8
9

Q23.

Major reason
Minor reason
Not a reason
(Don’t know)
(Refused)

[Ask all:]
These next questions are about your personal experiences with our health care system. Do
you have a regular doctor or other health professional who you see for general health care,
that is, when you are sick, need a check-up or want advice about your health?
1
2
8
9

Yes
No
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

9

Q24.

Ask Q24-Q26 if have regular doctor or health care provider [Q23 = 1]:
I would like you to give this doctor or health professional an overall letter grade. A means
excellent, B means good, C average, D poor and F failing.
1
2
3
4
5
8
9

Q25.

Man
Woman
(Don’t know)
(Refused)

Is this person white, African American, Latino, Asian or some other background?
1
2
3
4
5
8
9

Q27A.

10

Is this person a man or a woman?
1
2
8
9

Q26.

A, excellent
B, good
C, average
D, poor
F, failing
(Don’t know)
(Refused)

White
African American
Latino
Asian
Other [Record verbatim]
(Don’t know)
(Refused)

Ask Q27A-Q28 if do not have regular doctor or health care provider [Q23 = 2-9]:
Thinking about your last visit for a health care appointment, what overall letter grade would
you give the doctor or health professional? A means excellent, B means good, C average, D
poor and F failing.
1
2
3
4
5
8
9

A, excellent
B, good
C, average
D, poor
F, failing
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q27B.

Was the doctor or other health provider a man or a woman?
1
2
8
9

Q28.

11

Was this person white, African American, Latino, Asian or some other background?
1
2
3
4
5
8
9

Q29.

Man
Woman
(Don’t know)
(Refused)

White
African American
Latino
Asian
Other [Record verbatim]
(Don’t know)
(Refused)

[Ask all:]
Thinking about your most recent visit with a doctor or other health provider, we would like to
know a little about how you felt during this visit.
[Randomize items:]
a. Did you feel the doctor or provider knew enough or asked enough questions about your
health history, such as what medications you take, whether you have ever been
hospitalized and your family health history?
b. Did the doctor or provider explain things in a way you could understand?
c. Were there any tests or treatments you felt you needed but did not get?
d. Did you feel the doctor or provider and other staff members paid attention to you and
your concerns?
1
2
8
9

Q30.

Yes
No
(Don’t know)
(Refused)

Many Americans do not have health insurance. Are you now covered by any form of health
insurance or health plan, including any private insurance plan or a government program such
as Medicare or (Insert state assistance program), or don’t you have health insurance at this
time?
1
2
8
9

Yes
No
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q31.

Ask Q31-Q32 if have health insurance [Q30 = 1]:
Which of the following is your main source of health insurance coverage? (Read responses
1-5:)
1
2
3
4
5
8
9

Q32.

Based on all your experiences with your current main health insurance plan, what overall
letter grade would give it? A means excellent, B means good, C average, D poor and F
failing.
1
2
3
4
5
8
9

Q33.

Private insurance through an employer
Private insurance from some other source
Medicare, the government program that helps pay medical bills for people over age
65 and the disabled
(Insert state assistance program), the government program that helps pay medical
bills for people with low incomes
Some other public medical assistance program
(Don’t know)
(Refused)

A, excellent
B, good
C, average
D, poor
F, failing
(Don’t know)
(Refused)

[Ask all:]
How often do you usually have health care exams or check-ups? Would you say more than
once a year, about once a year, less than once a year, or is there no particular schedule for
these health care exams or appointments?
1
2
3
4
8
9

More than once a year
Once a year
Less than once a year
No particular schedule
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

12

Q34.

At what type of facility do you usually receive your medical care? Is it a doctor’s office, a
clinic or health center, an HMO, a hospital emergency room, a hospital outpatient department
or some other place?
1
2
3
4
5
6
8
9

Q36.

Doctor’s office
Clinic or health center
HMO
Hospital emergency room
Hospital outpatient department
Other
(Don’t know)
(Refused)

13

Thinking about all of the experiences you have had with health care visits in the last few
years, have you ever felt that the doctor or health provider you saw or any other staff
members judged you unfairly or treated you with disrespect because of (Insert)?
[Randomize items:]
a. your ability to pay for the care
b. something in your medical history
c. the treatment you needed that day
d. how well you speak English
e. your race or ethnic background
f. the type of health insurance you have or because you do you not have health insurance
1
2
8
9

Q37.

Yes
No
(Don’t know)
(Refused)

Ask Q37 if form A:
Do you think your experiences in society, in general, would be better, worse or no different if
you were (Insert)?
[Randomize items:]
a. a ([D1 = 1:] woman | [D1 = 2:] man)
b. of another race or ethnic background
1
2
3
8
9

Better
Worse
No different
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q38.

Ask Q38 if form B:
Do you think your experiences with our health care system would be better, worse or no
different if you were (Insert)?
[Randomize items:]
a. a ([D1 = 1:] woman | [D1 = 2:] man)
b. of another race or ethnic background
1
2
3
8
9

Q39.

Better
Worse
No different
(Don’t know)
(Refused)

[Ask all:]
Over the past few years, (Insert) been treated unfairly specifically because of race or ethnic
background when seeking medical care?
a.
b.
c.

1
2
8
9
Q40.

14

have you
has a family member
has a friend or someone else you know
Yes
No
(Don’t know)
(Refused)

Thinking about the future, how concerned are you that you or a family member will someday
be treated unfairly specifically because of your race or ethnic background when seeking
medical care? Are you very concerned, somewhat concerned, not too concerned or not at all
concerned?
1
2
3
4
8
9

Very concerned
Somewhat concerned
Not too concerned
Not at all concerned
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q40B.

If you had to choose, would you prefer to be treated by a doctor or nurse of your own race or
ethnic group, or not?
1
2
3
8
9

Q41.

Prefer own race
Not prefer own race
(Doesn’t matter)
(Don’t know)
(Refused)

15

[Read Q41-Q42B in a series for each item:]
Do you believe our government should spend more money on programs to make sure African
Americans, Latinos and other minority groups have the same opportunities as whites in terms
of (Insert)?
[Randomize items:]
a. education
b. employment and income
c. health care
1
2
8
9

Q42A.

Yes
No
(Don’t know)
(Refused)

Ask Q42A if support increased government spending to ensure equal opportunity in
area [item in Q41 = 1]:
Would you still support government spending in this if it meant you had to pay more in
taxes?
Repeat items from Q41
1
Yes
2
No
8
(Don’t know)
9
(Refused)

Q42B.

Ask Q42B if oppose increased government spending to ensure equal opportunity in area
[item in Q41 = 2]:
Would you still oppose government spending even if it meant that African Americans,
Latinos and other minorities continued to receive unequal opportunities in this area?
Repeat items from Q41
1
Yes
2
No
8
(Don’t know)
9
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

Q43.

Ask Q43 if form A:
In your opinion, who should be primarily responsible for ensuring that patients get the same
quality of health care to meet their needs regardless of their race and ethnic background? The
government, the medical community, both or neither?
1
2
3
4
8
9

Q44.

Government
Medical community
Both
Neither
(Don’t know)
(Refused)

[Ask all:]
Have you ever heard of the Tuskegee Experiment involving African American men?
1
2
8
9

Q46.

16

Ask Q44 if form B:
In your opinion, who should be primarily responsible for setting and enforcing standards for
how all patients should be treated by doctors and other health providers regardless of their
race or ethnic background? The government, the medical community, both or neither?
1
2
3
4
8
9

Q45.

Government
Medical community
Both
Neither
(Don’t know)
(Refused)

Yes
No
(Don’t know)
(Refused)

Ask Q46 if heard of Tuskegee Experiment [Q45 = 1]:
As far as you know, when people talk about the Tuskegee Experiment, are they referring to ...
(Read responses 1-3)
[Randomize 1-3:]
1
A much-criticized government study of syphilis treatment involving African
American men
2
The African American airmen who fought in World War II
3
A study of heart disease among African American men
8
(Don’t know)
9
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

D1.

[Ask all:]
Respondent’s sex:
1
2

Male
Female
17

D2.

I have one last set of questions to help us better understand the people who took part in our
survey. In general, how would you describe your own health? Is it excellent, good, only fair
or poor?
1
2
3
4
8
9

D3.

In politics today do you consider yourself a Republican, a Democrat or an Independent?
1
2
3
4
8
9

D5.

Very conservative
Conservative
Moderate
Liberal
Very liberal
(Don’t know)
(Refused)

How many children under 18 currently live in your household?
0-98
99

D7.

Republican
Democrat
Independent
(Other)
(Don’t know)
(Refused)

Would you describe your political views as very conservative, conservative, moderate, liberal
or very liberal?
1
2
3
4
5
8
9

D6.

Excellent
Good
Fair
Poor
(Don’t know)
(Refused)

Record number
(Refused)

And counting yourself, how many adults 18 and older currently live in your household?
1-98
99

Record number
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

D8.

Are you currently married, living as married, widowed, divorced, separated, or have you
never been married?
1
2
3
4
5
6
9

D9.

18

Do you own or rent your own home?
1
2
3
8
9

D10.

Married
Living as married
Widowed
Divorced
Separated
Never married
(Refused)

Own
Rent
(Other)
(Don’t know)
(Refused)

What is your age?
18-98 Record number
99
(Refused)

D11.

What is the last grade or class you completed in school? (Do not read responses)
1
2
3
4
5
6
7
8
99

D12.

Grade 8 or lower
High school incomplete
High school diploma or equivalent
Business, technical or vocational school after high school
Some college, no degree
Two-year or associate’s college degree
Four-year college degree
Graduate or professional school after college
(Refused)

Are you yourself of Latino or Hispanic origin or descent such as Mexican, Puerto Rican or
some other Latin American background?
1
2
8
9

Yes
No
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

D13.

What is your race? (If Latino [D12 = 1]:) Are you white Latino, black Latino or some other
race? (Else:) Are you white, African American or black, Asian or some other race?
1
2
3
4
8
9

D14A.

Under $25,000
Over $25,000
(Don’t know)
(Refused)

Ask D14B if income less than $25,000 [D14A = 1]:
Now just stop me when I get to the right category. Was your income ... (Read responses 1-4:)
1
2
3
4
8
9

D14C.

19

Last year, that is in 1998, what was your total household income from all sources before
taxes? Was it over or under $25,000?
1
2
8
9

D14B.

White/White Latino
African American/Black/Black Latino
Asian
Other
(Don’t know)
(Refused)

Less than $10,000
$10,000 to under $15,000
$15,000 to under $20,000
$20,000 to under $25,000
(Don’t know)
(Refused)

Ask D14C if income more than $25,000 [D14A = 2]:
Now just stop me when I get to the right category. Was your income ... (Read responses 1-6:)
1
2
3
4
5
6
8
9

$25,000 to under $30,000
$30,000 to under $35,000
$35,000 to under $40,000
$40,000 to under $50,000
$50,000 to under $75,000
$75,000 or more
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S

D15.

[Ask all:]
Were you born in the US or in another country?
1
2
8
9

D16.

20

Ask D16 if not born in US [D15 = 2-8]:
How long have you lived in the US?
0-98
98
99

D17.

US
Other country
(Don’t know)
(Refused)

Record number
(Don’t know)
(Refused)

[Ask all:]
Have you lived somewhere in the last 12 months without a telephone?
1
2
8
9

Yes
No
(Don’t know)
(Refused)

PRINCETO N

SURVEY

RE SE ARCH

ASSO CIAT E S