Attachment C R79 SCQ revisions (Feb 2017 non-sub change request)

Satisfaction with Care (SCQ)
Variable Name

MCQUALTY

MR Screen Name

SC1

Question text/description
SHOW CARD SC1
We’re interested in how you feel about the health care [you have/(SP) has] received [over the past
year/since (SURVEY REFERENCE MONTH AND YEAR)] from doctors and hospitals. Please tell me how
satisfied or dissatisfied you have been with the following:
The overall quality of the health care [you have /(SP) has] received [over the past year/since (TODAY'S
DATE - 12 MONTHS)]. Have you been very satisfied, satisfied, dissatisfied, or very dissatisfied?

SHOW CARD SC1
MCAVAIL

SC2

[Please tell me how satisfied or dissatisfied you have been with . . .]
The availability of health care at night and on weekends.
SHOW CARD SC1

MCEASE

SC3

[Please tell me how satisfied or dissatisfied you have been with . . .]
The ease and convenience of getting to a doctor or other health professional from where [you/(SP)]
[live/lives].
SHOW CARD SC1

MCCOSTS

SC4

[Please tell me how satisfied or dissatisfied you have been with . . .]
The out-of-pocket costs [you/(SP)] paid for health care.

SHOW CARD SC1
MCINFO

SC5

[Please tell me how satisfied or dissatisfied you have been with . . .]
The information given to [you/you or (SP)] about what was wrong with [you/(SP)].

SHOW CARD SC1
MCFOLUP

SC6

[Please tell me how satisfied you have been with . . .]
The follow-up care [you/(SP)] received after an initial treatment or operation.

Code list
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
[Please tell me how satisfied or dissatisfied you have been with . . .]
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
The concern of doctors or other health professionals for [your/(SP’s)] overall health rather than just for an
(-8) Don't Know
isolated symptom or disease.
(-9) Refused
(01) VERY SATISFIED
(02) SATISFIED
SHOW CARD SC1
(03) DISSATISFIED
[Please tell me how satisfied or dissatisfied you have been with . . .]
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
Getting all [your/(SP’s)] health care needs taken care of at the same location.
(-8) Don't Know
(-9) Refused
(01) VERY SATISFIED
(02) SATISFIED
SHOW CARD SC1
(03) DISSATISFIED
[Please tell me how satisfied or dissatisfied you have been with . . .]
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
The availability of care by specialists when [you/(SP)] (feel/feels) (you/he/she) (need/needs) it.
(-8) Don't Know
(-9) Refused
(01) VERY SATISFIED
SHOW CARD SC1
(02) SATISFIED
(03) DISSATISFIED
[Please tell me how satisfied or dissatisfied you have been with . . .]
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
The ease of obtaining answers to questions over the telephone about [your/(SP’s)] treatment or
(-8) Don't Know
prescriptions.
(-9) Refused
(01) VERY SATISFIED
SHOW CARD SC1
(02) SATISFIED
(03) DISSATISFIED
[Please tell me how satisfied or dissatisfied you have been with . . .]
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
The amount [you have/(SP) has] to pay for [your/(SP's)] prescribed medicines.
(-8) Don't Know
(-9) Refused
SHOW CARD SC1

MCCONCRN

SC7

MCSAMLOC

SC8

MCSPECAR

SC8A

MCTELANS

SC8B

MCAMTPAY

SC8C

BOX SC1A

IF (SP HAD PRESCRIPTION DRUG COVERAGE ANYTIME IN THE CURRENT ROUND) OR (SP IS COVERED BY A
MEDICARE PRESCRIPTION DRUG PLAN ANYTIME IN THE CURRENT ROUND), GO TO SC8D - MCDRGLST.
ELSE GO TO SC9 - MDISSFY.
SHOW CARD SC1

MCDRGLST

SC8D

(01) VERY SATISFIED
(02) SATISFIED
[Please tell me how satisfied you have been with . . .]
(03) DISSATISFIED
(04) VERY DISSATISFIED
[Your/(SP's)] prescription drug plan's formulary or the list of drugs covered by the plan.
(05) NOT APPLICABLE
(-8) Don't Know
[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any health insurance plan that provides drug
(-9) Refused
coverage.]

SHOW CARD SC1
[Please tell me how satisfied you have been with . . .]
MCFNDPCY

SC8E

MCRECPLN

SC8F

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
The ease of finding a pharmacy which accepts your prescription drug plan.
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any health insurance plan that provides drug (-8) Don't Know
coverage.]
(-9) Refused
(01) YES
Would [you/(SP)] recommend [your/his/her] prescription drug plan to other people like [you/him/her]?
(02) NO
(03) NOT APPLICABLE
[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any health insurance plan that provides your
(-8) Don't Know
drug coverage.]
(-9) Refused
[[You receive/(SP) receives] [your/his/her] prescription drug coverage through a [Medicare Prescription
Drug Plan/Medicare Advantage plan./Some Medicare beneficiaries receive their prescription drug coverage
through Medicare Prescription Drug plans, also called "Medicare Part D" plans.]

DHEVHEAR

SC8G

In many Medicare drug plans there is a coverage gap, sometimes called a "doughnut hole", during which
there is a reduction in coverage and people have to pay a higher share of their drug costs.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Before today, have you heard about the coverage gap or "doughnut hole" that is part of most Medicare
drug plans?
BOX SC1AA

DHPLAN

DHTHISYR

SC8I

SC8L

IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR (SP HAS A "CURRENT" MEDICARE
ADVANTAGE PLAN THAT HAS RX COVERAGE), GO TO SC8I - DHPLAN.
ELSE GO TO SC9 - MDISSFY.
Does [your/(SP's)] [(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT MEDICARE ADVANTAGE
PLAN)] plan have a coverage gap, or “doughnut hole”?

(01) YES
(02) NO
(-8) Don't Know
[EXPLAIN IF NECESSARY: The coverage gap, or "doughnut hole", is a phase in coverage during which there
(-9) Refused
is a reduction in coverage and people have to pay a higher share of their drug costs.]
[Have you/Has (SP)] reached the start of the coverage gap during (CURRENT YEAR)?
(01) YES
[EXPLAIN IF NECESSARY: If [you have/(SP) has] reached the start of the coverage gap, it means [you
(02) NO
have/he has/she has] reached a phase during which there is a reduction in coverage and [you/he/she] will
(-8) Don't Know
have to pay a higher share of [your/his/her] drug costs.]
(-9) Refused
REFER TO THE MOST RECENT MEDICARE PRESCRIPTION DRUG PLAN STATEMENT TO HELP THE
RESPONDENT VERIFY THIS INFORMATION.

DHSTART

SC8M

How did [you/(SP)] first find out that (you/he/she) reached the start of the coverage gap?

DHSTAROS

SC8M

OTHER (SPECIFY)
[Have you/Has (SP)] reached the end of the coverage gap during [CURRENT YEAR]?

DHEND

SC8N

(01) SP OR SOMEONE FOR THE SP KEPT TRACK OF
TOTAL MEDICINE SPENDING
(02) INFORMATION PROVIDED BY THE PART D PLAN
(03) INFORMATION PROVIDED BY THE PHARMACY
(91)OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]

(01) YES
[EXPLAIN IF NECESSARY: If [you have/(SP) has] reached the end of the coverage gap, it means (you
(02) NO
have/he has/she has) reached a phase in coverage when [you pay/(he/she) pays] a small percentage of the
(-8) Don't Know
total cost of each prescription and (your/his/her) drug plan pays the remaining amount.]
(-9) Refused
REFER TO THE MOST RECENT MEDICARE PRESCRIPTION DRUG PLAN STATEMENT TO HELP THE
RESPONDENT VERIFY THIS INFORMATION.

DHWORRY

SC8O

For (CURRENT YEAR), how worried (are/is/were/was) [you/(SP)] about [your/his/her] ability to pay for
[your/his/her] medicines during the coverage gap?
Would you say that [you/(SP)] [are/is/were/was] very worried, somewhat worried, or not at all worried?
Please think about all of the health care services [you/(SP)] [receive/receives], including services provided
by doctors or other health professionals, hospitals and pharmacies.

MDISSFY

SC9
What things, if anything, about the health care services [you/(SP)] [receive/receives] are you dissatisfied
with?

(01) VERY WORRIED
(02) SOMEWHAT WORRIED
(03) NOT AT ALL WORRIED
(-8) Don't Know
(-9) Refused
(01) RESPONDENT IS NOT DISSATISFIED WITH
ANYTHING
(91) RESPONDENT IS DISSATISFIED (RECORD
VERBATIM IN THE NEXT SCREEN)
(-8) Don't Know
(-9) Refused

Please think about all of the health care services [you/(SP)] (receive/receives), including services provided
by doctors or other health professionals, hospitals and pharmacies.
MCDISVB

SC9

(01) [Continuous answer.]
What things, if anything, about the health care services [you/(SP)] (receive/receives) are you dissatisfied
with?
Please tell me whether each of the following statements is true or false.

MCWORRY

SC10A

[You/(SP)] (worry/worries) about (your/his/her) health more than other people (your/his/her) age.
[Is this statement true or false?]
[Please tell me whether each of the following statements is true or false.]

MCAVOID

SC10A
[You/(SP)] will do just about anything to avoid going to the doctor.
[Please tell me whether each of the following statements is true or false.]

MCSICK

SC10A
When [you/(SP)] [are/is] sick, [you/he/she] [try/tries] to keep it to [yourself/himself/herself].
[Please tell me whether each of the following statements is true or false.]

MCDRSOON

SC10A

MCDRNSEE

SC11

TEMPCOND1

SC12AA

TEMPCOND2

SC12AA

TEMPCOND3

SC12AA

MCDRATMP

SC12A

Usually, [you/(SP)] (go/goes) to the doctor or other health professional as soon as (you/he/she)
(start/starts) to feel bad.
During (CURRENT YEAR), did [you/(SP)] have any health problem or condition about which you think
[you/he/she] should have seen a doctor or other health professional, but did not?
[INCLUDE ALL TYPES OF HEALTH PROBLEMS RANGING FROM MINOR TO SERIOUS ISSUES.]
What was the health problem or condition?
ENTER ALL CONDITIONS.
What was the health problem or condition?
ENTER ALL CONDITIONS.
What was the health problem or condition?
ENTER ALL CONDITIONS.
Did [you/(SP)] attempt to see a doctor or other health professional about this [READ CONDITION(S)
BELOW]?
(CONDITION 1 FROM SC12AA)
(CONDITION 2 FROM SC12AA)
(CONDITION 3 FROM SC12AA)
[PROBE: By "attempt" I mean, did [you/(SP)] contact a doctor’s office or other medical place in order to set
an appointment or talk to someone about the condition(s)?]

(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused
(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused
(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused
(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) [Continuous answer.]
(-7) Empty
(01) [Continuous answer.]
(-7) Empty

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

SCRCODES

SC13A

SCROTOS

SC13A
BOX SC1B

SHOW CARD SC2
(01) DIDN'T THINK THE PROBLEM WAS SERIOUS
This card lists some reasons people have given for not seeing a doctor or other health professional about a
(02) THOUGHT IT WOULD COST TOO MUCH
health problem or condition.
(03) TROUBLE FINDING/GETTING TO DOCTOR
(04) TIME/SCHEDULE OR PERSONAL CONFLICTS
Which of these reasons explains why [you/(SP)] did not see a doctor or other health professional about
(05) THOUGHT DOCTOR COULDN'T DO MUCH
the [READ CONDITION(S) BELOW]?
ABOUT PROBLEM
(06) WAS AFRAID OF FINDING OUT WHAT WAS
(CONDITION 1 FROM SC12AA)
WRONG
(CONDITION 2 FROM SC12AA)
(07) DOCTOR WOULD NOT ACCEPT MY INSURANCE
(CONDITION 3 FROM SC12AA)
(91) (OTHER/SC13A - SCROTOS OTHER SPECIFY TEXT)
(-8) Don't Know
[PROBE: Any other reason?]
(-9) Refused
CHECK ALL THAT APPLY.
OTHER (SPECIFY)
IF SC13A - SCRCODES INCLUDES MORE THAN ONE RESPONSE, GO TO SC14A - SCRMAIN.
ELSE GO TO SC15 - PMNOTGET.

Which of these was the main reason [you/(SP)] did not see a doctor or other health professional about
(this condition/these conditions) during (CURRENT YEAR)?
[READ REASONS BELOW IF NECESSARY.]
SCRMAIN

SC14A
(CONDITION 1 FROM SC12AA)
(CONDITION 2 FROM SC12AA)
(CONDITION 3 FROM SC12AA)

PMNOTGET

SC15

TEMPMED1

SC16

TEMPMED2

SC16

TEMPMED3

SC16

TEMPMED4

SC16

TEMPMED5

SC16

SCINT2

SC17INTR

During (CURRENT YEAR), were any medicines prescribed for [you/(SP)] that [you/he/she] did not get?
Please include refills of earlier prescriptions as well as prescriptions that were written or phoned in by a
doctor or other health professional.
What were the names of those medicines?
ENTER ALL MEDICINES.
What were the names of those medicines?
ENTER ALL MEDICINES.
What were the names of those medicines?
ENTER ALL MEDICINES.
What were the names of those medicines?
ENTER ALL MEDICINES.
What were the names of those medicines?
ENTER ALL MEDICINES.
SHOW CARD SC3
This card lists some reasons people have given for not having prescriptions filled or refilled.

(01) [Continuous answer.]

(01) DIDN'T THINK THE PROBLEM WAS SERIOUS
(02) THOUGHT IT WOULD COST TOO MUCH
(03) TROUBLE FINDING/GETTING TO DOCTOR
(04) TIME/SCHEDULE OR PERSONAL CONFLICTS
(05) THOUGHT DOCTOR COULDN'T DO MUCH
ABOUT PROBLEM
(06) WAS AFRAID OF FINDING OUT WHAT WAS
WRONG
(07) DOCTOR WOULD NOT ACCEPT MY INSURANCE
(91) (OTHER/SC13A - SCROTOS OTHER SPECIFY TEXT)
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) [Continuous answer.]
(-7) Empty
(01) [Continuous answer.]
(-7) Empty
(01) [Continuous answer.]
(-7) Empty
(01) [Continuous answer.]
(-7) Empty
(01) CONTINUE
(-7) Empty

Which of these reasons explains why [you/(SP)] did not obtain the [READ MEDICINE(S) BELOW]?

SCPMCODS

SC17A

[MEDICINE 1 FROM SC16]
[MEDICINE 2 FROM SC16]
[MEDICINE 3 FROM SC16]
[MEDICINE 4 FROM SC16]
[MEDICINE 5 FROM SC16]
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.

SCPMOTOS

SC17A
BOX SC2

OTHER (SPECIFY)
IF SC17A - SCPMCODS INCLUDES MORE THAN ONE RESPONSE, GO TO SC18A - SCPMMAIN.
ELSE GO TO SC20 - GENERRX.

Which of these was the main reason [you/(SP)] did not obtain [this medicine/these medicines] during
(CURRENT YEAR)?
[READ REASONS BELOW IF NECESSARY.]
SCPMMAIN

GENERRX

MAILRX

DOSESRX

SC18A

[MEDICINE 1 FROM SC16]
[MEDICINE 2 FROM SC16]
[MEDICINE 3 FROM SC16]
[MEDICINE 4 FROM SC16]
[MEDICINE 5 FROM SC16]

SC20

SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…

SC20

asked for generics instead of brand name drugs?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…

SC20

purchased prescription drugs through the mail or on the Internet?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…
taken smaller doses than prescribed of a medicine to make the medicine last longer?

(01) THOUGHT IT WOULD COST TOO MUCH
(02) DIDN'T THINK MEDICINE WOULD HELP
CONDITION
(03) WAS AFRAID OF MEDICINE
REACTIONS/CONTRAINDICATIONS
(04) DON'T LIKE TO TAKE MEDICINE
(05) DIDN'T THINK MEDICINE WAS NECESSARY
(06) NOT COVERED BY INSURANCE/NOT ON PLAN
FORMULARY
(07) TROUBLE OBTAINING MEDICINE
(08) OBTAINED/USED SAMPLES
(09) USED ANOTHER MEDICINE AS A SUBSTITUTION
(91) (OTHER/SC17A - SCPMOTOS OTHER SPECIFY
TEXT)
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]

(01) THOUGHT IT WOULD COST TOO MUCH
(02) DIDN'T THINK MEDICINE WOULD HELP
CONDITION
(03) WAS AFRAID OF MEDICINE
REACTIONS/CONTRAINDICATIONS
(04) DON'T LIKE TO TAKE MEDICINE
(05) DIDN'T THINK MEDICINE WAS NECESSARY
(06) NOT COVERED BY INSURANCE/NOT ON PLAN
FORMULARY
(07) TROUBLE OBTAINING MEDICINE
(08) OBTAINED/USED SAMPLES
(09) USED ANOTHER MEDICINE AS A SUBSTITUTION
(91) (OTHER/SC17A - SCPMOTOS OTHER SPECIFY
TEXT)
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused

SKIPRX

DELAYRX

SAMPLERX

COMPARRX

NOFILLRX

SPENTLRX

CHAINRX

SC20

SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…

SC20

skipped doses to make the medicine last longer?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…

SC21

delayed getting a prescription filled because the medicine cost too much?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…

SC21

asked for or received free samples from (your/his/her) doctor or other health professional?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…

SC21

compared prices or shopped around for the best price?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…

SC21

SC22

STOPRX

SC22

CREDRX

SC22

decided not to fill a prescription because it cost too much?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…
spent less money on food, heat, or other basic needs so that (you/he/she) would have money for
medicine?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…
purchased prescription drugs from a large retail chain, like Wal-Mart or Target, because of its discount
plan?
SHOW CARD SC4
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…

(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused

(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
talked with (your/his/her) doctor or other health professional about stopping a medicine to save money or
(-9) Refused
substituting a medicine with one that is less expensive?
SHOW CARD SC4
(01) OFTEN
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
(02) SOMETIMES
[Have you/has (SP)] often, sometimes, or never…
(03) NEVER
(-8) Don't Know
used a credit card so that (you/he/she) could pay for prescription drugs over time?
(-9) Refused

NOINSRX

SC23

BOX PA1

PAINTRO

SHOW CARD SC4
(01) OFTEN
Some pharmacies offer discounted prices for some generic prescription drugs that are lower than a typical
(02) SOMETIMES
insurance copayment. For example, the discounted price may be $4 to fill a one-month prescription.
(03) NEVER
(-8) Don't Know
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] purchased discounted prescription
(-9) Refused
drugs, without using any drug insurance, in order to reduce (your/his/her) own spending on drugs?
IF IN4-SPPROXY=1/SP then go to PAINTRO- PAINTRO. ELSE GO TO BOX SCEND
Now I have some questions about how you make health care decisions. Answers to questions like these
will help Medicare better understand how people use medical services.

PAINTRO
Please keep in mind that there are no right or wrong answers to these questions. Your opinions and
experiences are important to us.
SHOW CARD SC3
Please use this card to respond to the following statements.

PACHGDRS
PA5

How likely are you to change doctors or other health professionals if you are dissatisfied with the way you
and your doctor or other health professional communicate?

SHOW CARD SC3
How likely are you to tell your doctor or other health professional when you disagree with him or her?

PADISAGR
PA6

SHOW CARD SC4

PARXINFO

PA10

PADRQUEX
PA11

PAANSWR
PA12

PALISTRX

PA13

(01) CONTINUE
(-7) Empty
(01) VERY LIKELY
(02) LIKELY
(03) UNLIKELY
(04) VERY UNLIKELY
(-8) Don't Know
(-9) Refused
(01) VERY LIKELY
(02) LIKELY
(03) UNLIKELY
(04) VERY UNLIKELY
(-8) Don't Know
(-9) Refused

(01) ALWAYS
(02) USUALLY
These next questions are about practices sometimes associated with receiving medical care. Please tell me
(03) SOMETIMES
if you always, usually, sometimes, or never do the following:
(04) NEVER
(-8) Don't Know
Do you always, usually, sometimes, or never read information about a new prescription, such as side
(-9) Refused
effects and precautions?
(01) ALWAYS
SHOW CARD SC4
(02) USUALLY
[Do you always, usually, sometimes, or never...]
(03) SOMETIMES
(04) NEVER
Bring with you to your doctor or other health professional visits a list of questions or concerns you want to
(-8) Don't Know
cover?
(-9) Refused
(01) ALWAYS
SHOW CARD SC4
(02) USUALLY
[Do you always, usually, sometimes, or never...]
(03) SOMETIMES
(04) NEVER
Leave your doctor or other health professional's office feeling that all of your concerns or questions have
(-8) Don't Know
been fully answered?
(-9) Refused
(01) ALWAYS
(02) USUALLY
SHOW CARD SC4
(03) SOMETIMES
[Do you always, usually, sometimes, or never...]
(04) NEVER
(05) NOT APPLICABLE
Take a list of all of your prescribed medicines to your doctor or other health professional visits?
(-8) Don't Know
(-9) Refused

(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
Make sure you understand the results of any medical test or procedure such as an x-ray, blood test, or EKG
(-8) Don't Know
for heart conditions?
(-9) Refused
(01) ALWAYS
SHOW CARD SC4
(02) USUALLY
[Do you always, usually, sometimes, or never...]
(03) SOMETIMES
(04) NEVER
Talk with your doctor or other health professional about your options if you need tests, follow-up care, or
(-8) Don't Know
a referral for care by a medical specialist?
(-9) Refused
(01) ALWAYS
SHOW CARD SC4
(02) USUALLY
[Do you always, usually, sometimes, or never...]
(03) SOMETIMES
(04) NEVER
I can Call my your doctor or other health professional's office to get medical advice when I you need it.
(-8) Don't Know
Does that always, usually, sometimes, or never happen?
(-9) Refused
SHOW CARD SC4
[Do you always, usually, sometimes, or never...]

PATRSLT
PA14

PAOPTION
PA15

PADVICE
PA21