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pdf2020 MCBS Community Questionnaire
Variable Name
MR Screen Name
ACQ- ACCESS TO CARE
Question Type
Question Text/Description
Code List
Routing
ACCESS TO CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007
SPALIVE=1
SEASON= WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after MPQ.
BOX AC1AA
routing
IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT HAVE ER
VISIT IN CURRENT ROUND AND AC6A NOT ALREADY ASKED), GO TO ACINTRO - ACINT.
ELSE IF (SP HAD AN ER VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND
(AC6A NOT ALREADY ASKED), GO TO AC6A - EWAITUNT.
ELSE GO TO BOX AC1C.
ACINT
ACINTRO
no entry
The next questions are about health care services [you/(SP)] may have used since [TODAY’S MONTH YEAR-12
MONTHS].
ERVISIT
AC1
yes/no
Since [TODAY’S MONTH YEAR-12 MONTHS], did [you/(SP)] go to a hospital emergency room?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC6A - EWAITUNT
(02) BOX AC1C
(-8) BOX AC1C
(-9) BOX AC1C
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
(00) BOX AC1C.
(01) AC6A - EWAITHRS
(02) AC6A - EWAITMIN
(03) AC6A - EWAITHRS
(-8) BOX AC1C
(-9) BOX AC1C
AC1 - ERVISIT
EWAITUNT
AC6A
code one
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)]
have to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person? Please
include the time spent in the waiting room and exam room.
EWAITHRS
AC6A
numeric
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)]
have to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person? Please
include the time spent in the waiting room and exam room.
(01) continuous answer
If AC6A - EWAITUNT = 3/HoursAndMinutes, go to AC6A EWAITMIN.
Else go to BOX AC1C.
EWAITMIN
AC6A
numeric
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)]
have to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person? Please
include the time spent in the waiting room and exam room.
(01) continuous answer
BOX AC1C
BOX AC1C
routing
IF AC6A ASKED WHILE ADMINISTERING ER, GO TO BOX ER6.
ELSE IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT HAVE
OP VISIT IN CURRENT ROUND AND AC16A NOT ALREADY ASKED), GO TO AC8 - OPDVISIT.
ELSE IF (SP HAD AN OP VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND
(AC9-AC16A NOT ALREADY ASKED), GO TO AC9 - OPDREAS.
ELSE GO TO BOX AC1E.
AC8
yes/no
Since [TODAY’S MONTH YEAR-12 MONTHS], did [you/(SP)] go to a hospital clinic or outpatient department?
DO NOT INCLUDE HOSPITAL INPATIENT STAYS.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC9 - OPDREAS
(02) BOX AC1E
(-8) BOX AC1E
(-9) BOX AC1E
OPDVISIT
Page 1 of 8
2020 MCBS Community Questionnaire
Variable Name
Question Text/Description
Code List
Routing
[I have a few more questions about visits that [you/(SP)] had in the past.]
CHECK ALL THAT APPLY.
(01) MEDICAL CONDITION NAMED
(02) TESTS
(03) FOLLOW-UP
(04) CHECKUP
(05) REFERRAL
(06) SURGERY
(07) PREVENTIVE SHOT
(08) TREATMENT SHOT
(09) TO GET OR REFILL PRESCRIPTION
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX AC1D
(02) BOX AC1D
(03) BOX AC1D
(04) BOX AC1D
(05) BOX AC1D
(06) BOX AC1D
(07) BOX AC1D
(08) BOX AC1D
(09) BOX AC1D
(91) AC9 - OPDOTHOS
(-8) BOX AC1D
(-9) BOX AC1D
verbatim text
OTHER (SPECIFY)
(01) continuous answer
BOX AC1D
BOX AC1D
routing
IF (INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND SP DID NOT REPORT
OUTPATIENT DEPARTMENT VISIT AT OP4) AND (RESPONSE TO AC9 - OPDREAS INCLUDES
1/MedCondNamed OR 6/Surgery), GO TO AC12 - OPDAPPT.
ELSE IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND SP DID NOT
REPORT OUTPATIENT DEPARTMENT VISIT AT OP4) AND (RESPONSE TO AC9 - OPDREAS DOES NOT
INCLUDE 1/MedCondNamed AND DOES NOT INCLUDE 6/Surgery), GO TO AC10 - OPDSCOND.
ELSE GO TO AC12 - OPDAPPT.
OPDSCOND
AC10
yes/no
Was that for a specific condition?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
AC12 - OPDAPPT
OPDAPPT
AC12
code one
Did [you/(SP)] have an appointment for this visit to the hospital clinic or outpatient department, or did
(you/he/she) just walk in?
(01) APPOINTMENT
(02) WALKED IN
(-8) Don't Know
(-9) Refused
(01) AC13 - OPDDRTEL
(02) AC16A - HWAITUNT
(-8) AC16A - HWAITUNT
(-9) AC16A - HWAITUNT
(01) SOMEONE MADE APPOINTMENT DURING
EARLIER VISIT
(02) SP CONTACTED OFFICE TO SET UP
APPOINTMENT
(03) DOCTOR'S OFFICE CONTACTED SP TO SET UP
APPOINTMENT
(-8) Don't Know
(-9) Refused
(01) AC14 - OPDAWUNT
(02) AC14 - OPDAWUNT
(03) AC14 - OPDAWUNT
(-8) AC16A - HWAITUNT
(-9) AC16A - HWAITUNT
(00) DID NOT HAVE TO WAIT
(01) DAYS
(02) WEEKS
(03) MONTHS
(-8) Don't Know
(-9) Refused
(00) AC16A - HWAITUNT
(01) AC14 - OPDAWDAY
(02) AC14 - OPDAWWKS
(03) AC14 - OPDAWMOS
(-8) AC16A - HWAITUNT
(-9) AC16A - HWAITUNT
OPDREAS
MR Screen Name
ACQ- ACCESS TO CARE
AC9
Question Type
code all
Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department. What was the
reason [you/(SP)] went to the hospital clinic or outpatient department?
[PROBE FOR THE MOST RECENT VISIT IF RESPONDENT MENTIONS MORE THAN ONE. IF NEEDED,
PROBE WITH ‘What did you have done during your most recent visit to the hospital clinic or outpatient
department?’ SELECT ALL THAT APPLY.]
[PROBE: Any other reason?]
THE MOST RECENT VISIT CAN BE OUTSIDE OF THE REFERENCE PERIOD USED IN OTHER SECTIONS
OPDOTHOS
AC9
We are interested in knowing how the appointment was made for the visit to the hospital clinic or outpatient
department you just told me about.
OPDDRTEL
AC13
code one
Did someone make this appointment during an earlier visit, or did [you/(SP)] contact the hospital clinic or
outpatient department to set up the appointment ?
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
OPDAWUNT
AC14
code one
OPDAWDAY
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - HWAITUNT
OPDAWWKS
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - HWAITUNT
OPDAWMOS
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - HWAITUNT
WE ARE ASKING HOW MUCH TIME PASSED BETWEEN THE FIRST CONTACT FOR SETTING THE
APPOINTMENT AND THE ACTUAL DATE OF THE APPOINTMENT
Page 2 of 8
2020 MCBS Community Questionnaire
Variable Name
ACQ- ACCESS TO CARE
MR Screen Name
Question Type
AC16A
code one
AC16A
numeric
AC16A
numeric
Question Text/Description
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
HWAITUNT
How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] during (your/his/her) most recent
visit before (you/he/she) saw a doctor or some other medical person? Please include the time spent in the
waiting room and exam room.
Code List
Routing
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
(00) BOX AC1E
(01) AC16A - HWAITHRS
(02) AC16A - HWAITMIN
(03) AC16A - HWAITHRS
(-8) BOX AC1E
(-9) BOX AC1E
(01) continuous answer
If AC16A - HWAITUNT = 3/HoursAndMinutes, go to
AC16A - HWAITMIN
Else go to BOX AC1E.
(01) continuous answer
BOX AC1E
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC20 - DRSPCLTY
(02) BOX AC1G
(-8) BOX AC1G
(-9) BOX AC1G
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
HWAITHRS
How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] time during (your/his/her) most
recent visit before (you/he/she) saw a doctor or some other medical person? Please include the time spent in
the waiting room and exam room.
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
HWAITMIN
How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] during (your/his/her) most recent
visit before (you/he/she) saw a doctor or some other medical person? Please include the time spent in the
waiting room and exam room.
IF AC9-AC16A ASKED WHILE ADMINISTERING OP, GO TO BOX OP7.
BOX AC1E
routing
ELSE IF BENEFICIARY IS IN THE SECOND ROUND BASELINE INTERVIEW (INTTYPE=7) AND IS NONNEWLY ELIGIBLE (VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1) AND [(SP DID NOT REPORT A
MEDICAL PROVIDER VISIT OR REPORTED ONLY MEDICAL PROVIDER VISITS THAT WERE ALSO SD
EVENTS (THE EVNT LOOP CONTAINS NO ENTRIES WHERE EVNTTYPE=MP AND
EVNTRNDC=CURROUND)) OR REPORTED ONLY MEDICAL PROVIDER VISITS THAT ARE FLAGGED AS
ERRORS OR DELETIONS (THE ONLY ENTRIES IN THE EVNT LOOP WHERE EVNTTYPE=MP AND
EVNTRNDC=CURROUND ARE FLAGGED WITH EVERRFLG=1 OR EVNTDFLG=1) AND (AC20-AC28A1 NOT
ALREADY ASKED), GO TO AC19-MDVISIT.
ELSE IF (SP HAD AN MP VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND
(AC20-AC28A1 NOT ALREADY ASKED), GO TO AC20 - DRSPCLTY
ELSE GO TO BOX AC1G.
MDVISIT
AC19
yes/no
Next, I want to ask about [your/(SP)’s] visits to doctors since [TODAY’S MONTH YEAR-12 MONTHS]. [Have
you/Has (SP)] seen a medical doctor since [TODAY’S MONTH YEAR-12 MONTHS]? Please do not include a
doctor seen at home, at an emergency room or outpatient department, or while an inpatient at a hospital.
[IF NECESSARY, SAY, ‘Please look at show card AC1 for examples of types of medical doctors.’]
Page 3 of 8
2020 MCBS Community Questionnaire
Variable Name
MR Screen Name
ACQ- ACCESS TO CARE
Question Type
Question Text/Description
Code List
(01) AC21 - MDREAS
(02) AC21 - MDREAS
(03) AC21 - MDREAS
(04) AC21 - MDREAS
(05) AC21 - MDREAS
(06) AC21 - MDREAS
(07) AC21 - MDREAS
(08) AC21 - MDREAS
(09) AC21 - MDREAS
(10) AC21 - MDREAS
(11) AC21 - MDREAS
(12) AC21 - MDREAS
(13) AC21 - MDREAS
(14) AC21 - MDREAS
(15) AC21 - MDREAS
(16) AC21 - MDREAS
(17) AC21 - MDREAS
(18) AC21 - MDREAS
(19) AC21 - MDREAS
(20) AC21 - MDREAS
(21) AC21 - MDREAS
(22) AC21 - MDREAS
(23) AC21 - MDREAS
(24) AC21 - MDREAS
(25) AC21 - MDREAS
(26) AC21 - MDREAS
(27) AC21 - MDREAS
(28) AC21 - MDREAS
(29) AC21 - MDREAS
(30) AC21 - MDREAS
(31) AC21 - MDREAS
(32) AC21 - MDREAS
(33) AC21 - MDREAS
(34) AC21 - MDREAS
(35) AC21 - MDREAS
(36) AC21 - MDREAS
(37) AC21 - MDREAS
(38) AC21 - MDREAS
(39) AC21 - MDREAS
(40) AC21 - MDREAS
(41) AC21 - MDREAS
(42) AC21 - MDREAS
(43) AC21 - MDREAS
(91) AC20 - MDSPCLOS
(-8) AC21 - MDREAS
(-9) AC21 - MDREAS
(01) continuous answer
AC21 - MDREAS
(01) MEDICAL CONDITION NAMED
(02) TESTS
(03) FOLLOW-UP
(04) CHECKUP
(05) REFERRAL
(06) SURGERY
(07) PREVENTIVE SHOT
(08) TREATMENT SHOT
(09) TO GET OR REFILL PRESCRIPTION
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX AC1F
(02) BOX AC1F
(03) BOX AC1F
(04) BOX AC1F
(05) BOX AC1F
(06) BOX AC1F
(07) BOX AC1F
(08) BOX AC1F
(09) BOX AC1F
(91) AC21 - MDOTHOS
(-8) BOX AC1F
(-9) BOX AC1F
(01) continuous answer
BOX AC1F
DRSPCLTY
AC20
code one
(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(04) DERMATOLOGY (SKIN)
(05) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(06) FAMILY PRACTICE
(07) GASTROENTEROLOGY
(08) GENERAL PRACTICE
(09) GENERAL SURGERY
(10) GERIATRICS (ELDERLY)
(11) GYNECOLOGY - OBSTETRICS
(12) HEMATOLOGY (BLOOD)
(13) HOSPITAL RESIDENCE
(14) INTERNAL MEDICINE (INTERNIST)
(15) NEPHROLOGY (KIDNEYS)
(16) NEUROLOGY
(17) NUCLEAR MEDICINE
(18) ONCOLOGY (TUMORS, CANCER)
SHOW CARD AC1
(19) OPHTHALMOLOGY (EYES)
(20) ORTHOPEDICS
[I have a few more questions about visits that [you/(SP)] had in the past.]
(21) OSTEOPATHY (DO)
(22) OTORHINOLARYNGOLOGY (EAR, NOSE,
Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
THROAT)
hospital. What was the doctor’s specialty?
(23) PAIN MANAGEMENT SPECIALIST
(24) PATHOLOGY
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
(25) PHYS MED/REHAB
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
(26) PHYSICIAN’S ASSISTANT
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR (27) PLASTIC SURGERY
(28) PODIATRIST
SPECIALTY'.]
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(32) RADIOLOGY
(33) RHEUMATOLOGY (ARTHRITIS)
(34) THORACIC SURGERY (CHEST)
(35) UROLOGY
(36) VASCULAR SURGEON/SPECIALIST
(37) AUDIOLOGIST
(38) CHIROPRACTOR
(39) DENTIST
(40) OPTOMETRIST
(41) PHYSICAL THERAPIST
(42) PSYCHOLOGIST
(43) NURSE PRACTITIONER
(91) OTHER DR SPECIALTY
(-8) Don't Know
(-9) Refused
MDSPCLOS
AC20
verbatim text
OTHER DR SPECIALTY (SPECIFY)
What was the reason [you/(SP)] saw the doctor?
MDREAS
AC21
code all
[PROBE: ‘What did you have done during the visit?’ IF RESPONDENT DOES NOT UNDERSTAND WHAT IS
BEING ASKED. PROBE: ‘Any other reason?’ TO OBTAIN ALL REASONS.]
CHECK ALL THAT APPLY.
MDOTHOS
AC21
verbatim text
OTHER (SPECIFY)
Routing
Page 4 of 8
2020 MCBS Community Questionnaire
Variable Name
MR Screen Name
BOX AC1F
ACQ- ACCESS TO CARE
Question Type
routing
Question Text/Description
Code List
Routing
IF THE BENEFICIARY IS IN THE SECOND ROUND BASELINE INTERVIEW (INTTYPE=7) AND IS NONNEWLY ELIGIBLE (VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1) AND [((SP DID NOT REPORT
A MEDICAL PROVIDER VISIT OR REPORTED ONLY MEDICAL PROVIDER VISITS THAT WERE ALSO SD
EVENTS ((THE EVNT LOOP CONTAINS NO ENTRIES WHERE EVNTTYPE=MP AND
EVNTRNDC=CURROUND)) OR REPORTED ONLY MEDICAL PROVIDER VISITS THAT ARE FLAGGED AS
ERRORS OR DELETIONS (THE ONLY ENTRIES IN THE EVNT LOOP WHERE EVNTTYPE=MP AND
EVNTRNDC=CURROUND ARE FLAGGED WITH EVERRFLG=1 OR EVNTDFLG=1)) AND (RESPONSE TO
AC21- MDREAS DOES NOT INCLUDE 1/MedCondNamed AND DOES NOT INCLUDE 6/Surgery), GO TO
AC22 - MDSCOND.
ELSE GO TO AC24 - MDAPPT.
MDSCOND
AC22
yes/no
Was that for a specific condition?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
AC24 - MDAPPT
MDAPPT
AC24
code one
Did [you/(SP)] have an appointment for this visit with the doctor, or did (you/he/she) just walk in?
(01) APPOINTMENT
(02) WALKED IN
(-8) Don't Know
(-9) Refused
(01) AC25 - MDDRTEL
(02) AC28A1 - DWAITUNT
(-8) AC28A1 - DWAITUNT
(-9) AC28A1 - DWAITUNT
(01) SOMEONE MADE APPOINTMENT DURING
EARLIER VISIT
(02) SP CONTACTED OFFICE TO SET UP
APPOINTMENT
(03) DOCTOR'S OFFICE CONTACTED SP TO SET UP
Did someone make this appointment during an earlier visit, or did [you/(SP)] contact the doctor’s office to set up APPOINTMENT
(04) STANDING APPOINTMENT
the appointment?
(-8) Don't Know
(-9) Refused
We are interested in knowing how the appointment was made for the visit to the doctor’s office you just told me
about.
MDDRTEL
AC25
code one
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days,
weeks, or months?
MDAWUNT
AC26
code one
WE ARE ASKING HOW MUCH TIME PASSED BETWEEN THE FIRST CONTACT FOR SETTING THE
APPOINTMENT AND THE ACTUAL DATE OF THE APPOINTMENT
(01) AC26 - MDAWUNT
(02) AC26 - MDAWUNT
(03) AC26 - MDAWUNT
(04) AC28A1 - DWAITUNT
(-8) AC28A1 - DWAITUNT
(-9) AC28A1 - DWAITUNT
(00) DID NOT HAVE TO WAIT
(01) DAYS
(02) WEEKS
(03) MONTHS
(-8) Don't Know
(-9) Refused
(00) AC28A1 - DWAITUNT
(01) AC26 - MDAWDAY
(02) AC26 - MDAWWKS
(03) AC26 - MDAWMOS
(-8) AC28A1 - DWAITUNT
(-9) AC28A1 - DWAITUNT
MDAWDAY
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days,
weeks, or months?
(01) continuous answer
AC28A1 - DWAITUNT
MDAWWKS
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days,
weeks, or months?
(01) continuous answer
AC28A1 - DWAITUNT
MDAWMOS
AC26
numeric
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days,
weeks, or months?
(01) continuous answer
AC28A1 - DWAITUNT
code one
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
hospital.] How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] during (your/his/her)
most recent visit before (you/he/she) saw a doctor or some other medical person? Please include the time
spent in the waiting room and exam room.
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
(00) BOX AC1G
(01) AC28A1 - DWAITHRS
(02) AC28A1 - DWAITMIN
(03) AC28A1 - DWAITHRS
(-8) BOX AC1G
(-9) BOX AC1G
DWAITUNT
AC28A1
Page 5 of 8
2020 MCBS Community Questionnaire
ACQ- ACCESS TO CARE
Variable Name
MR Screen Name
Question Type
Question Text/Description
Code List
Routing
DWAITHRS
AC28A1
numeric
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
hospital.] How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] during (your/his/her)
most recent visit before (you/he/she) saw a doctor or some other medical person? Please include the time
spent in the waiting room and exam room.
(01) continuous answer
If AC28A1 - DWAITUNT = 3/HoursAndMinutes, go to
AC28A1 - DWAITMIN
Else go to BOX AC1G.
DWAITMIN
AC28A1
numeric
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
hospital.] How long did [you/(SP)] have to wait [beyond [your/(SP's)] appointment time] during (your/his/her)
most recent visit before (you/he/she) saw a doctor or some other medical person? Please include the time
spent in the waiting room and exam room.
(01) continuous answer
BOX AC1G
BOX AC1G
routing
IF AC20-AC28A1 ASKED WHILE ADMINISTERING MP, GO TO MP18 - MPHPRAC.
ELSE IF SP HAS A CURRENT MEDICARE MANAGED CARE PLAN, GO TO AC33 - MHREFDIF.
ELSE GO TO BOX AC3.
(01) YES
(02) NO
(03) N/A, HAVEN'T TRIED TO OBTAIN REFERRAL
(-8) Don't Know
(-9) Refused
(01) AC34A - MPSPCLTY
(02) AC36 - MHREFPAY
(03) AC36 - MHREFPAY
(-8) AC36 - MHREFPAY
(-9) AC36 - MHREFPAY
The following questions are about health care that [you/(SP)] received through (CURRENT MEDICARE
MANAGED CARE PLAN NAME).
MHREFDIF
AC33
code one
While a member of (CURRENT MEDICARE MANAGED CARE PLAN NAME), [have you/has (SP)] had difficulty
in obtaining referrals for the services of a specialist or other medical person within (CURRENT MEDICARE
MANAGED CARE PLAN NAME) that [you/(SP)] thought were necessary?
[IF NECESSARY, SAY: ‘The referral must have been for services provided by a specialist or medical provider
who is associated with your Medicare Managed Care plan, not a specialist or medical provider who is "outside"
of the plan.’]
Page 6 of 8
2020 MCBS Community Questionnaire
Variable Name
MR Screen Name
ACQ- ACCESS TO CARE
Question Type
Question Text/Description
Code List
(01) AC35 - MHDIFCLT
(02) AC35 - MHDIFCLT
(03) AC35 - MHDIFCLT
(04) AC35 - MHDIFCLT
(05) AC35 - MHDIFCLT
(07) AC35 - MHDIFCLT
(08) AC35 - MHDIFCLT
(09) AC35 - MHDIFCLT
(10) AC35 - MHDIFCLT
(11) AC35 - MHDIFCLT
(12) AC35 - MHDIFCLT
(13) AC35 - MHDIFCLT
(14) AC35 - MHDIFCLT
(15) AC35 - MHDIFCLT
(16) AC35 - MHDIFCLT
(17) AC35 - MHDIFCLT
(18) AC35 - MHDIFCLT
(19) AC35 - MHDIFCLT
(20) AC35 - MHDIFCLT
(21) AC35 - MHDIFCLT
(22) AC35 - MHDIFCLT
(23) AC35 - MHDIFCLT
(24) AC35 - MHDIFCLT
(25) AC35 - MHDIFCLT
(26) AC35 - MHDIFCLT
(27) AC35 - MHDIFCLT
(28) AC35 - MHDIFCLT
(29) AC35 - MHDIFCLT
(30) AC35 - MHDIFCLT
(31) AC35 - MHDIFCLT
(32) AC35 - MHDIFCLT
(33) AC35 - MHDIFCLT
(34) AC35 - MHDIFCLT
(35) AC35 - MHDIFCLT
(36) AC35 - MHDIFCLT
(37) AC35 - MHDIFCLT
(38) AC35 - MHDIFCLT
(39) AC35 - MHDIFCLT
(40) AC35 - MHDIFCLT
(41) AC35 - MHDIFCLT
(42) AC35 - MHDIFCLT
(43) AC35 - MHDIFCLT
(91) AC34A - MHSPCLOS
(-8) AC35 - MHDIFCLT
(-9) AC35 - MHDIFCLT
(01) continuous answer
AC35 - MHDIFCLT
(01) PLAN WOULDN’T AUTHORIZE SERVICE
(02) THE WAIT FOR APPOINTMENT WAS TOO
LONG
(03) PROVIDER’S LOCATION WAS NOT
CONVENIENT
(04) DOCTOR/PLAN WOULDN'T GIVE SP REFERRAL
TO SEE PROVIDER SP WANTED TO SEE
(05) SP DIDN'T LIKE/NOT CONFIDENT IN PROVIDER
PLAN REFERRED SP TO
(06) PROVIDER’S OFFICE HOURS WERE NOT
CONVENIENT
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) AC36 - MHREFPAY
(02) AC36 - MHREFPAY
(03) AC36 - MHREFPAY
(04) AC36 - MHREFPAY
(05) AC36 - MHREFPAY
(06) AC36 - MHREFPAY
(91) AC35 - MHOTHOS
(-8) AC36 - MHREFPAY
(-9) AC36 - MHREFPAY
(01) continuous answer
AC36 - MHREFPAY
MPSPCLTY
AC34A
code one
(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(04) DERMATOLOGY (SKIN)
(05) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(06) FAMILY PRACTICE
(07) GASTROENTEROLOGY
(08) GENERAL PRACTICE
(09) GENERAL SURGERY
(10) GERIATRICS (ELDERLY)
(11) GYNECOLOGY - OBSTETRICS
(12) HEMATOLOGY (BLOOD)
(13) HOSPITAL RESIDENCE
(14) INTERNAL MEDICINE (INTERNIST)
(15) NEPHROLOGY (KIDNEYS)
(16) NEUROLOGY
(17) NUCLEAR MEDICINE
(18) ONCOLOGY (TUMORS, CANCER)
(19) OPHTHALMOLOGY (EYES)
(20) ORTHOPEDICS
SHOW CARD AC1
(21) OSTEOPATHY (DO)
What kind of specialist or medical person was this?
(22) OTORHINOLARYNGOLOGY (EAR, NOSE,
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
THROAT)
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
(23) PAIN MANAGEMENT SPECIALIST
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
(24) PATHOLOGY
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
(25) PHYS MED/REHAB
SPECIALTY'.]
(26) PHYSICIAN’S ASSISTANT
(27) PLASTIC SURGERY
(28) PODIATRIST
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(32) RADIOLOGY
(33) RHEUMATOLOGY (ARTHRITIS)
(34) THORACIC SURGERY (CHEST)
(35) UROLOGY
(36) VASCULAR SURGEON/SPECIALIST
(37) AUDIOLOGIST
(38) CHIROPRACTOR
(39) DENTIST
(40) OPTOMETRIST
(41) PHYSICAL THERAPIST
(42) PSYCHOLOGIST
(43) NURSE PRACTITIONER
(91) OTHER DR SPECIALTY
(-8) Don't Know
(-9) Refused
MHSPCLOS
AC34A
verbatim text
OTHER (SPECIFY)
What kind of difficulty did [you/(SP)] have?
MHDIFCLT
AC35
code all
MHOTHOS
AC35
verbatim text
[PROBE: Any other difficulty?]
CHECK ALL THAT APPLY.
OTHER (SPECIFY)
Routing
Page 7 of 8
2020 MCBS Community Questionnaire
ACQ- ACCESS TO CARE
Variable Name
MR Screen Name
Question Type
Question Text/Description
Code List
Routing
MHREFPAY
AC36
code one
Has (CURRENT MEDICARE MANAGED CARE PLAN NAME) ever refused to pay for emergency treatment that
[you/(SP)] felt was necessary?
[‘EMERGENCY TREATMENT’ REFERS TO URGENTLY NEEDED MEDICAL CARE THAT IS REQUIRED
WHEN THE BENEFICIARY IS OUTSIDE OF THE PLAN'S SERVICE AREA OR WHEN THE CARE IS
REQUIRED DURING A TIME THAT IS OUTSIDE THE PLAN'S NORMAL OPERATING HOURS.]
(01) YES
(02) NO
(03) N/A, HAVEN'T NEEDED EMERGENCY
TREATMENT
(-8) Don't Know
(-9) Refused
BOX AC3
BOX AC3
routing
IF 11TH ROUND INTERVIEW AND (INTTYPE IN C001) AND (MREFDATE) IS AFTER (JANUARY 1
(CURRENT YEAR)) GO TO STQ.
ELSE GO TO PMQ.
Page 8 of 8
| File Type | application/pdf |
| File Title | ACQ.xlsx |
| Author | Wishart-Marisa |
| File Modified | 2019-12-11 |
| File Created | 2019-12-11 |