CMS-P-0015A Satisfaction Care

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

SCQ- SATISFACTION WITH CARE

Question Text/Description

Code List

Routing

SATISFACTION WITH CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY until BOX PA1
Other: N/A
PLACEMENT
Administer after NAQ.

SHOW CARD SC1

MCQUALTY

SC1

code 1

(01) VERY SATISFIED
We’re interested in how you feel about the health care [you have/(SP) has] received [over the past year/since
(02) SATISFIED
(TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)] from doctors and hospitals. Please tell me how satisfied or (03) DISSATISFIED
dissatisfied you have been with the following:
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
The overall quality of the health care [you have /(SP) has] received [over the past year/since (TODAY'S DATE - 12 (-8) Don't Know
MONTHS)]. Have you been very satisfied, satisfied, dissatisfied, or very dissatisfied?
(-9) Refused

SC2 - MCAVAIL

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

SC3 - MCEASE

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

SC4 - MCCOSTS

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

SC5 - MCINFO

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

SC7-MCCONCRN

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

SC8 - MCSAMLOC

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

SC8A - MCSPECAR

SHOW CARD SC1
MCAVAIL

SC2

code 1

[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

code 1

[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

code 1

[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

code 1

[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
MCCONCRN

SC7

code 1

[Please tell me how satisfied or dissatisfied you have been with . . .]
The concern of doctors or other health professionals for [your/(SP’s)] overall health rather than just for an isolated
symptom or disease.

MCSAMLOC

SC8

code 1

SHOW CARD SC1
[Please tell me how satisfied or dissatisfied you have been with . . .]
Getting all [your/(SP’s)] health care needs taken care of at the same location.

Page 1 of 3

2020 MCBS Community Questionnaire

Variable Name

MCSPECAR

MR Screen Name Question Type

SC8A

code 1

SCQ- SATISFACTION WITH CARE

Question Text/Description
SHOW CARD SC1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The availability of care by specialists when [you/(SP)] (feel/feels) (you/he/she) (need/needs) it.

SHOW CARD SC1
MCTELANS

SC8B

code 1

[Please tell me how satisfied or dissatisfied you have been with . . .]
The ease of obtaining answers to questions over the telephone about [your/(SP’s)] treatment or prescriptions.

MDISSFY

SC9

verbatim text

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

MCDISVB

SC9

verbatim text

[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.

Code List

Routing

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

SC8B - MCTELANS

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

SC9-MDISSFY

(01) RESPONDENT IS NOT DISSATISFIED WITH
ANYTHING
(91) RESPONDENT IS DISSATISFIED (RECORD
VERBATIM IN THE NEXT SCREEN)
(-8) Don't Know
(-9) Refused

(01) SC10A - MCWORRY
(91) SC9 - MCDISVB
(-8) SC10A - MCWORRY
(-9) SC10A - MCWORRY

(01) [Continuous answer.]

SC10A - MCWORRY

(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused

SC10A - MCAVOID

(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused

SC10A - MCSICK

(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused

SC10A - MCDRSOON

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

list

[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

list
[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

list
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

list

BOX PA1

PAINTRO

PAINTRO

(01) TRUE
(02) FALSE
Usually, [you/(SP)] (go/goes) to the doctor or other health professional as soon as (you/he/she) (start/starts) to feel (-8) Don't Know
bad.
(-9) Refused
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.

(01) CONTINUE
(-7) Empty

PA3 - PAINSTRC

code 1

SHOW CARD SC2
Doctors often give instructions about how you should care for yourself at home, like changing a bandage, taking
medicines on schedule, or applying ice packs. How confident are you that you can follow instructions to care for
yourself at home?

(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused

PA4 - PAMEDREC

code 1

SHOW CARD SC2
Doctors also often give instructions about changing your habits or lifestyle, such as changing your diet, stopping
smoking, or getting regular exercise. How confident are you that you can follow this kind of instruction, to change
your habits or lifestyle?

(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused

PA5 - PACHGDRS

no entry
Please keep in mind that there are no right or wrong answers to these questions. Your opinions and experiences
are important to us.

PAINSTRC

PAMEDREC

PA3

PA4

BOX PA1

(01) VERY LIKELY
(02) LIKELY
(03) UNLIKELY
(04) VERY UNLIKELY
How likely are you to change doctors or other health professionals if you are dissatisfied with the way you and your
(-8) Don't Know
doctor or other health professional communicate?
(-9) Refused
SHOW CARD SC3
Please use this card to respond to the following questions.

PACHGDRS

PA5

code 1

PA6-PADISAGR

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2020 MCBS Community Questionnaire

Variable Name

PADISAGR

MR Screen Name Question Type

PA6

code 1

SCQ- SATISFACTION WITH CARE

Question Text/Description

Code List

Routing

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

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

PA10-PARXINFO

SHOW CARD SC4

PARXINFO

PADRQUEX

PA10

PA11

code 1

code 1

(01) ALWAYS
(02) USUALLY
These next questions are about practices sometimes associated with receiving medical care. Please tell me if you
(03) SOMETIMES
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 effects and
(-9) Refused
precautions?

PA11-PADRQUEX

(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused

PA12-PAANSWR

(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
Leave your doctor or other health professional's office feeling that all of your concerns or questions have been fully
(-8) Don't Know
answered?
(-9) Refused

PA13-PALISTRX

SHOW CARD SC4
Do you always, usually, sometimes, or never...
Bring with you to your doctor or other health professional visits a list of questions or concerns you want to cover?

SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
PAANSWR

PALISTRX

PA12

PA13

code 1

code 1

SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Take a list of all of your prescribed medicines to your doctor or other health professional visits?

(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(05) NOT APPLICABLE
(-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 for hear
(-8) Don't Know
conditions?
(-9) Refused

PA14-PATRSLT

SHOW CARD SC4
[Do you always, usually, sometimes, or never...]

PATRSLT

PA14

code 1

SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
PAOPTION

PA15

code 1
Talk with your doctor or other health professional about your options if you need tests, follow-up care, or a referral
for care by a medical specialist?

PADVICE

PA21

code 1

SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Contact your doctor or other health professional's office to get medical advice when you need it.

BOX SCEND

routing

PA15-PAOPTION

(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused

PA21-PADVICE

(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused

BOX SCEND

GO TO CMQ.

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