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pdf2023 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
END-END QUESTIONNAIRE
Question Text/Description
Code List
Routing
(01) CONTINUE
EX1A - EXTHANK
END QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in (C001, C002, C004, C005, C006, C007) and SEASON=WINTER, administer after USQ.
If INTTYPE in (C003), administer after DIQ.
If (INTTYPE in(C001, C002, C004, C005, C006, C010) and SEASON=SUMMER), administer after RXQ.
EXINTRO
EXTHANK
BOX EN1
IF SP IS IN THE 11TH ROUND INTERVIEW OR R IS DECEASED (SPAISTATUS in (3,4)) GO TO EX1.
ELSE IF SP IS IN THE SUPPLEMENTAL SAMPLE (INTTYPE=C003), GO TO ETY2 - THANK_SUPP.
ELSE IF (SP IS THE RESPONDENT), GO TO ETY1 - THANK_SP.
ELSE GO TO ETY3 - THANK_PROXYPLANNER.
EX1
As I mentioned earlier, this is [your/(SP's)] final interview with this study. We have learned much from [your/(SP's)]
participation in the MCBS. Data from the study have already been used to inform Congress of the problems
Medicare beneficiaries might face regarding their access to health care. [Your/(SP's)] participation in this study has
given the United States government a much clearer picture of [your/(SP's)] health care needs and those of more
than 62 million Medicare participants.
I thank you sincerely for all the time and effort that you have put into this study. You have made a very important
contribution to the Medicare program and all of its beneficiaries by sharing [your/(SP's)] health care experiences with
us. [Even though [you/(SP)] will no longer be a participant in our survey, [your/(SP's)] health care needs will continue
to be covered through the Medicare program.] I'd like to express to [you/you and (SP)] appreciation on behalf of the
(01) CONTINUE
Centers for Medicare and Medicaid Services. Both NORC at the University of Chicago and the Centers for Medicare
and Medicaid Services wish [you/you and (SP)] the very best for the future.
EX1A
EX1B-EXSTUDY
[RESPONDENT MAY KEEP THE CALENDAR]
IF R IS DECEASED, SELECT “NO” WITHOUT ASKING
EXSTUDY
EX1B
yes/no
We sometimes conduct short surveys to improve the way information is collected for the MCBS. Would [you/(SP)]
be willing to be contacted in the future about one of these short surveys?
(01) YES
(02) NO
(-8) DK
(-9) RF
END1-INTLANG
THANK_SP
ETY1
no entry
[I would like to thank you for keeping the planner for this interview.] I would [also] appreciate it if you would [continue
to] record health care visits and keep information about medical expenses for the next interview. Thank you for your
time and cooperation during this interview.
(01) CONTINUE
CIRCLE TODAY'S DATE IN THE PLANNER AS A REFERENCE FOR THE RESPONDENT. EXPLAIN PLANNER
SECTIONS AS NECESSARY.
THANK_SUPP
ETY2
no entry
Please keep any medical bills, receipts, Medicare statements, and insurance statements that would be connected to
[your/(SP)'s] health care visits and other medical expenses so that we can talk about them during the next interview. (01) CONTINUE
I'd like to thank you for your time and cooperation and I look forward to seeing you soon.
END1-INTLANG
THANK_PROXYPL
ETY3
ANNER
no entry
I would like to make sure you are aware of the planner we use to record health care visits as well as the folder for
keeping information about medical expenses for the next interview.
CIRCLE TODAY'S DATE IN PLANNER AS A REFERENCE FOR THE RESPONDENT. EXPLAIN PLANNER
SECTIONS IN DETAIL TO RESPONDENT.
(01) CONTINUE
THANK_PROXY
THANK_PROXY
ETY4
no entry
I would like to thank you for your time and cooperation during this interview. We may be contacting you in the future
(01) CONTINUE
for further information.
END1-INTLANG
INTLANG
END1
code 1
WAS THIS INTERVIEW CONDUCTED MOSTLY IN ENGLISH OR
SPANISH?
(02) ENGLISH
(03) SPANISH
END1-INTLANG
(02) END2 - SAVECASE
(03) END2 - SAVECASE
Page 1 of 2
2023 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
END-END QUESTIONNAIRE
Question Text/Description
Code List
Routing
(01) CONTINUE
(-7) Empty
BOX END
THE INTERVIEW IS OVER. PRESS ENTER OR CLICK [CLOSE] TO RETURN TO CM FIELD.
SAVECASE
END2
no entry
BOX END
routing
IF COMMUNITY CONTACT DATA COLLECTION (CCDC) MODULE HAS NOT BEEN COMPLETED (CCDC
INSTRUMENT STATUS IS "NO ACTION" OR "BREAKOFF") THEN DISPLAY "THE COMMUNITY CONTACT
DATA COLLECTION (CCDC) MODULE HAS NOT YET BEEN COMPLETED FOR THIS CASE. IF POSSIBLE,
PLEASE COMPLETE THAT MODULE WITH THE [RESPONDENT/PROXY] DIRECTLY FOLLOWING THE
INTERVIEW."
CASE IS COMPLETE.
Page 2 of 2
File Type | application/pdf |
Author | Megan Bjorgo |
File Modified | 2021-12-08 |
File Created | 2021-12-08 |