CMS-P-0015A Satisfaction Care

2023 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

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.

MCSPECAR

SC8A

code 1

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/(SP)) (need/needs) it.

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

SC2 - MCAVAIL

SC3 - MCEASE

SC4 - MCCOSTS

SC5 - MCINFO

SC7-MCCONCRN

SC8 - MCSAMLOC

SC8A - MCSPECAR

SC8B - MCTELANS

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2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

MCTELANS

SC8B

SCQ-SATISFACTION WITH CARE

Question Text/Description
SHOW CARD SC1

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
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-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

(01) continuous answer

Routing

SC9-MDISSFY

(01) SC9A-RCEQTY
(91) SC9 - MCDISVB
(-8) SC9A-RCEQTY
(-9) SC9A-RCEQTY

SC9A-RCEQTY

What things, if anything, about the health care services [you/(SP)] (receive/receives) are you dissatisfied with?]
Now I have a question about [your/(SP's)] health care experiences.
[Over the past year/Since (TODAY'S DATE - 12 MONTHS)], did anyone from a clinic, emergency room, or doctor’s (01) YES
office where [you/(SP)] got care treat [you/(SP)] in an unfair or insensitive way because of any of the following things (02) NO
about [you/(SP)]?
(-8) Don't Know
(-9) Refused
Race or ethnicity?

SC9A-LANGEQTY

RCEQTY

SC9A

grid

LANGEQTY

SC9A

grid

Language or accent?

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

SC9A-GENDEQTY

GENDEQTY

SC9A

grid

Gender or gender identity?

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

SC9A-SEXEQTY

SEXEQTY

SC9A

grid

Sexual orientation?

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

SC9A-AGEEQTY

AGEEQTY

SC9A

grid

Age?

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

SC9A-CULTEQTY

CULTEQTY

SC9A

grid

Culture or religion?

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

SC9A-DISEQTY

DISEQTY

SC9A

grid

Disability?

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

SC9A-HISTEQTY

HISTEQTY

SC9A

grid

Medical history?

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

SC10A-MCWORRY

MCWORRY

SC10A

list

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

SC10A - MCAVOID

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

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2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

SCQ-SATISFACTION WITH CARE

Question Text/Description
[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/(SP)] [try/tries] to keep it to [yourself/themselves].
[Please tell me whether each of the following statements is true or false.]

MCDRSOON

SC10A

list

BOX PA1

PAINTRO

PAINTRO

Usually, [you/(SP)] (go/goes) to the doctor or other health professional as soon as (you/(SP)) (start/starts) to feel
bad.
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.

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

PA3

code 1

PAMEDREC

PA4

code 1

PACHGDRS

PA5

code 1

PADISAGR

PA6

code 1

PARXINFO

PA10

code 1

PADRQUEX

PA11

code 1

PAANSWR

PA12

code 1

PALISTRX

PA13

code 1

PATRSLT

PA14

code 1

Code List
(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) CONTINUE
(-7) Empty

(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused
(01) VERY CONFIDENT
SHOW CARD SC2
(02) CONFIDENT
Doctors also often give instructions about changing your habits or lifestyle, such as changing your diet, stopping
(03) SOMEWHAT CONFIDENT
smoking, or getting regular exercise. How confident are you that you can follow this kind of instruction, to change (04) NOT AT ALL CONFIDENT
your habits or lifestyle?
(-8) Don't Know
(-9) Refused
(01) VERY LIKELY
SHOW CARD SC3
(02) LIKELY
Please use this card to respond to the following questions.
(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
(01) VERY LIKELY
(02) LIKELY
SHOW CARD SC3
(03) UNLIKELY
How likely are you to tell your doctor or other health professional when you disagree with him or her?
(04) VERY UNLIKELY
(-8) Don't Know
(-9) Refused
SHOW CARD SC4
(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?
(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 cover?
(-8) Don't Know
(-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 been fully
(-8) Don't Know
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
SHOW CARD SC4
(02) USUALLY
[Do you always, usually, sometimes, or never...]
(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
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?

Routing
SC10A - MCSICK

SC10A - MCDRSOON

BOX PA1

PA3 - PAINSTRC

PA4 - PAMEDREC

PA5 - PACHGDRS

PA6-PADISAGR

PA10-PARXINFO

PA11-PADRQUEX

PA12-PAANSWR

PA13-PALISTRX

PA14-PATRSLT

PA15-PAOPTION

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2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

SCQ-SATISFACTION WITH CARE

Question Text/Description
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

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

Routing

PA21-PADVICE

BOX SCEND

GO TO CMQ.

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