Routing for UAS179
he_intro
This short survey asks you questions about your health insurance, healthcare, and health. It is only open for a small group of study members so we hope you can complete it for us.
he_001_year := dateofbirth_year
he_001_month := dateofbirth_month
Group of questions presented on the same screen
he_001_intro
Please tell us the month and year you were born:
he_001_month (month of birth)
Month
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December
he_001_year (year of birth)
Year
1910 1910
1911 1911
1912 1912
1913 1913
1914 1914
1915 1915
1916 1916
1917 1917
1918 1918
1919 1919
1920 1920
1921 1921
1922 1922
1923 1923
1924 1924
1925 1925
1926 1926
1927 1927
1928 1928
1929 1929
1930 1930
1931 1931
1932 1932
1933 1933
1934 1934
1935 1935
1936 1936
1937 1937
1938 1938
1939 1939
1940 1940
1941 1941
1942 1942
1943 1943
1944 1944
1945 1945
1946 1946
1947 1947
1948 1948
1949 1949
1950 1950
1951 1951
1952 1952
1953 1953
1954 1954
1955 1955
1956 1956
1957 1957
1958 1958
1959 1959
1960 1960
1961 1961
1962 1962
1963 1963
1964 1964
1965 1965
1966 1966
1967 1967
1968 1968
1969 1969
1970 1970
1971 1971
1972 1972
1973 1973
1974 1974
1975 1975
1976 1976
1977 1977
1978 1978
1979 1979
1980 1980
1981 1981
1982 1982
1983 1983
1984 1984
1985 1985
1986 1986
1987 1987
1988 1988
1989 1989
1990 1990
1991 1991
1992 1992
1993 1993
1994 1994
1995 1995
1996 1996
1997 1997
1998 1998
1999 1999
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
2015 2015
2016 2016
2017 2017
2018 2018
2019 2019
End of group of questions
if he_001_year > 1954 OR (he_001_year = 1954 AND he_001_month > 1) then
he_exit
Thank you for your interest! Unfortunately, you are not eligible to participate in this survey. Please click "Next" to return to your panel member pages.
Exit the survey
End of if
he_002 (have health insurance coverage)
Do you have health insurance coverage?
1 (YES) Yes
2 (NO) No
if he_002 = 1 then
Group of questions presented on the same screen
he_002b (types of health insurance coverage)
Which of the following best describes your current health insurance or health coverage plan?
Please check all that apply.
1 Medicare
2 Insurance through my or my spouse’s/partner’s employer/union
3 Retiree Insurance through my or my spouse’s/partner’s former employer/union
4 Private insurance purchased directly from an insurance company or through a state or federal exchange marketplace.
5 Medicaid, Medical Assistance or any kind of government assistance plan for those with low incomes or a disability
6 Tricare or other military health care
7 VA, including CHAMPVA or VA Care
8 Other program:
he_002b_other (other types of health insurance coverage)
STRING
End of group of questions
if 1 in he_002b then
he_002c (type of medicare coverage)
Which of the following best describes your Medicare coverage:
1 Traditional Medicare
2 HMO Medicare Advantage Plan
3 PPO Medicare Advantage Plan
4 Medicare Advantage Plan, other or unsure of plan type
5 Medicare but do not know specific type.
End of if
End of if
he_003 (general health)
In general, would you say your health is:
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
he_004 (general mental health)
In general, would you say your mental health is:
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
Group of questions presented on the same screen
he_005_intro
Please respond to each question or statement by choosing one option per row.
In the past 7 days...
Subgroup of questions
he_005a (sleep quality)
My sleep quality was
5 Very poor
4 Poor
3 Fair
2 Good
1 Very good
End of subgroup of questions
Subgroup of questions
he_005b (sleep refreshing)
My sleep was refreshing
1 Not at all
2 A little bit
3 Somewhat
4 Quite a bit
5 Very much
he_005c (sleep problem)
I had a problem with my sleep
1 Not at all
2 A little bit
3 Somewhat
4 Quite a bit
5 Very much
he_005d (difficulty falling asleep)
I had difficulty falling asleep
1 Not at all
2 A little bit
3 Somewhat
4 Quite a bit
5 Very much
End of subgroup of questions
End of group of questions
he_005_2 (past 12 months provider about sleep problems)
In the past 12 months, have you talked to a health care provider about sleep problems?
1 (YES) Yes
2 (NO) No
Group of questions presented on the same screen
he_006_intro
Please respond to each question or statement by choosing one option per row.
In the past 7 days...
Subgroup of questions
he_006a (thinking has been slow)
My thinking has been slow
5 Never
4 Rarely
(Once)
3 Sometimes
(Two or three times)
2 Often (About once a day)
1 Very often (Several times a day)
he_006b (brain not working as well)
It has seemed like my brain was not working as well as usual
5 Never
4 Rarely
(Once)
3 Sometimes
(Two or three times)
2 Often (About once a day)
1 Very often (Several times a day)
he_006c (work harder than usual to keep track)
I have had to work harder than usual to keep track of what I was doing
5 Never
4 Rarely
(Once)
3 Sometimes
(Two or three times)
2 Often (About once a day)
1 Very often (Several times a day)
he_006d (trouble shifting between activities)
I have had trouble shifting back and forth between different activities that require thinking
5 Never
4 Rarely
(Once)
3 Sometimes
(Two or three times)
2 Often (About once a day)
1 Very often (Several times a day)
End of subgroup of questions
End of group of questions
he_006_2 (past 12 months provider about memory problems)
In the past 12 months, have you talked to a health care provider about memory problems?
1 (YES) Yes
2 (NO) No
he_006_3 (doctor ever told memory related disease)
Has a doctor ever told you that you have a memory-related disease?
1 (YES) Yes
2 (NO) No
Group of questions presented on the same screen
he_007_intro
The following two questions ask about how you have been feeling in the past 2 weeks.
Over the past 2 weeks, how often have you been bothered by any of the following problems?
Subgroup of questions
he_007a (little interest or pleasure in things)
Little interest or pleasure in doing things.
1 Nearly every day
2 More than half the days
3 Several days
4 Not at all
he_007b (feeling down, depressed, or hopeless)
Feeling down, depressed, or hopeless.
1 Nearly every day
2 More than half the days
3 Several days
4 Not at all
End of subgroup of questions
End of group of questions
Group of questions presented on the same screen
he_008_intro
The following questions ask about how you have been feeling during the past 30 days.
For each question, please choose one option that best describes how often you had this feeling.
During the past 30 days, how often did you feel...
Subgroup of questions
he_008a (feeling nervous)
...nervous
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
he_008b (feeling hopeless)
...hopeless
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
he_008c (feeling restless or fidgety)
...restless or fidgety
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
he_008d (feeling so sad that nothing could cheer you up)
...so sad that nothing could cheer you up
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
he_008e (feeling that everything was an effort)
...that everything was an effort
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
he_008f (feeling worthless)
...worthless
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
End of subgroup of questions
End of group of questions
he_009 (past 12 months seen mental health professional)
During the past 12 months, have you seen a mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
1 (YES) Yes
2 (NO) No
he_010 (doctor ever told problems with depression)
Has a doctor ever told you that you have had problems with depression?
1 (YES) Yes
2 (NO) No
Group of questions presented on the same screen
he_011_intro
Individuals enrolled in Medicare Part B are entitled to a Welcome to Medicare Visit within 12 months of enrolling and an annual wellness visit (AWV) ever year thereafter. The Welcome to Medicare Visit includes a review of your health and medical history as well as education and counseling about the preventive services you need, like certain screenings, shots, and referrals for other care. The AWV is a yearly appointment that updates your personal prevention plan.
To the best of your knowledge,
Subgroup of questions
he_011a (enrolled in medicare part b)
are you enrolled in Medicare Part B?
1 Yes
2 No
3 I don't know
he_011b (had a Welcome to Medicare Visit)
have you had a Welcome to Medicare Visit?
1 Yes
2 No
3 I don't know
he_011c (had Medicare's Annual Wellness Visit)
have you had Medicare's Annual Wellness Visit?
1 Yes
2 No
3 I don't know
End of subgroup of questions
End of group of questions
Group of questions presented on the same screen
he_012_intro
The annual wellness visit should include, among other things, a cognitive assessment. These assessments normally include a word recall test and/or number tasks such as backwards counting. To the best of your knowledge, have you:
Subgroup of questions
he_012a (ever had a cognitive assessment)
Ever had a cognitive assessment?
1 Yes
2 No
3 I don't know
he_012b (had a cognitive assessment at an Annual Wellness Visit)
Had a cognitive assessment at an Annual Wellness Visit?
1 Yes
2 No
3 I don't know
End of subgroup of questions
End of group of questions
he_013 (generally, cognitive assessment is a good addition to medical services)
Please tell us if you strongly agree, neither agree nor disagree or strongly disagree with the following statement:
Generally, cognitive assessment is a good addition to medical services.
1 Strongly disagree
2 Disagree
3 No opinion
4 Agree
5 Strongly agree
CS_001 (HOW PLEASANT INTERVIEW)
Could you tell us how interesting or uninteresting you found the questions in this interview?
1 Very interesting
2 Interesting
3 Neither interesting nor uninteresting
4 Uninteresting
5 Very uninteresting
CS_003 (comments)
Do you have any other comments on the interview? Please type these in the box below.(If you have no comments, please click next to complete this survey.)
STRING