SIPP Home > Survey Content > Topical Modules > Topical Module Chart Listing > 2001 Schedule > 2001 Topical Module Questionnaires > Wave 3 Questionnaires > Medical Expenses
-FIN1-
Now I am going to ask questions about the sharing of major expenses with the household.
Do you pay for all your housing expenses with your own money?
(1) Yes
(2) No
-FIN2-
Do you pay for all your food expenses with your own money?
(1) Yes
(2) No
-FIN3-
Do you pay for all your other living expenses such as clothing, transportation, etc., with your own money?
(1) Yes
(2) No
-FIN4-
Does all or part of the money to pay for these expenses come from someone in this household?
(1) Yes
(2) No
-FIN5-
Who are these persons?
ENTER "A" FOR ALL
ENTER LINE NUMBER OF EACH PERSON
(N) No more
-ME01-
These next few questions are about your health. Would you say your health in general is excellent, very good, good, fair, or poor?
(1) Excellent
(2) Very good
(3) Good
(4) Fair
(5) Poor
-ME02-
During the past 12 months, that is, the period from today back to this date one year ago, were you a patient in a hospital overnight or longer?
(1) Yes
(2) No
-ME03-
How many nights in all did you spend in a hospital of any type during the past 12 months?
ENTER "N" FOR NONE OR NO TIMES
____ nights
-ME04-
Which of the following best describes the reasons why you entered the hospital during the most recent stay of one night or longer.
FR NOTE: READ ALL ANSWER CATEGORIES BELOW.
(1) Yes - Applies
(2) No - Does not apply
Diagnostic tests to determine what was wrong?
Give birth, including cesarean section?
Operation or surgery?
Treatment or therapy, not including surgery?
Any other reason?
-ME05-
During the past 12 months, did you take any prescription medications?
(1) Yes
(2) No
-ME06-
Do you take prescription medicines on a daily basis?
(1) Yes
(2) No
-ME07-
Do you have the Flashcard pamphlet we sent you in the mail?
It would have come with the introductory letter.
(1) Yes
(2) No
-ME08-
During the past 12 months, how many visits did you make to a dentist or other dental professional such as a hygienist, orthodontist, or oral surgeon?
ENTER "N" FOR NONE OR NO TIMES
____ times
-ME09-
Have you lost any of your permanent adult teeth?
(1) Yes
(2) No
-ME10-
Have you lost ALL of your permanent adult teeth?
(1) Yes
(2) No
-ME11-
[During the/Not counting contacts during hospital stays during the] past 12 months, how many times did you see or talk to a medical doctor or other medical provider about your health?
ENTER "N" FOR NONE OR NO TIMES
____ times
-ME12-
Did that visit or call include contact with a physician?
(1) Yes
(2) No
-ME13-
About how many of those [FILL IN VALUE FROM -ME11-] visits or calls included contact with a physician?
ENTER "A" FOR ALL TIMES
ENTER "N" FOR NONE OR NO TIMES
____ times
-ME14-
In the last 12 months, did you purchase any other medical supplies or services such as over the counter medicines, eyeglasses or contact lenses, diabetic equipment, or transportation services?
(1) Yes
(2) No
-ME15-
[During the/Including days while a patient at a hospital, during the] past 12 months, about how many days did illness or injury keep you in bed more than half of the day?
ENTER "N" FOR NONE OR NO TIMES
____ days
-ME16-
During the past 12 months, about how much did you pay for health insurance for yourself or others in the household?
NOTE TO FR: If someone else in the household pays for the health insurance that covers this respondent, do NOT try to separate the amounts for each person. Just mark N (none) for this respondent and mark the whole amount when you ask this question for the person who pays the premium.
ENTER "N" FOR NO PAYMENTS
_____ dollars
-ME17-
Was it...
(N) None
(1) $1-$10
(2) $11 to $50
(3) $51 to $100
(4) $101 to $200
(5) $201 to $300
(6) $301 to 500
(7) $501 to $1000
(8) $1001 to $5000
(9) $5001+
-ME18-
During the past 12 months, about how much was paid for your own medical care, including payments for hospital visits, medical providers, dentists, medicine, or medical supplies? Exclude Health Insurance premiums.
Include any amount paid on your behalf by you or anyone else in this household.
ENTER "N" FOR NO PAYMENTS
_____ dollars
-ME19-
Was it...
(N) None
(1) $1-$10
(2) $11 to $50
(3) $51 to $100
(4) $101 to $200
(5) $201 to $300
(6) $301 to 500
(7) $501 to $1000
(8) $1001 to $5000
(9) $5001+
-ME20-
Were these amounts for medical care and health insurance the total cost to your household or did you get reimbursed by some outside source?
(1) Total Cost
(2) Got Reimbursed
(3) Expects to get reimbursed but has not yet
-ME21-
How much of these expenses were reimbursed?
ENTER "N" FOR NONE
ENTER "A" FOR ALL EXPENSES REIMBURSED
____ dollars
OR
____ % ( percent reimbursed if answer given as a percentage )
-MEWR01-
Earlier you said that you were not covered by any health insurance.
During the time you were not covered did you go to a dentist or other dental professional?
(1) Yes
(2) No
-MEWR02-
Earlier you said that you were not covered by any health insurance.
During that time, did you go to a doctor, nurse, or another health care provider?
(1) Yes
(2) No
-MEWR03-
Did you receive treatment for an illness or injury?
(1) Yes
(2) No
-MEWR04-
Did you receive any routine or preventive care, such as a checkup, or family planning?
(1) Yes
(2) No
-MEWR05-
Did you receive treatment for a drug or alcohol problem?
(1) Yes
(2) No
-MEWR06-
What kind of treatment did you receive?
_____
-MEWR07-
Where did you go to get those health care services?
MARK ALL THAT APPLY ENTER "N" AFTER LAST ENTRY
(1) Clinic or Public Health Department
(2) Emergency room
(3) Hospital, excluding emergency room
(4) VA hospital
(5) Doctor's office
(6) Dentist's office
(7) Someplace else
What was that?
_____
-MEWR08-
Were these services free, or did you have to pay something for them?
(1) Free
(2) Paid something
(3) Both (if respondent volunteers)
-MEWR09-
Do you think you paid the full price for these services or do you think you paid a reduced price?
(1) Full price
(2) Reduced price
(3) Don't know
-MEWR10-
Did anyone ask what your income was before they set a price for the services?
(1) Yes
(2) No
-ME22-
The next few questions are about the health of your child(ren) (read above for names of all children).
Would you say [Child's Names]'s health in general is excellent, very good, good, fair, or poor?
(1) Excellent
(2) Very good
(3) Good
(4) Fair
(5) Poor
-ME23-
During the past 12 months, was [Child's Name] a patient in a hospital overnight or longer?
(1) Yes
(2) No
-ME24-
Which children were in a hospital overnight or longer?
ENTER "A" FOR ALL
ENTER LINE NUMBER OF EACH CHILD
(N) No more
-ME25-
How many nights in all did [Child's Name] spend in a hospital of any type during the past 12 months?
ENTER "N" FOR NONE OR NO TIMES
____ Nights
-ME26-
Which of the following best describes the reasons why [Child's Name] entered the hospital during the most recent visit of one night or longer.
FR NOTE: READ ALL ANSWER CATEGORIES BELOW.
(1) Yes - Applies
(2) No - Does not apply
Diagnostic tests to determine what was wrong?
Give birth, including cesarean section (mother)
To be born (baby)?
Operation or surgery?
Treatment or therapy, not including surgery?
Any other reason?
-ME27-
During the past 12 months did (read above for names of all children) take any prescription medications?
(1) Yes
(2) No
-ME28-
Which children took prescription medications?
ENTER "A" FOR ALL
ENTER LINE NUMBER OF EACH CHILD
(N) No more
-ME29-
Does [Child's Name] take prescription medicines on a daily basis?
(1) Yes
(2) No
-ME30-
During the past 12 months, did (read above for names of all children) visit a dentist, or other dental professional such as a hygienist, orthodontist, or oral surgeon?
(1) Yes
(2) No
-ME31-
Which children visited a Dentist?
ENTER "A" FOR ALL
ENTER LINE NUMBER OF EACH CHILD
(N) No more
-ME32-
During the past 12 months, how many visits did [Child's Name] make to a dentist?
ENTER "N" FOR NONE OR NO TIMES
____ times
-ME33-
Dental sealants are special plastic coatings that are painted on the tops of the back teeth to prevent tooth decay. They are different from fillings, caps, crowns, and fluoride treatments.
Has [Child's Name] ever had dental sealants painted on their teeth?
(1) Yes
(2) No
-ME34-
During the past 12 months, did you or anyone else see or talk to a medical doctor or other medical provider about (read above for names of all children)'s health?
(1) Yes
(2) No
-ME35-
For which children?
ENTER "A" FOR ALL
ENTER LINE NUMBER OF EACH CHILD
ENTER "N" FOR "NO MORE" AFTER LINE ENTRIES
-ME36-
[During the/Not counting contacts during hospital stays during the] past 12 months, about how many times did you or anyone else see or talk to a medical doctor or other medical provider about [Child's Name]'s health?
ENTER "N" FOR NONE OR NO TIMES
____ times
-ME37-
Did that visit or call include contact with a physician?
(1) Yes
(2) No
-ME38-
In the past 12 months, about how many of the visits or calls included contact with a physician?
ENTER "A" FOR ALL VISITS
ENTER "N" FOR NONE
____ times
-ME39-
In the last 12 months, did you or anyone else buy for (read above for names of all children) any other medical supplies or services such as over the counter medicines, eyeglasses or contact lenses, diabetic equipment, or transportation services?
(1) Yes
(2) No
-ME40-
For which children were purchases made?
ENTER "A" FOR ALL
ENTER LINE NUMBER OF EACH CHILD
(N) No more
-ME40a-
During the past 12 months, about how much was paid by anyone in this household for [Child's Name] medical care, including payments for hospital visits, medical providers, dentists, medicine, or medical supplies? Exclude Health Insurance premiums.
ENTER "N" FOR NO PAYMENTS
_____ dollars
-ME40b-
Was it...
(N) None
(1) $1-$10
(2) $11 to $50
(3) $51 to $100
(4) $101 to $200
(5) $201 to $300
(6) $301 to 500
(7) $501 to $1000
(8) $1001 to $5000
(9) $5001+
-ME40c-
Were these amounts for medical care for [Child's Name] the total cost to your household or did you get reimbursed by some outside source?
(1) Total Cost
(2) Got Reimbursed
(3) Expects to get reimbursed but has not yet
-ME40d-
How much of these expenses for [Child's Name] were reimbursed?
ENTER "N" FOR NONE
ENTER "A" FOR ALL EXPENSES REIMBURSED
____ dollars
OR
____ % ( percent reimbursed if answer given as a percentage )
-ME41-
We have recorded that your health or condition prevents you from working.
For how long have you been prevented from working? Has it been a year or longer, or has it been less than a year?
(1) A year or longer
(2) Less than a year
-ME42-
Is it likely that you will be able to work at some time in the next 12 months?
(1) Yes
(2) No
End of the Medical Expenses and Utilization of Health Care Services Topical Module.
End of the Medical Expenses and Utilization of Health Care Topical Module
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Page Last Modified: May 12, 2006
