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2006
MEPS Medical Expenditure Panel Survey
THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY AND
THE CENTERS FOR DISEASE CONTROL AND PREVENTION OF THE U.S. PUBLIC HEALTH
SERVICE
OMB # 09350104
Your Health and Health Opinions
Your opinion matters!
Understanding how people feel about their health and health care is
an important goal of MEPS. Please take a few minutes to answer the questions
in this booklet.
Survey Instructions
Please answer every question by checking one box. If you are unsure
about how to answer a question, please give the best answer you can.
You are sometimes told to skip over some questions in this survey.
When this happens you will see arrows that tell you what questions
to answer next, like
this:
1 Yes
2 No Skip to Question 3
Next Question
This Booklet Should Be Completed By:
RUID:
PID:
Name:
Version:
DOB:
Panel/Round:
Your participation is voluntary and all of your answers will be kept
confidential. If you have any questions about this booklet, please
call Alex Scott at 1-800-945-MEPS (6377).
When you have completed the booklet, please seal it with this label-->
and place it in the envelope provided. Have it ready to give to your
interviewer at his or her next visit.
START HERE
Your Health Care in the Last 12 Months
1. In the last 12 months, did you have an illness, injury, or condition
that needed care right away in a clinic, emergency room, or doctor’s
office?
1 Yes
2 No Skip to Question 3
2. In the last 12 months, when you needed care right away for an illness,
injury, or condition how often did you get care as soon as you wanted?
1 Never
2 Sometimes
3 Usually
4 Always
3. A health provider could be a general doctor, a specialist doctor,
a nurse practitioner, a physician assistant, a nurse, or anyone else
you would see for health care.
In the last 12 months, not counting the times you needed health care
right away,
did you make any appointments with a doctor or other health provider
for health care?
1 Yes
2 No Skip to Question 5
4. In the last 12 months, not counting times you needed health care
right away, how often did you get an appointment for health care as soon
as you wanted?
1 Never
2 Sometimes
3 Usually
4 Always
5. In the last 12 months (not counting times you went to an emergency
room), how many times did you go to a doctor’s office or clinic
to get care for yourself?
0 None: Skip to Question 13
1
2
3
4
5 to 9
10 or more
6. In the last 12 months, did you or a doctor believe you needed any
care, tests, or treatment?
1 Yes
2 No Skip to Question 8
7. In the last 12 months, how much of a problem, if any, was it to get
the care,
tests, or treatment you or a doctor believed necessary?
1 A big problem
2 A small problem
3 Not a problem
8. In the last 12 months, how often did doctors or other health providers
listen carefully to you?
1 Never
2 Sometimes
3 Usually
4 Always
9. In the last 12 months, how often did doctors or other health providers
explain things in a way you could understand?
1 Never
2 Sometimes
3 Usually
4 Always
10. In the last 12 months, how often did doctors or other health providers
show respect for what you had to say?
1 Never
2 Sometimes
3 Usually
4 Always
11. In the last 12 months, how often did doctors or other health providers
spend enough time with you?
1 Never
2 Sometimes
3 Usually
4 Always
12. Using any number from 0 to 10 where 0 is the worst health care possible
and 10 is the best health care possible, what number would you use to
rate all your health care in the last 12 months?
0 Worst health care possible
1
2
3
4
5
6
7
8
9
10 Best health care possible
13. Do you currently smoke?
1 Yes
2 No Skip to Question 15
14. In the last 12 months did a doctor advise you to quit smoking?
1 Yes
2 No
3 Had no visits in the last 12 months
15. In the last 2 years, has your blood pressure been checked by a doctor,
nurse, or other health professional?
1 Yes
2 No
Getting Health Care from a Specialist
When you answer the next questions,
do not include dental visits.
16. Specialists are doctors like surgeons, heart doctors, allergy doctors,
skin doctors, and others who specialize in one area of health care.
In the last 12 months, did you or a doctor think you needed to see a
specialist?
1 Yes
2 No Skip to Question 18
17. In the last 12 months, how much of a problem, if any, was it to
see a specialist that you needed to see?
1 A big problem
2 A small problem
3 Not a problem
General Health
18. In general, would you say your health is:
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
The following questions are about activities you might do during a typical
day. Does your health now limit you in these activities? If so, how much?
19. Moderate activities, such as moving a table,
pushing a vacuum cleaner, bowling, or playing golf
1 Yes, limited a lot
2 Yes, limited a little
3 No, not limited at all
20. Climbing several flights of stairs
1 Yes, limited a lot
2 Yes, limited a little
3 No, not limited at all
During the past 4 weeks how much of the time have you had any of the
following problems with your work or other regular daily activities as
a result of your physical health?
21. Accomplished less than you would like
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
22. Were limited in the kind of work or other activities
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
During the past 4 weeks, how much of the time have you had any of the
following problems with your work or other regular daily activities as
a result of an emotional problems (such as feeling depressed or anxious)?
23. Accomplished less than you would like
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
24. Did work or other activities less carefully than usual
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
25. During the past 4 weeks, how much did pain interfere with your normal
work (including both work outside the home and housework)?
1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely
These questions are about how you feel and how things have been with
you during the past 4 weeks. For each question, please give the one answer
that comes closest to the way you have been feeling.
How much of the time during the past 4 weeks:
26. Have you felt calm and peaceful?
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
27. Did you have a lot of energy?
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
28. Have you felt downhearted and depressed?
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
29. During the past 4 weeks, how much of the time has your physical
health or emotional problems interfered with your social activities (like
visiting friends,
relatives, etc.)?
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
The following questions ask about how you have been feeling during the
past 30 days.
For each question, please place a check mark in the box that best describes
how often you had this feeling.
During the past 30 days, about how did you feel...
30....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
31....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
32....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
33....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
34....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
35....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
The following two questions ask about how you have been feeling in the
past 2 weeks.
Over the last 2 weeks, how often have you been bothered by any of the
following problems?
36. Little interest or pleasure in doing things.
1 Nearly every day
2 More than half the days
3 Several days
4 Not at all
37. Feeling down, depressed, or hopeless.
1 Nearly every day
2 More than half the days
3 Several days
4 Not at all
Opinions about Health
For items 38-41, please check one of the boxes
to indicate how strongly you agree or disagree for each statement. If
you are uncertain, check the box for uncertain (3 ).
38. I’m healthy enough that I really don’t need health insurance.
1 Disagree strongly
2 Disagree somewhat
3 Uncertain
4 Agree somewhat
5 Agree strongly
39. Health insurance is not worth the money it costs.
1 Disagree strongly
2 Disagree somewhat
3 Uncertain
4 Agree somewhat
5 Agree strongly
40. I’m more likely to take risks than the average person.
1 Disagree strongly
2 Disagree somewhat
3 Uncertain
4 Agree somewhat
5 Agree strongly
41. I can overcome illness without help from a medically trained person.
1 Disagree strongly
2 Disagree somewhat
3 Uncertain
4 Agree somewhat
5 Agree strongly
Date completed:
If this booklet was not completed by the person named on the front,
who completed it:
What is this person’s relationship to the person named on the
front:
Thank you for taking the time to complete this survey.
Remember to seal it and place it in the envelope provided.
This survey is part of the Medical Expenditure Panel Survey, conducted
by the U.S.
Public Health Service. This survey is authorized under Section 902(a)
of the Public Health Service Act [42 U.S.C. 299a].
The confidentiality of personal information is protected by Federal Statutes,
Section 924(c) and Section 308(d) of the
Public Health Service Act [42 U.S.C. 299c3( c) and 242m(d)].
This law prohibits release of personal information outside the public
health agencies
sponsoring the survey or their contractor without first obtaining permission
from the person who gave the information. The Federal government requires
that all persons asked to respond to one of its surveys be given the
following information: Public reporting burden for this collection of
information is estimated to average 5 minutes per interview, the
estimated time required to complete the survey about Your Health and
Health Opinions. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions
for reducing
this burden, to:
Reports Clearance Officer
Attn: PRA, United States Public Health Service
Paperwork Reduction Project (09350098)
Hubert H. Humphrey Building, Room 721-B
200 Independence Avenue,
SW
Washington, DC 2020106228
20027.0406.76903402
06-228
OMB # 09350104
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