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MEPS
Medical Expenditure Panel Survey
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:
Yes Next Question
No, Skip to Question 3
This Booklet Should Be Completed By
RUID:
Version:
Name:
DOB:
PID:
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 fold it, 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.
THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY AND THE NATIONAL CENTER
FOR HEALTH STATISTICS OF THE U.S. PUBLIC HEALTH SERVICE
OMB # 0935-0104
Y our Health Care in the Last 12 Months
1. 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 healthcare. In the last 12 months, did
you make any appointments with a doctor or other
health provider for regular or routine health care?
Yes
No, Skip to Question 3
2. In the last 12 months, how often did you get an appointment for regular
or routine health care as soon as you wanted?
Never
Sometimes
Usually
Always
3. In the last 12 months, did you have an illness or injury that needed
care right away from a doctor’s office, clinic, or emergency room?
Yes
No, Skip to Question 5
4. In the last 12 months, when you needed care right away for an illness
or injury, how often did you get care as soon as you wanted?
Never
Sometimes
Usually
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?
None, Skip to Question 12
1
2
3
4
5 to 9
10 or more
6. In the last 12 months, how much of a problem, if any, was it to get
the care you or a doctor believed necessary?
A big problem
A small problem
Not a problem
7. In the last 12 months, how often did doctors or other health providers
listen carefully to you?
Never
Sometimes
Usually
Always
8. In the last 12 months, how often did doctors or other health providers
explain things in a way you could understand?
Never
Sometimes
Usually
Always
9. In the last 12 months, how often did doctors or other health providers
show respect for what you had to say?
Never
Sometimes
Usually
Always
10. In the last 12 months, how often did doctors or other health providers
spend enough time with you?
Never
Sometimes
Usually
Always
11. We want to know your rating of all your health care in the last
12 months from all doctors and other health providers.
Use any number from 0 to 10 where 0 is the worst health care possible,
and 10 is the best health care possible.
How would you rate all your health care?
Worst health care possible 1
2
3
4
5
6
7
8
9
10 Best health care possible
12. Do you currently smoke?
Yes
No, Skip to Question 14
13. In the last 12 months did a doctor advise you to quit smoking?
Yes
No
14. In the last 2 years, has your blood pressure been checked by a doctor,
nurse, or other health professional?
Yes
No
Getting Health Care from a Specialist
When you answer the next questions, do not include dental visits
15. Specialists are doctors like surgeons, heart doctors, allergy doctors,
skin doctors, and others who specialize
in one area of healthcare. In the last 12 months, did you or a doctor
think you needed to see a specialist?
Yes
No, Skip to Question 17
16. In the last 12 months, how much of a problem, if any, was it to
get a referral to a specialist that you needed to see?
A big problem
A small problem
Not a problem
General Health
17. In general, would you say your health is:
Excellent
Very good
Good
Fair
Poor
The following items are about activities you might do during a typical
day. Does your health now limit you in these activities? If so, how much?
18. Moderate activities, such as moving a table, pushing a vacuum cleaner,
bowling, or playing golf
Yes, limited a lot
Yes, limited a little
No, not limited at all
19. Climbing several flights of stairs?
Yes, limited a lot
Yes, limited a little
No, not limited at all
During the past 4 weeks, have you had any of the following problems
with your work or other regular daily
activities as a result of your physical health?
20. Accomplished less than you would like
Yes
No
21. Were limited in the kind of work or other activities
Yes
No
During the past 4 weeks, have you had any of the following problems
with your work or other regular daily
activities as a result of any emotional problems (such as feeling depressed
or anxious)?
22. Accomplished less than you would like
Yes
No
23. Didn’t do work or other activities as carefully as usual
Yes
No
24. During the past 4 weeks, how much did pain interfere with your normal
work (including both work outside
the home and housework)?
Not at all
A little bit
Moderately
Quite a bit
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:
25. Have you felt calm and peaceful?
All of the time
Most of the time
A good bit of the time
Some of the time
A little of the time
None of the time
26. Did you have a lot of energy?
All of the time
Most of the time
A good bit of the time
Some of the time
A little of the time
None of the time
27. Have you felt downhearted and blue?
All of the time
Most of the time
A good bit of the time
Some of the time
A little of the time?
None of the time
28. During the past 4 weeks, how much of the time has your physical
health or emotional problems interfered
with your social activities (like visiting with friends, relatives, etc.)?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
Your Health Today
By placing a check in one box for items 29-33, please indicate which
statement best describes your own health today.
29. Mobility
I have no problems in walking about
I have some problems in walking about
I am confined to bed
30. Self-Care
I have no problems with self-care
I have some problems washing or dressing myself
I am unable to wash or dress myself
31. Usual Activities (e.g., work, study, housework, family or leisure
activities)
I have no problems with performing my usual activities
I have some problems with performing my usual activities
I am unable to perform my usual activities
32. Pain/Discomfort
I have no pain or discomfort
I have moderate pain or discomfort
I have extreme pain or discomfort
33. Anxiety/Depression
I am not anxious or depressed
I am moderately anxious or depressed
I am extremely anxious or depressed
34. Rating of Your Own Health Today
To help you say how good or bad your own health is today, we have drawn
a scale (rather like a thermometer) on
which the best imaginable health is marked by 100 and the worst imaginable
is marked by 0.We would like you to
indicate on this scale how good or bad your own health is today, in your
opinion. Please do this by drawing a line
from the circle at the bottom of thermometer below to whichever point
on the thermometer indicates how good or
bad your own health is today.
Start here
Worst Imaginable Health 0
10
20
30
40
50
60
70
80
90
100 Best Imaginable Health
Opinions about Health
For items 35-38, 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.
35. I’m healthy enough that I really don’t need health insurance.
Disagree Strongly
Disagree Somewhat
Uncertain
Agree Somewhat
Agree Strongly
36. Health insurance is not worth the money it costs.
Disagree Strongly
Disagree Somewhat
Uncertain
Agree Somewhat
Agree Strongly
37. I’m more likely to take risks than the average person.
Disagree Strongly
Disagree Somewhat
Uncertain
Agree Somewhat
Agree Strongly
38. I can overcome illness without help from a medically trained person.
Disagree Strongly
Disagree Somewhat
Uncertain
Agree Somewhat
Agree Strongly
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 fold it, 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 statute, Section 903(c)
and Section 308(d) of the Public Health Service Act [42 U.S.C299a–1(c)
and 242m(d)]. This law prohibits release of personal information outside
the public health agencies sponsoring the survey or their contractors
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 (0935-0098)
Hubert H. Humphrey Building,
Room 721-B200
Independence Avenue, SW
Washington, DC 20201
Medical Expenditure Panel Survey
01-228
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