2005
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:
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.
THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY AND
THE CENTERS FOR DISEASE CONTROL AND PREVENTION OF THE U.S. PUBLIC HEALTH
SERVICE
OMB # 0935-0104
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?
Yes
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?
Never
Sometimes
Usually
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?
Yes
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?
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 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?
Yes
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?
A big problem
A small problem
Not a problem
8. In the last 12 months, how often did
doctors or other health providers listen
carefully to you?
Never
Sometimes
Usually
Always
9. 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
10. 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
11. In the last 12 months, how often did
doctors or other health providers spend
enough time with you?
Never
Sometimes
Usually
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?
Yes
No Skip to Question 15
14. In the last 12 months did a doctor advise
you to quit smoking?
Yes
No
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?
Yes
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?
Yes
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?
A big problem
A small problem
Not a problem
General Health
18. In general, would you say your health is:
Excellent
Very good
Good
Fair
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
Yes, limited a lot
Yes, limited a little
No, not limited at all
20. Climbing several flights of stairs
Yes, limited a lot
Yes, limited a little
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
All of the time
Most of the time
Some of the time
A little of the time
None of the time
22. Were limited in the kind of work or other
activities
All of the time
Most of the time
Some of the time
A little of the time
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 any emotional problems (such as
feeling depressed or anxious)?
23. Accomplished less than you would like
All of the time
Most of the time
Some of the time
A little of the time
None of the time
24. Did work or other activities less carefully
than usual
All of the time
Most of the time
Some of the time
A little of the time
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)?
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:
26. Have you felt calm and peaceful?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
27. Did you have a lot of energy?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
28. Have you felt downhearted and depressed?
All of the time
Most of the time
Some of the time
A little of the time
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.)?
All of the time
Most of the time
Some of the time
A little of the time
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 often did you feel...
30. ...nervous?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
31. ...hopeless?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
32. ...restless or fidgety?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
33. ...so sad that nothing could cheer you up?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
34. ...that everything was an effort?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
35. ...worthless?
All of the time
Most of the time
Some of the time
A little of the time
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.
Nearly every day
More than half the days
Several days
Not at all
37. Feeling down, depressed, or hopeless.
Nearly every day
More than half the days
Several days
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.
38. I’m healthy enough that I really don’t need health insurance.
Disagree strongly
Disagree somewhat
Uncertain
Agree somewhat
Agree strongly
39. Health insurance is not worth the money it costs.
Disagree strongly
Disagree somewhat
Uncertain
Agree somewhat
Agree strongly
40. I’m more likely to take risks than the average person.
Disagree strongly
Disagree somewhat
Uncertain
Agree somewhat
Agree strongly
41. I can overcome illness without help from a medically trained person.
Disagree strongly
Disagree somewhat
Uncertain
Agree somewhat
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.
299c-3(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-B
200 Independence Avenue, SW
Washington, DC 20201
05-228R
18812.1005.76903301
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