Health Care Rights and Access Survey
Please share your health care story by filling out the questionnaire below. You story will help the Campaign for New York Health can better understand challenges New Yorkers face accessing health care. Your participation will help us advocate more effectively for a health care system that guarantees care for all New Yorkers.
Do you currently have health insurance? *
If you answered yes, you do have health insurance, what type?
What is your insurance company?
Your answer
If your insurance was purchased on the Health Insurance Marketplace, which tier did you select?
By approximately how much did your insurance costs to change in 2018?
What’s the longest period of time you have gone without health insurance?
Your answer
Have you ever had problems getting the health care you need?
If yes, what were/are the reasons?
Your answer
Have you ever had to forgo needed health care because of costs?
If YES, what type of care?
What costs have been difficult for you (check all that apply)
Have you, or someone in your family, ever experienced any of the following:
Stayed in a job only to keep your health insurance?
If yes, please describe:
Your answer
Been discriminated against when trying to get healthcare because of your race, immigration status, gender, sexual orientation, age, or disability?
If yes, please describe
Your answer
Developed more serious health problems or delayed treatment because of concerns around cost?
If yes, please describe
Your answer
Have had problems paying medical bills?
If yes, please explain:
Your answer
Had problems paying for home care?
If yes, please explain:
Your answer
For those who work in health care settings
Do you work in a clinical setting?
Please describe
Your answer
Have you ever observed different treatment for patients based on health insurance status?
If yes, please describe
Your answer
Have you ever observed a patient delay or refuse health care because of cost?
If yes, please describe
Your answer
Do you feel that a patient’s concern with cost of health care has affected your relationship with the patient?
If yes, please describe
Your answer
Claiming Our Rights
Do you think we should make sure that everyone in New York can get the health care they need?
Do you believe that health care is a human right?
Do you believe our government has an obligation to protect the human right to health care?
Would you say that the human right to health care is protected here in New York?
Do you feel that you have a say in decisions about our health care system?
Responsibilities of Government: The Solution
What do you think of the idea of a universal health care system, which would be publicly funded from our taxes rather than paying premiums and deductibles to insurers and medical care providers? This type of coverage would allow for you to choose your doctor and hospital. It is often called a single-payer system or improved Medicare for All.
If you could change anything about our health care system, what would it be?
Your answer
Any other comments you’d like to make?
Your answer
About you (this will help us analyze the results of this survey)
Which New York county do you live in?
Your answer
Gender
Your race or ethnicity
Your age
Your answer
Are you a medical practitioner?
If yes, what field?
Your answer
Do you want to get involved?
It is not necessary to give your personal information to do the survey. You can choose to remain anonymous. However, if you would like to get involved in the Campaign for New York Health, for example by telling your story, we need some way to get in touch with you!
I would like to get more involved in the Campaign for New York Health
Name
Your answer
Street Address
Your answer
City
Your answer
Zip code
Your answer
Phone
Your answer
Email *
Your answer
What's the best way to contact you to discuss your story?
Would you be willing to speak with the media, lawmakers, and others about your story?* *
Would you be willing to allow the Campaign for New York Health to share your story in letters, press releases, or social media campaigns? *
Thank you for sharing your story.
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