C-HIT Survey on out-of-pocket health costs
The Conn. Health I-Team is collecting information about out-of-pocket health care expenses for an upcoming story.
Your out-of-pocket costs have increased for which of the following in the last two years? (Please check all that are applicable)
Primary care visits
Routine medical procedure such as blood test, x-ray, etc.
Emergency room visits
Which of these costs have increased in the last two years for you? (Please check the applicable box)
Health insurance premium
Health insurance co-payment
Overall, your out-of-pocket medical expenses in the last two years have increased by:
Less than 10 percent
More than 15 percent
More than 25 percent
More than 50 percent
Which of these two statements are true for you? Because of higher out-of-pocket expenses, you have:
Put off doctor visits by a few weeks or longer
Experienced no change in the frequency of doctor visits
Due to your out-of-pocket medical expenses, you have, in the last two years: (Select all that apply)
Cut back on vacations, purchases and other expenditures
Withdrawn money from your 401(k) or savings account
Taken a second mortgage on our house
Are you, or is someone in your family, dealing with a significant illness?
Yes (please specify)
Please specify the illness
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