|
P-HL1. In the last 12 months, how often did your personal doctor ask if you had any questions about your health?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After core question 11
|
|
P-HL2. In the last 12 months, how often did your personal doctor use medical words you did not understand?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After core question 16
|
|
P-HL3. In the last 12 months, how often did your personal doctor talk too fast when talking with you?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL2
|
|
P-HL4. In the last 12 months, did you talk with your personal doctor about any health questions or concerns?
1 ☐ Yes
2 ☐ No → If No, go to P-HL8
|
After P-HL3
|
|
P-HL5. In the last 12 months, how often did your personal doctor show interest in your questions or concerns?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL4
Must use P-HL4 if using this item
|
|
P-HL6. In the last 12 months, how often did your personal doctor give you easy to understand information about these health questions or concerns?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL5
Must use P-HL4 if using this item
|
|
P-HL7. In the last 12 months, how often did your personal doctor answer all of your questions?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL6
Must use P-HL4 if using this item
|
|
P-HL8. In the last 12 months, how often did your personal doctor give you all the information you wanted about your health?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL7
|
|
P-HL9. In the last 12 months, did you see your personal doctor for a specific illness or for any health condition?
1 ☐ Yes
2 ☐ No → If No, go to P-HL13
|
After P-HL8
|
|
P-HL10. In the last 12 months, did your personal doctor give you instructions about what to do to take care of this illness or health condition?
1 ☐ Yes
2 ☐ No → If No, go to P-HL13
|
After P-HL9
Must use P-HL9 if using this item
|
|
P-HL11. In the last 12 months, how often were these instructions easy to understand?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL10
Must use P-HL9 and P-HL10 if using this item
|
|
P-HL12. In the last 12 months, how often did your personal doctor ask you to describe how you were going to follow these instructions?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL11
Must use P-HL9 and P-HL10 if using this item
|
|
P-HL13. In the last 12 months, did you start a prescription medicine?
1 ☐ Yes
2 ☐ No → If No, go to P-HL16
|
After P-HL12
|
|
P-HL14. In the last 12 months, how often did your personal doctor give you easy to understand instructions about how to take your medicines?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL13
Must use P-HL13 if using this item
|
|
P-HL15. In the last 12 months, how often did your personal doctor explain the possible side effects of your medicines in a way that was easy to understand?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL14
Must use P-HL13 if using this item
|
|
P-HL16. In the last 12 months, did your personal doctor order a blood test, x-ray, or other test for you?
1 ☐ Yes
2 ☐ No → If No, go to core question 17
|
After P-HL15
|
|
P-HL17. In the last 12 months, before you had a blood test, x-ray, or other test, how often did your personal doctor explain what it was for?
1 ☐ Never → If Never, go to P-HL19
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL16
|
|
P-HL18. In the last 12 months, how often was the explanation of what the test was for easy to understand?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL17
|
|
P-HL19. In the last 12 months, when your personal doctor ordered a blood test, x-ray, or other test for you, how often did someone from your personal doctor's office follow up to give you those test results?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL18
Must use with P-HL16 if using this item
|
|
P-HL20. In the last 12 months, how often were the results of your blood test, x-ray, or other test easy to understand?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After P-HL19
|
|
P-HL21. In the last 12 months, how often was the information you got from your health plan's customer service easy to understand?
1 ☐ Never
2 ☐ Sometimes
3 ☐ Usually
4 ☐ Always
|
After core question 22
|
|
P-HL22. In the last 12 months, did you look for any information about how your health plan works?
1 ☐ Yes
2 ☐ No → If No, go to P-HL32
|
After core question 26
Do not use if using P-HL27 or P-HL53
|
|
P-HL23. Did you find the information you needed about how your health plan works?
1 ☐ Yes
2 ☐ No → If No, go to P-HL32
|
After P-HL22
Must use P-HL22 if using this item
|
|
P-HL24. Was the information about how your health plan works easy to understand?
1 ☐ Yes → If Yes, go to P-HL32
2 ☐ No
|
After P-HL23
Must use P-HL22 and P-HL23 if using this item |
|
P-HL25. Was there too much information about how your health plan works?
1 ☐ Yes
2 ☐ No
|
After P-HL24
Must use P-HL22, P-HL23, and P-HL24 if using this item
|
|
P-HL26. Was the information about how your health plan works confusing?
1 ☐ Yes
2 ☐ No
|
After P-HL25
Must use P-HL22, P-HL23, and P-HL24 if using this item
|
|
P-HL27. In the last 12 months, did you look for any information about your health plan's coverage and benefits?
1 ☐ Yes
2 ☐ No → If No, go to P-HL32
|
After core question 26
Do not use if using P-HL22 or P-HL53
|
|
P-HL28. Did you find the information you needed about your health plan's coverage and benefits?
1 ☐ Yes
2 ☐ No → If No, go to P-HL32
|
After P-HL27
Must use P-HL27 if using this item
|
|
P-HL29. Was the information about your health plan's coverage and benefits easy to understand?
1 ☐ Yes → If Yes, go to P-HL32
2 ☐ No
|
After P-HL28
Must use P-HL27 and P-HL28 if using this item
|
|
P-HL30. Was there too much information about your health plan’s coverage and benefits?
1 ☐ Yes
2 ☐ No
|
After P-HL29
Must use P-HL27, P-HL28, and P-HL29 if using this item
|
|
P-HL31. Was the information about your health plan’s coverage and benefits confusing?
1 ☐ Yes
2 ☐ No
|
After P-HL30
Must use P-HL27, P-HL28, and P-HL29 if using this item
|
|
P-HL32. In the last 12 months, did you look for any information from your health plan about how much you would have to pay for specific prescription medicines?
1 ☐ Yes
2 ☐ No →If No, go to P-HL37
|
After P-HL26 or P-HL31
|
|
P-HL33. Did you find the information you needed about how much you would have to pay for prescription medicines?
1 ☐ Yes
2 ☐ No → If No, go to P-HL37
|
After P-HL32
Must use P-HL32 if using this item
|
|
P-HL34. Was the information about how much you would have to pay for prescription medicines easy to understand?
1 ☐ Yes → If Yes, go to P-HL37
2 ☐ No
|
After P-HL33
Must use P-HL32 and P-HL33 if using this item
|
|
P-HL35. Was there too much information about how much you would have to pay for prescription medicines?
1 ☐ Yes
2 ☐ No
|
After P-HL34
Must use P-HL32, P-HL33, and P-HL34 if using this item
|
|
P-HL36. Was the information about how much you would have to pay for prescription medicines confusing?
1 ☐ Yes
2 ☐ No
|
After P-HL35
Must use P-HL32, P-HL33, and P-HL34 if using this item
|
|
P-HL37. Did you know you could make a complaint to your health plan about the care or services you received or decisions your health plan made?
1 ☐ Yes
2 ☐ No → If No, go to P-HL43
|
After P-HL36
This item only recommended for use if the referenced health plan includes prescription drug coverage
|
|
P-HL38. In the last 12 months, did you look for any information about how to make a complaint to your health plan?
1 ☐ Yes
2 ☐ No → If No, go to P-HL43
|
After P-HL37
Must use P-HL37 if using this item
|
|
P-HL39. Did you find the information you needed about how to make a complaint to your health plan?
1 ☐ Yes
2 ☐ No → If No, go to P-HL43
|
After P-HL38
Must use P-HL37 and P-HL38 if using this item
|
|
P-HL40. Was the information about how to make a complaint to your health plan easy to understand?
1 ☐ Yes → If Yes, go to P-HL43
2 ☐ No
|
After P-HL39
Must use P-HL37, P-HL38, and P-HL39 if using this item
|
|
P-HL41. Was there too much information about how to make a complaint?
1 ☐ Yes
2 ☐ No
|
After P-HL40
Must use P-HL37, P-HL38, P-HL39, and P-HL40 if using this item
|
|
P-HL42. Was the information about how to make a complaint confusing?
1 ☐ Yes
2 ☐ No
|
After P-HL41
Must use P-HL37, P-HL38, P-HL39, and P-HL40 if using this item
|
|
P-HL43. Sometimes people need special services or equipment such as care from a specialist, physical therapy, a hearing aid, or oxygen. In the last 12 months, did you look for any information from your health plan about how much you would have to pay for special services or equipment?
1 ☐ Yes
2 ☐ No → If No, go to P-HL48
|
After P-HL42
|
|
P-HL44. Did you find the information you needed about how much you would have to pay for special services or equipment?
1 ☐ Yes
2 ☐ No → If No, go to P-HL48
|
After P-HL43
Must use P-HL43 if using this item
|
|
P-HL45. Was the information about how much you would have to pay for special services or equipment easy to understand?
1 ☐ Yes → If Yes, go to P-HL48
2 ☐ No
|
After P-HL44
Must use P-HL43 and P-HL44 if using this item
|
|
P-HL46. Was there too much information about how much you would have to pay for special services or equipment?
1 ☐ Yes
2 ☐ No
|
After P-HL45
Must use P-HL43, P-HL44, and P-HL45 if using this item
|
|
P-HL47. Was the information about how much you would have to pay for special services or equipment confusing?
1 ☐ Yes
2 ☐ No
|
After P-HL46
Must use P-HL43, P-HL44, and P-HL45 if using this item
|
|
P-HL48. In the last 12 months, did you look for information from your health plan about how to stay healthy? Do not include information that was given to you at a doctor's office.
1 ☐ Yes
2 ☐ No → If No, go to P-HL53
|
After P-HL47
|
|
P-HL49. Did you find the information you needed about how to stay healthy?
1 ☐ Yes
2 ☐ No → If No, go to P-HL53
|
After P-HL48
Must use P-HL48 if using this item
|
|
P-HL50. Was the information about how to stay healthy easy to understand?
1 ☐ Yes → If No, go to P-HL53
2 ☐ No
|
After P-HL49
Must use P-HL48 and P-HL49 if using this item
|
|
P-HL51. Was there too much information about how to stay healthy?
1 ☐ Yes
2 ☐ No
|
After P-HL50
Must use P-HL48, P-HL49, and P-HL50 if using this item
|
|
P-HL52. Was the information about how to stay healthy confusing?
1 ☐ Yes
2 ☐ No
|
After P-HL51
Must use P-HL48, P-HL49, and P-HL50 if using this item
|
|
HP-L53. In the last 12 months, did you visit your health plan's Website to look for information?
1 ☐ Yes
2 ☐ No → If No, go to P-HL32
|
After P-HL52
Do not use if using P-HL22 or P-HL27
|
|
P-HL54. Was the information on your health plan's Website easy to understand?
1 ☐ Yes
2 ☐ No
|
After P-HL53
Must use P-HL53 if using this item
|
|
P-HL55. In the last 12 months, was it easy to find the information you needed on your health plan's Website?
1 ☐ Yes
2 ☐ No
|
After P-HL54
Must use P-HL53 if using this item
|
