Section 15, Part A - Medical and Health Expenditures - Screening Questions for Payments
Section 15, Part A collects out-of-pocket medical payments, including payments for medical services,
prescription drug purchases, and rentals or purchases of medical supplies and equipment. IMPORTANT: The Census Bureau does not release to the Bureau of Labor Statistics any confidential information such as names and
addresses. This information is only used during the course of the interview.
Now I am going to ask you some questions about medical payments and
reimbursements. I will begin with your payments.
By payments I mean any expenses paid by any members of your CU
directly to a medical provider by cash, check, or credit card for a
medical service or item. Include all payments, even those for
persons who are outside of your CU.
- Enter 1 to continue
For definitions Information Booklet »
Since the first of the reference month, have you or any members of your CU made any
payments for the following?
* Read each item on list
- Eye examinations, treatment, or surgery
- Purchase of eye glasses or contact lenses
- Dental care
- Inpatient hospital room
- Inpatient hospital services
- Services by medical professionals other than physicians
- Physician services
- Lab tests or x-rays
- Care in convalescent or nursing homes
- Other medical care
- Hearing aids
- Prescribed medicines or prescribed drugs
- Rental of supportive or convalescent equipment
- Purchase of supportive or convalescent equipment
- Rental of medical or surgical equipment for general use
- Purchase of medical or surgical equipment for general use
- 99. None/No more
* Ask if not apparent
Describe the care/service/item.[enter text] _______________
* Ask if not apparent
Who was/were the "care/service/item" for?
- 1. Active member CU "number"
- 95. Non-CU member
* Enter name of person: [enter text] _____________
In what month was(were) the payment(s) made?
[enter text] _____________
* Enter 13 for a continuous expense
What was the total amount paid? [enter value] _____________
* For continuous payments, do not include expenses for the current month
* Enter 'C' for a combined expense
- C
- Not combined expense
What is the "care/service/item" combined with?
* * Enter all that apply
- Eye examinations, treatment, or surgery
- Purchase of eye glasses or contact lenses
- Dental care
- Inpatient hospital room
- Inpatient hospital services
- Services by medical professionals other than physicians
- Physician services
- Lab tests or x-rays
- Care in convalescent or nursing homes
- Other medical care
- Hearing aids
- Prescribed medicines or prescribed drugs
- Rental of supportive or convalescent equipment
- Purchase of supportive or convalescent equipment
- Rental of medical or surgical equipment for general use
- Purchase of medical or surgical equipment for general use
- Misc. combined (unable to specify/DK)
Did you or any members of your CU make any other payments for
the "care/service/item"?
- Yes
- No
End of Section 15A
Go to Section 15 Part B - Screening Questions for Reimbursements »
Go to CE CAPI Survey Instrument Home Page »
Last Modified Date: October 11, 2005