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High Costs In Healthcare
This survey was made to help collect data on how much people are paying for healthcare in America, as well as learning if Americans are getting the aid that they are paying for.
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* Indicates required question
What is your ethnicity?
*
American Indian or Alaskan Native.
Asian / Pacific Islander
Black or African American
Hispanic
White / Caucasian
Prefer not to say.
Do you have health insurance?
*
Yes.
No.
If you answered "No." to having health insurance, why do you not have it?
I cannot afford an insurance plan.
I do not qualify for an insurance plan.
I am not sure how to apply for an insurance plan.
Clear selection
What is your family income?
*
40-50k
50-60k
60-75k
75-90k
100k+
Prefer not to say.
How often do you go to a medical visit?
*
0-2 times a year. (Not often)
2-4 times a year. (Often)
4-6 times a year. (Very often)
If you don't have health insurance, do you pay out of pocket? If so, how much do you usually have to pay?
Your answer
How much of the medical bill does your insurance cover?
0-40% (A little)
40-85% (Almost all of the bill)
85-100% (All of the bill is paid)
Not sure/Would not like to answer.
Clear selection
Do you have a family plan for health insurance?
*
Yes.
No.
When you can't make it to a medical appointment, does the hospital charge you for it?
*
Yes.
No.
Not sure.
When you're getting a prescription, do you have the option for a low-cost treatment?
Yes.
No.
Not sure.
Clear selection
Do you think healthcare should be low-cost, if not free?
*
Yes.
No.
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This form was created inside of West Contra Costa Unified School District.
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