Influence of Health Care Co-Pays Survey

Courage Center is conducting this survey to evaluate how individuals have been affected by recent changes made to the percentage or dollar amount required to be paid by the person using health care services. These payments are called "co-payments or co-pays".

We plan to use this survey, your answers, comments and quotes to determine and report on the outcomes of changing co-payments. The information you give may be used to advocate for reducing co-payments and/or influence future policy decisions pertinent to co-payments. We plan on sharing our results with the public, legislatures and other appropriate parties.

This survey may be completed by anyone living in Minnesota who uses health care services and holds either private or public health insurance, including Medical Assistance. Family members who are aware of the impact of changes in co-payments can also complete the survey.

This survey consists of 14 questions and will take 10 minutes to answer.

This survey is completely anonymous and confidential.

Participation in this survey is entirely voluntary. You need not answer any questions you consider inappropriate.

If you have any questions about this survey and your rights, please contact Nancy Flinn, Courage Center Outcomes & Research Director, at 763-520-0210.

The completion of this survey is your consent to participate in the research.

Please answer the following questions for the person who is responsible for managing co-payments and/or health care utilization and the household budget.

1. Which of the following would describe you? Please indicate only one answer.

Which of the following would describe you? Please indicate only one answer. I am the primary person responsible for managing my health care co-payments.

I am a family member.

Other (please specify)

2. How have co-payments influenced your use of prescription medications or over the counter medication use? Please select all that apply.

How have co-payments influenced your use of prescription medications or over the counter medication use? Please select all that apply. I now pay more for my medication but I fill all of my prescriptions.

I am not able to fill all of my prescriptions each month because of co-payments.

No change

I now pay less for my medication and I fill all of my prescriptions.

I do not use medications.

3. How have co-payments influenced your use of doctors? Please select all that apply.

How have co-payments influenced your use of doctors? Please select all that apply. I now pay more to see my doctor but I go to all of my appointments.

I schedule doctor appointments less than suggested because of co-payments.

I choose to not go to all of my doctor appointments because of co-payments.

I now pay less to see my doctor and I go to all of my appointments.

No change

4. How have co-payments influenced your use of therapy? Please select all that apply.

How have co-payments influenced your use of therapy? Please select all that apply. I now pay more to go to therapy but I go to all of my appointments.

I choose to not go to all of my therapy appointments because of co-payments.

I schedule therapy appointments less than recommended because of co-payments.

I now pay less to go to therapy and I go to all of my appointments.

No change

I do not use therapy services.

5. How have co-payments influenced your use of dentists? Please select all that apply.

How have co-payments influenced your use of dentists? Please select all that apply. I now pay more to see my dentist but I go to all of my appointments.

I schedule dentist appointments less often than suggested because of co-payments.

I choose to not go to all of my dental appointments because of co-payments.

I now pay less to see my dentist and I go to all of my appointments.

No change

I do not use dentist services.

6. How has the change in co-payments influenced how you approach your health care? Please select all that apply.

How has the change in co-payments influenced how you approach your health care? Please select all that apply. Decreased the frequency of services I utilize

Decreased my over-all health

I am now not able to attend all recommended health care services such as appointments.

No change

Increased the frequency of services I utilize

Improved my over-all health

I can now attend all recommended health care services such as appointments.