Cost-Related Unmet Health Needs Survey

The questions below focus on the experiences of your organization’s members regarding affordability barriers across a broad range of clinical and support areas. Notably, If you have summaries of experiences or stories that received strong reactions—such as those that touched you deeply or sparked important discussion—please share them.
Responses will be kept confidential and analyzed collectively.

	Not at all true	Slightly true	Moderately true	Very true	Extremely true
Members could not afford to buy necessary prescribed medicines	Members could not afford to buy necessary prescribed medicines Not at all true	Members could not afford to buy necessary prescribed medicines Slightly true	Members could not afford to buy necessary prescribed medicines Moderately true	Members could not afford to buy necessary prescribed medicines Very true	Members could not afford to buy necessary prescribed medicines Extremely true
Members could not afford to buy non-prescribed medicines	Members could not afford to buy non-prescribed medicines Not at all true	Members could not afford to buy non-prescribed medicines Slightly true	Members could not afford to buy non-prescribed medicines Moderately true	Members could not afford to buy non-prescribed medicines Very true	Members could not afford to buy non-prescribed medicines Extremely true
The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use	The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Not at all true	The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Slightly true	The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Moderately true	The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Very true	The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Extremely true
Members had to delay or forgo a visit to a family doctor because of the cost	Members had to delay or forgo a visit to a family doctor because of the cost Not at all true	Members had to delay or forgo a visit to a family doctor because of the cost Slightly true	Members had to delay or forgo a visit to a family doctor because of the cost Moderately true	Members had to delay or forgo a visit to a family doctor because of the cost Very true	Members had to delay or forgo a visit to a family doctor because of the cost Extremely true
Members had to delay or forgo a visit to a medical specialist because of the cost	Members had to delay or forgo a visit to a medical specialist because of the cost Not at all true	Members had to delay or forgo a visit to a medical specialist because of the cost Slightly true	Members had to delay or forgo a visit to a medical specialist because of the cost Moderately true	Members had to delay or forgo a visit to a medical specialist because of the cost Very true	Members had to delay or forgo a visit to a medical specialist because of the cost Extremely true
The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use	The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Not at all true	The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Slightly true	The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Moderately true	The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Very true	The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Extremely true
High costs prevented members from accessing necessary hospital or diagnostic services	High costs prevented members from accessing necessary hospital or diagnostic services Not at all true	High costs prevented members from accessing necessary hospital or diagnostic services Slightly true	High costs prevented members from accessing necessary hospital or diagnostic services Moderately true	High costs prevented members from accessing necessary hospital or diagnostic services Very true	High costs prevented members from accessing necessary hospital or diagnostic services Extremely true
Dental care (routine or urgent) was not affordable for the members	Dental care (routine or urgent) was not affordable for the members Not at all true	Dental care (routine or urgent) was not affordable for the members Slightly true	Dental care (routine or urgent) was not affordable for the members Moderately true	Dental care (routine or urgent) was not affordable for the members Very true	Dental care (routine or urgent) was not affordable for the members Extremely true
Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs	Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Not at all true	Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Slightly true	Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Moderately true	Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Very true	Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Extremely true
Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost	Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Not at all true	Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Slightly true	Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Moderately true	Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Very true	Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Extremely true
Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members	Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Not at all true	Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Slightly true	Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Moderately true	Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Very true	Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Extremely true
The costs of personal assistance or home nursing services were a barrier for members	The costs of personal assistance or home nursing services were a barrier for members Not at all true	The costs of personal assistance or home nursing services were a barrier for members Slightly true	The costs of personal assistance or home nursing services were a barrier for members Moderately true	The costs of personal assistance or home nursing services were a barrier for members Very true	The costs of personal assistance or home nursing services were a barrier for members Extremely true
Members missed medical appointments or therapies because they could not afford transportation needing support	Members missed medical appointments or therapies because they could not afford transportation needing support Not at all true	Members missed medical appointments or therapies because they could not afford transportation needing support Slightly true	Members missed medical appointments or therapies because they could not afford transportation needing support Moderately true	Members missed medical appointments or therapies because they could not afford transportation needing support Very true	Members missed medical appointments or therapies because they could not afford transportation needing support Extremely true
Members used savings or went into debt to afford essential healthcare	Members used savings or went into debt to afford essential healthcare Not at all true	Members used savings or went into debt to afford essential healthcare Slightly true	Members used savings or went into debt to afford essential healthcare Moderately true	Members used savings or went into debt to afford essential healthcare Very true	Members used savings or went into debt to afford essential healthcare Extremely true
Members can not afford essential social care	Members can not afford essential social care Not at all true	Members can not afford essential social care Slightly true	Members can not afford essential social care Moderately true	Members can not afford essential social care Very true	Members can not afford essential social care Extremely true
Other	Other Not at all true	Other Slightly true	Other Moderately true	Other Very true	Other Extremely true

Not at all true

Slightly true

Moderately true

Very true

Extremely true

Members could not afford to buy necessary prescribed medicines

Members could not afford to buy necessary prescribed medicines Not at all true

Members could not afford to buy necessary prescribed medicines Slightly true

Members could not afford to buy necessary prescribed medicines Moderately true

Members could not afford to buy necessary prescribed medicines Very true

Members could not afford to buy necessary prescribed medicines Extremely true

Members could not afford to buy non-prescribed medicines

Members could not afford to buy non-prescribed medicines Not at all true

Members could not afford to buy non-prescribed medicines Slightly true

Members could not afford to buy non-prescribed medicines Moderately true

Members could not afford to buy non-prescribed medicines Very true

Members could not afford to buy non-prescribed medicines Extremely true

The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use

The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Not at all true

The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Slightly true

The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Moderately true

The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Very true

The cost of medical supplies (e.g., catheters, wound dressings, nutritional formulas) led the members to skip or reduce use Extremely true

Members had to delay or forgo a visit to a family doctor because of the cost

Members had to delay or forgo a visit to a family doctor because of the cost Not at all true

Members had to delay or forgo a visit to a family doctor because of the cost Slightly true

Members had to delay or forgo a visit to a family doctor because of the cost Moderately true

Members had to delay or forgo a visit to a family doctor because of the cost Very true

Members had to delay or forgo a visit to a family doctor because of the cost Extremely true

Members had to delay or forgo a visit to a medical specialist because of the cost

Members had to delay or forgo a visit to a medical specialist because of the cost Not at all true

Members had to delay or forgo a visit to a medical specialist because of the cost Slightly true

Members had to delay or forgo a visit to a medical specialist because of the cost Moderately true

Members had to delay or forgo a visit to a medical specialist because of the cost Very true

Members had to delay or forgo a visit to a medical specialist because of the cost Extremely true

The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use

The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Not at all true

The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Slightly true

The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Moderately true

The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Very true

The cost of rehabilitation services (physiotherapy, occupational, speech therapy) was too high for the members’ regular use Extremely true

High costs prevented members from accessing necessary hospital or diagnostic services

High costs prevented members from accessing necessary hospital or diagnostic services Not at all true

High costs prevented members from accessing necessary hospital or diagnostic services Slightly true

High costs prevented members from accessing necessary hospital or diagnostic services Moderately true

High costs prevented members from accessing necessary hospital or diagnostic services Very true

High costs prevented members from accessing necessary hospital or diagnostic services Extremely true

Dental care (routine or urgent) was not affordable for the members

Dental care (routine or urgent) was not affordable for the members Not at all true

Dental care (routine or urgent) was not affordable for the members Slightly true

Dental care (routine or urgent) was not affordable for the members Moderately true

Dental care (routine or urgent) was not affordable for the members Very true

Dental care (routine or urgent) was not affordable for the members Extremely true

Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs

Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Not at all true

Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Slightly true

Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Moderately true

Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Very true

Psychological counseling or psychiatric treatment was unaffordable due to out-of-pocket costs Extremely true

Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost

Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Not at all true

Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Slightly true

Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Moderately true

Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Very true

Members were not able to purchase or repair necessary assistive devices (e.g., mobility/communication aids) due to cost Extremely true

Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members

Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Not at all true

Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Slightly true

Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Moderately true

Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Very true

Home adaptations needed for independent living (e.g., ramps, accessible bathroom) were out of financial reach for the members Extremely true

The costs of personal assistance or home nursing services were a barrier for members

The costs of personal assistance or home nursing services were a barrier for members Not at all true

The costs of personal assistance or home nursing services were a barrier for members Slightly true

The costs of personal assistance or home nursing services were a barrier for members Moderately true

The costs of personal assistance or home nursing services were a barrier for members Very true

The costs of personal assistance or home nursing services were a barrier for members Extremely true

Members missed medical appointments or therapies because they could not afford transportation needing support

Members missed medical appointments or therapies because they could not afford transportation needing support Not at all true

Members missed medical appointments or therapies because they could not afford transportation needing support Slightly true

Members missed medical appointments or therapies because they could not afford transportation needing support Moderately true

Members missed medical appointments or therapies because they could not afford transportation needing support Very true

Members missed medical appointments or therapies because they could not afford transportation needing support Extremely true

Members used savings or went into debt to afford essential healthcare

Members used savings or went into debt to afford essential healthcare Not at all true

Members used savings or went into debt to afford essential healthcare Slightly true

Members used savings or went into debt to afford essential healthcare Moderately true

Members used savings or went into debt to afford essential healthcare Very true

Members used savings or went into debt to afford essential healthcare Extremely true

Members can not afford essential social care

Members can not afford essential social care Not at all true

Members can not afford essential social care Slightly true

Members can not afford essential social care Moderately true

Members can not afford essential social care Very true

Members can not afford essential social care Extremely true

Other

Other Not at all true

Other Slightly true

Other Moderately true

Other Very true

Other Extremely true

Cost-Related Unmet Health Needs

Question Title

* For each statement, please indicate how true it is for your members in need in the past 12 months.