Health Care Decision Makers
1.
What is your first and last name?
2.
What is your phone number?
3.
What is your email address?
4.
What is your age?
5.
Do you or anyone in your household currently work in any of the following industries or have worked in them in the past 5 years?
Marketing
Market Research
Online Advertising/Digital Marketing
Advertising/PR
Journalism/Media/News/Blogging
Health Insurance
Hospital or Medical Practice
Hospitality
Food or Beverage Company
None of the above
6.
Do you currently live in PA?
7.
When it comes to health care and health insurance decisions in your household, would you say?
I am the primary health care decision maker
I share the responsibility equally with someone else
Someone else in my household is the primary health care decision maker
8.
Do you currently have health insurance coverage?
9.
To your knowledge, does your insurance allow you to go to Allegheny Health Network? (AHN)
10.
How do you obtain your current primary health insurance coverage?
Through your current employer
Through your spouse's current or former employer
Through COBRA
Through a health insurance Exchange or online marketplace (Obamacare)
Purchased from a broker
Purchased directly from a health insurance company
Through Medicare or Medicare Advantage plan
From the Veteran's Administration, TRICARE, or CHAMPUS
Through Medicaid (includes Medical Assistance, ACCESS, BEST Healthcare, Unison, Gateway, Three River's)
Some other way
11.
Other than Medicare coverage provided by the government, do you have any other health insurance such as Medicare Supplement, Medicare Advantage or Medigap plan or health insurance provided through an employer
12.
If you answered previously that you are on Medicare, what is the name of your primary health insurance company (that is the company that provides your Medicare Plan)?
AARP
Aetna
Cigna
Gelsinger Health Plan
Highmark Blue Cross Blue Shield
Humana
UnitedHealthcare/UHC
UPMC Health Plan
Some other brand
13.
Please review the list of healthcare systems below and indicate all those that you are aware of
Allegheny Health Network (AHN)
UPMC
Lake Erie College of Osteopathic Medicine (LEMCOM)
Excela Health System (EHS)
Heritage Valley Health System (HVHS)
None of the above
14.
Have you or any member of your household used any AHN affillated physicians, hospitals, or health care facilities in the past 2 years?
15.
If you answered yes that you used an AHN affiliated facilities in the past 2 years, for whom did it get use for?
Yourself
Child under 18 in my household
Other members of my household
16.
In general, how would you rate your overall health now?
Excellent
Very Good
Good
Fair
Poor
17.
For each of the following types of visits, approximately how many total visits/stays, did you and any household member that you accompanied make to each of the following in the last 12 months
0- no visits
1 visit
2 visits
3-4 visits
5-6 visits
7-9 visits
10+ visits
Don't know
A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics)
0- no visits
1 visit
2 visits
3-4 visits
5-6 visits
7-9 visits
10+ visits
Don't know
An emergency room
0- no visits
1 visit
2 visits
3-4 visits
5-6 visits
7-9 visits
10+ visits
Don't know
An Urgent care or walk-in clinic
0- no visits
1 visit
2 visits
3-4 visits
5-6 visits
7-9 visits
10+ visits
Don't know
A specialist office (including orthopedics, cardiologist, dermatologist, etc.)
0- no visits
1 visit
2 visits
3-4 visits
5-6 visits
7-9 visits
10+ visits
Don't know
A hospital stay where you were admitted as an overnight patient
0- no visits
1 visit
2 visits
3-4 visits
5-6 visits
7-9 visits
10+ visits
Don't know
A hospital, but on an outpatient basis, where you were not admitted for an overnight stay
0- no visits
1 visit
2 visits
3-4 visits
5-6 visits
7-9 visits
10+ visits
Don't know
Telehealth visit
0- no visits
1 visit
2 visits
3-4 visits
5-6 visits
7-9 visits
10+ visits
Don't know
18.
To ensure we have a good cross-section of the population, which of the following best describes your total household income before taxes
Under $10k
$10-25K
$25-50k
$50-75k
$75-100k
$100-150k
Over $150k
19.
Now I'm going to read you a list of statements that may or may not describe you personally. Please rate how well each statement describes you on a scale of 1 to 10, where a 1 means it does not describe you at all and a 10 describes you completely
1
2
3
4
5
6
7
8
9
10
If asked to describe something I know about, I can usually do it in detail
1
2
3
4
5
6
7
8
9
10
I'm uncomfortable talking with others, especially if I haven't met them before
1
2
3
4
5
6
7
8
9
10
Others would describe me as having a strong sense of self
1
2
3
4
5
6
7
8
9
10
I do not see myself as naturally creative
1
2
3
4
5
6
7
8
9
10
I like to reflect about thigs in order to make new discoveries about myself
1
2
3
4
5
6
7
8
9
10
I have trouble expressing my thoughts and feelings
1
2
3
4
5
6
7
8
9
10
I consider myself very articulate
1
2
3
4
5
6
7
8
9
10
20.
Do you have daily access to a computer with high-speed internet access? By computer, we mean a traditional laptop or desktop machine, NOT a tablet or mobile device.
21.
On average, how often do you use the internet?
I'm pretty much always online
More than once a day
Once a day
A few times a week
Once a week
Less than once a week
22.
This study will require you to watch videos with sound and rate the videos using your computer mouse. Do you have working speakers and a working mouse on your computer?
23.
Do you currently have a working webcam on your computer that you are comfortable recording yourself with?
Current Progress,
0 of 23 answered