Houston Studies - Healthcare December 2017

Introduction Section

Plaza Research Houston is conducting a discussion with 50-64 year old consumers on Healthcare. The discussion will take place on Tuesday, December 19th or Thursday, December 21, 2017 throughout the day. If you qualify and participate, you will $150 for 2.25-hours of your time.

Please answer the questions below. If you look like a match, we will contact you by telephone.

**Due to the large response to our surveys, we are only able to contact those that look like a match. Please continue to answer future studies, as you may be a match to those.

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* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

Name:

ZIP/Postal Code:

Email Address:

Phone Number:

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* 2. Alternate Contact number

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* 3. What is your age? Whole number, no ranges or words

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* 4. Who in your household is responsible for selecting the family doctor or specialists you and your family use?

I am primary

I share with others

Someone else

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* 5. What is your gender?

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* 6. How do you pay for Primary Care visits, hospital and other medical services?

HMO, PPO, POS insurance plan provided by my employer or purchased from a third party

Indemnity or Fee-For-Service insurance plan provided by my employer or purchased from a third party

Insurance plan sponsored by the government (Medicare, Medicare Advantage, Medicaid, VA, Military or CHAMPUS)

Pay for visits with cash, check or credit card without insurance

I nor anyone in my household is covered by any type of health insurance

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* 7. Which of the following area hospitals have you ever heard of?

Houston Northwest Medical Center

Lyndon B. Johnson General Hospital

MD Anderson Cancer Center

Memorial-Herman Medical Center or Memorial-Herman Community Hospital

Houston Methodist Hospital (formerly Methodist Hospital)

CHI St. Luke’s Hospital

Texas Children’s Hospital

None of the above

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* 8. Which of the following area hospitals would you consider visiting for your healthcare needs, if any?

Houston Northwest Medical Center

Lyndon B. Johnson General Hospital

MD Anderson Cancer Center

Memorial-Herman Medical Center or Memorial-Herman Community Hospital

Houston Methodist Hospital (formerly Methodist Hospital)

CHI St. Luke’s Hospital

Texas Children’s Hospital

None of the above

Other (please specify)

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* 9. Have you or has your significant other had a partial or full joint replacement of the hip, knee, ankle, wrist, shoulder or elbow at a Houston area facility in the past two years?

Yes