I_D. Health Care Access and Utilization (HC)

I_D. Health Care Access and Utilization (HC) of LASI 2017-2019

item label type description
HC001 Question The next questions pertain to medical facilities or medical providers you may have visited for care during the last 12 months.
HC002 Question In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options]
HC003 Question In the past 12 months, have you consulted any health care provider? [Please identify ALL healthcare providers that you have visited] [Instruction for CAPI: If response is i, freeze all other options]
HC004 Question [Ask only if HC002 <= o or HC003 <= h] What were the reasons of your last visit to the healthcare facility? [Multiple answers are allowed]
HC005 Question [Ask if HC002=p and HC003= j] What was your main reason for not seeking a visit?
HC006 Question [Ask only if HC003 < i] In the past 12 months, did a health care provider ever recommend you to go to the hospital?
HC007 Question [Ask if HC002=a, k,l,m,n,o and HC006=1 ]What were the reasons you decided against going to a hospital? [Multiple answers are allowed]
HC101 Question I am going to ask you some questions on how you would pay for expenses incurred for health care if you were to fall ill or sustain an injury.
HC102 Question Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.]
HC103 Question [Ask only if HC102=1] What types of health insurance are you covered by? [Multiple answers are allowed]
HC104 Question [Ask only if HC102=1] What does this health insurance cover ()? [Multiple answers are allowed] [Instruction to the Interviewer: Record the covered services as per the respondents answer]
HC105 Question [Ask only if HC102=1] In which month and year did you first purchase/enroll in the health insurance policy which provides? _______Month [Hard check: if < 1or >12] _________Year [Hard check: if < 1954]
HC106 Question [Ask only if HC102=1] When did this health insurance benefit begin? _______Month [Hard check: if < 1or >12] _________Year [Hard check: if < 1954]
HC107 Question [Ask only if HC102=1] What was the amount of last premium(per year) paid for this policy (In rupees)? [Instruction for the interviewer: Enter 0 if no premium paid per year] __________Rs/year [Soft check: > 35,000 Rs.]
HC108 Question [Ask only if HC102=1] What is the maximum amount of insurance coverage (in rupees)? [Instruction for the interviewer: Enter 9 if total amount will be reimbursed by the organization/company where he/she works] _____________Rs. [Soft check: > 50, 00, 000 Rs.]
HC109 Question [Ask only if HC102=2] What is the main reason for not having health insurance?
HC201 Question [Ask only if HC002= b to j] The following questions pertain to hospitalization (inpatient care) that you have had during the past 12 months.
HC202 Question [Ask only if HC002=b to j] Over the last 12 months, how many times you were admitted as patient to a hospital/long-term care facility for at least one night? [[Instruction for the interviewer: If R did not stay at hospital, enter ‘0’ for none] ________Tim
HC203 Question [Ask only if HC202. 1] How many nights have you spent in the hospital during the past 12 months? Number of nights ____ [Hard check: <1]
HC204 Question [Ask only if HC202>=1] For the last hospitalization, how many months ago were you admitted to the hospital? [Instruction for the interviewer: This question asks how many months ago and not in which month the respondent was admitted. Please be careful while filling the answer, enter 0if less than one month ] Months ago ____ [Hard check: if < 1or >12] [Hard check: if < 1or >=53]
HC205 Question [Ask only if HC202 . 1] Which type of facility did you visit during your last hospitalization?
HC206 Question [Ask only if HC202 . 1] How many nights did you spend in the hospital during your last hospitalization? Number of nights ____ [Hard check: > 1]
HC207 Question [Ask only if HC206 . 1] Why were you hospitalized?
HC208 Question [Ask only if HC207=1 or 2] What is the main reason of your last hospitalization?
HC209 Question [Ask only if HC206.1] During your last hospitalization, what kind of treatment/services did you receive? [Multiple answers are allowed]
HC210 Question [Ask only if HC206.1] In your recent visit, how much did you or your household pay for: [Instruction for the Interviewer: Only one response for each category is possible. Either fill the amount or enter 0 if service is free or record dont know or not applicable.]
HC210a1 Question In your recent visit, how much did you or your household pay for: Health care providers fees (consultation charges)
HC210a2 Question In your recent visit, how much did you or your household pay for: Medicines from hospital
HC210a3 Question In your recent visit, how much did you or your household pay for: Medicines from outside
HC210a4 Question In your recent visit, how much did you or your household pay for: Tests/investigation
HC210a5 Question In your recent visit, how much did you or your household pay for: Hospital and nursing home charges including bed charges, food
HC210a6 Question In your recent visit, how much did you or your household pay for: Operation theater charges, surgery charges and related expenses
HC210a7 Question In your recent visit, how much did you or your household pay for: Blood, oxygen cylinder
HC210a8 Question In your recent visit, how much did you or your household pay for: Transportation
HC210a9 Question In your recent visit, how much did you or your household pay for: Expenses of the accompanying person(s) (food / accommodation)
HC210a10 Question In your recent visit, how much did you or your household pay for: Expenditure not elsewhere reported (others)
HC210b Question [Ask if respondent answered Dont know or Refused to any of the category in HC210a] What was the total amount that you or your household spent on this visit? Total expenditure________ [Hard check: HC210b < sum of HC210a (1-10)]
HC211a Question What were the sources through which you met the expenses for health care and what is the amount covered? Personal income
HC211b Question What were the sources through which you met the expenses for health care and what is the amount covered? Household income excluding personal income
HC211c Question What were the sources through which you met the expenses for health care and what is the amount covered? Savings
HC211d Question What were the sources through which you met the expenses for health care and what is the amount covered? Loans (bank/friends/relatives)
HC211e Question What were the sources through which you met the expenses for health care and what is the amount covered? Contribution from friends/relatives
HC211f Question What were the sources through which you met the expenses for health care and what is the amount covered? Selling assets/property
HC211g Question What were the sources through which you met the expenses for health care and what is the amount covered? Insurance coverage
HC211h Question What were the sources through which you met the expenses for health care and what is the amount covered? Reimbursement from employer
HC211i Question What were the sources through which you met the expenses for health care and what is the amount covered? Other, please specify _______
HC212 Question Who took care of you most of the time when you were admitted in the hospital?
HC213 Question [Ask only if HC206.1] Were you working at the time when you were last hospitalized?
HC214 Question Could you say how many person (work) days you and the person(s) accompanying you lost due to sickness? [Enter 0if the respondent did not miss any working days] (Ask only if HC213=1) Yours _______ (Ask only if HC 212<16) Accompanying person(s)______
HC215 Question [Ask only if HC206.1] What was your health status when you left the hospital?
HC216 Question [Ask only if HC215!= 1 or 4] Why did you want to leave the hospital before you were recovered? [Multiple answers are allowed]
HC217 Question [Ask only if HC206.1] Do you still suffer from the ailment you originally sought treatment for?
HC218 Question Did your treatment continue after discharge?
HC219 Question [Ask only if HC218=1] How long was the duration of treatment after discharge? [Hard check: Allow to enter number only for one option and at the same time freeze remaining options]
HC220 Question How many kilometers from your residence is the health care facility in which you were most recently admitted? Distance to health care facility: ________km [Soft check: >1000 km]
HC221 Question What is your travel time (one-way) to that facility? ______Hours AND ___ minutes [Hard check (For Minutes): Should not be >59 minutes]
HC222 Question What was the main transportation mode you used last time when you visited that facility?
HC223 Question [Ask only if HC206.1]After hospitalization, what was the change in your health condition? [Instruction for the interviewer: Read options to respondent]
HC224 Question For your last hospitalization or stay at long-term care facility, how would you rate the following: ....your experience about the length of the time you waited before being attended to
HC225 Question For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of being treated respectfully
HC226 Question For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of how clearly health care providers explained things to you
HC227 Question For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience the way the health care staff ensured that you could talk privately to providers
HC228 Question For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of seeing a health care provider of your choice
HC229 Question For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of the cleanliness in the health facility
HC230 Question [Ask only if HC206.1] Overall, how satisfied were you with healthcare you received during the hospital stay?
HC301 Question [Ask only if HC003 < i] I would like to ask you some questions about your consultation with a healthcare provider including folk healers (outpatient) in the past 12 months.
HC302 Question [Ask only if HC00310 times]
HC303 Question [Ask only if HC302>0] In which month and year was your most recent visit? Month: ____ [Hard check: 1-12] Year: ______ [2015-2016]
HC304 Question [Ask only if HC302>0] Which type of health care provider did you visit, or came to visit you, most recently in the past 12 months?
HC305 Question [Ask only if HC302>0] Which type of facility did you last visit to see that healthcare provider?
HC306 Question [Ask only if HC302>0] What was the main purpose of your visit?
HC307 Question [Ask only if HC306=d or e] What is the main reason of your recent outpatient visit? [Instruction for the interviewer: Please ask to see the medical records if available]
HC308 Question [Ask only if HC306=d or e]What kind of treatment and/or diagnostics did you receive? [Multiple answers are allowed]
HC309a1 Question In your last visit how much you or your household pays for: Health care providers fees (consultation charges)
HC309a2 Question In your last visit how much you or your household pays for: Medicines from hospital
HC309a3 Question In your last visit how much you or your household pays for: Medicine from outside
HC309a4 Question In your last visit how much you or your household pays for: Tests/investigation
HC309a5 Question In your last visit how much you or your household pays for: Hospital and nursing home charges including food charges etc.
HC309a6 Question In your last visit how much you or your household pays for: Operation theater charges, surgery charges and related expenses
HC309a7 Question In your last visit how much you or your household pays for: Blood, Oxygen, Cylinder
HC309a8 Question In your last visit how much you or your household pays for: Transport
HC309a9 Question In your last visit how much you or your household pays for: Expenses of the accompanying person(s) (food, accommodation)
HC309a10 Question In your last visit how much you or your household pays for: Expenditure not elsewhere reported (others)
HC309b Question [Ask if respondent Dont know or Refused to answer any of the category in HC309a] What was the total amount that you or your household spent on this visit? Total expenditure____________ Hard check: HC309b < sum of HC309a (1-10)]
HC310a Question What are the sources through which you meet the expenses for health care and the amount covered? Personal Income
HC310b Question What are the sources through which you meet the expenses for health care and the amount covered? Household income excluding personal income
HC310c Question What are the sources through which you meet the expenses for health care and the amount covered? Saving
HC310d Question What are the sources through which you meet the expenses for health care and the amount covered? Loans (bank/friends/relatives)
HC310e Question What are the sources through which you meet the expenses for health care and the amount covered? Contribution from friends/relatives
HC310f Question What are the sources through which you meet the expenses for health care and the amount covered? Selling assets/property
HC310g Question What are the sources through which you meet the expenses for health care and the amount covered? Insurance coverage
HC310h Question What are the sources through which you meet the expenses for health care and the amount covered? Reimbursement from employer
HC310i Question What are the sources through which you meet the expenses for health care and the amount covered? Other, please specify________
HC311 Question [Ask only if HC302>0] Could you say how many person (work) hours you and the person(s) accompanying you lost due to the sickness associated with your last hospital visit? [Instruction for the interviewer: Please enter 0 if the respondent did not miss any working hour] Yours__________ Accompanying person(s)____________
HC312 Question Who accompanied you during your most recent outpatient visit?
HC313 Question [Ask only if HC306!=a] Do you still suffer from the ailment you originally sought treatment for?
HC314 Question [Ask only if HC305 != 14] How many kilometers is the health care facility from your residence? Distance to medical facility: ____________km [Soft check: >50 Km]
HC315 Question [Ask only if HC305 != 14] What was your travel time (one-way) to that facility? ______Hours AND ___ minutes [Hard check (For Minutes): Should not be >60 minutes]
HC316 Question [Ask only if HC305 != 14] What was the main transportation mode you used last time you visited that facility?
HC317 Question [Ask only if HC306!=a] What was the outcome of your most recent visit to the health care provider? [Instruction for the interviewer: Read options to respondent]
HC318 Question For your last visit to a hospital or health care facility, how would you rate the following: ...your experience about the length of time you waited before being attended to
HC319 Question For your last visit to a hospital or health care facility, how would you rate the following: ...your experience of being treated respectfully
HC320 Question For your last visit to a hospital or health care facility, how would you rate the following: your experience how clearly health care providers explained things to you
HC321 Question For your last visit to a hospital or health care facility, how would you rate the following: ...your experience of the way the health care staff is ensured that you could talk privately to providers
HC322 Question For your last visit to a hospital or health care facility, how would you rate the following: your experience of getting a health care provider of your choice
HC323 Question For your last visit to a hospital or health care facility, how would you rate the following: ...your experience about the cleanliness in the health facility
HC324 Question [Ask only if HC302>0]Overall, how satisfied were you with health care you received at this visit?
HC325 Question [Ask only if HC302>0] How much in total did you spend on all your outpatient visits to health care facilities/providers (including your most recent visit) during last 12 months? ______Rs. (total amount spent) [Soft check: > 5000 Rs.] [Hard check:
HC326 Question During the past 12 months, have you used any of the following medications or health supplements without consulting a healthcare provider? Do not include the medicines you have already mentioned earlier in inpatient and outpatient sections. [Multiple answers are allowed] [Instruction for CAPI: If response is d, freeze all other options]
HC327 Question [Ask only if HC326 5000 Rs.]
HC328a Question How much of this amount was reimbursed by Government employer
HC328b Question How much of this amount was reimbursed by Private Employer
HC328c Question How much of this amount was reimbursed by Medical Insurance Company
HC328d Question How much of this amount was reimbursed by Other Agencies
HC328e Question How much of this amount was reimbursed by None [For the Interviewer]
HC329 Question How often did the respondent receive assistance in answering this section?
HC331 Question [Ask only if HC329>1]=1] What is his/her relationship to [R]? [Instruction for the interviewer: If unknown, please ask to the proxy.]
Start of I_D. Health Care Access and Utilization (HC)
 
HC001

The next questions pertain to medical facilities or medical providers you may have visited for care during the last 12 months.

THE NEXT QUESTIONS PERTAIN TO MEDICAL FACILITIES OR MEDICAL PROVIDERS YOU MAY HAVE VISITED FOR CARE DURING THE LAST 12 MONTHS.
 
HC002

In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options]

IN THE PAST 12 MONTHS, HAVE YOU VISITED ANY HEALTH CARE FACILITY OR ANY HEALTH PROFESSIONAL HAS VISITED YOU? [PLEASE IDENTIFY ALL THE FACILITIES THAT YOU HAVE VISITED] [INSTRUCTION FOR CAPI: IF RESPONSE IS P FREEZE ALL OTHER OPTIONS]
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HC003

In the past 12 months, have you consulted any health care provider? [Please identify ALL healthcare providers that you have visited] [Instruction for CAPI: If response is i, freeze all other options]

IN THE PAST 12 MONTHS, HAVE YOU CONSULTED ANY HEALTH CARE PROVIDER? [PLEASE IDENTIFY ALL HEALTHCARE PROVIDERS THAT YOU HAVE VISITED] [INSTRUCTION FOR CAPI: IF RESPONSE IS I, FREEZE ALL OTHER OPTIONS]
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If In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options] <= 0 or HC003 <= h »
 
   
 
HC004

[Ask only if HC002 <= o or HC003 <= h] What were the reasons of your last visit to the healthcare facility? [Multiple answers are allowed]

[ASK ONLY IF HC002 <= O OR HC003 <= H] WHAT WERE THE REASONS OF YOUR LAST VISIT TO THE HEALTHCARE FACILITY? [MULTIPLE ANSWERS ARE ALLOWED]
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If In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options] = p or HC003 = j »
 
   
 
HC005

[Ask if HC002=p and HC003= j] What was your main reason for not seeking a visit?

[ASK IF HC002=P AND HC003= J] WHAT WAS YOUR MAIN REASON FOR NOT SEEKING A VISIT?
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If In the past 12 months, have you consulted any health care provider? [Please identify ALL healthcare providers that you have visited] [Instruction for CAPI: If response is i, freeze all other options] < i »
 
   
 
HC006

[Ask only if HC003 < i] In the past 12 months, did a health care provider ever recommend you to go to the hospital?

[ASK ONLY IF HC003 < I] IN THE PAST 12 MONTHS, DID A HEALTH CARE PROVIDER EVER RECOMMEND YOU TO GO TO THE HOSPITAL?
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If In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options] = a, k, l, m, n, o and HC006 =1 »
 
     
   
HC007

[Ask if HC002=a, k,l,m,n,o and HC006=1 ]What were the reasons you decided against going to a hospital? [Multiple answers are allowed]

[ASK IF HC002=A, K,L,M,N,O AND HC006=1 ]WHAT WERE THE REASONS YOU DECIDED AGAINST GOING TO A HOSPITAL? [MULTIPLE ANSWERS ARE ALLOWED]
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HC101

I am going to ask you some questions on how you would pay for expenses incurred for health care if you were to fall ill or sustain an injury.

I AM GOING TO ASK YOU SOME QUESTIONS ON HOW YOU WOULD PAY FOR EXPENSES INCURRED FOR HEALTH CARE IF YOU WERE TO FALL ILL OR SUSTAIN AN INJURY.
 
HC102

Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.]

ARE YOU COVERED BY HEALTH INSURANCE? [INSTRUCTION FOR THE INTERVIEWER: INTERVIEWER SHOULD EXPLAIN ABOUT HEALTH INSURANCE AS A TYPE OF INSURANCE COVERAGE THAT PAYS FOR MEDICAL AND SURGICAL EXPENSES THAT ARE INCURRED BY THE INSURED. HEALTH INSURANCE CAN EITHER REIMBURSE THE INSURED FOR EXPENSES INCURRED FROM ILLNESS OR INJURY OR PAY THE CARE PROVIDER DIRECTLY.]
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If Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.] = 1 Yes 2 No Go to HC109  »
 
   
 
HC103

[Ask only if HC102=1] What types of health insurance are you covered by? [Multiple answers are allowed]

[ASK ONLY IF HC102=1] WHAT TYPES OF HEALTH INSURANCE ARE YOU COVERED BY? [MULTIPLE ANSWERS ARE ALLOWED]
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HC104

[Ask only if HC102=1] What does this health insurance cover ()? [Multiple answers are allowed] [Instruction to the Interviewer: Record the covered services as per the respondents answer]

[ASK ONLY IF HC102=1] WHAT DOES THIS HEALTH INSURANCE COVER ()? [MULTIPLE ANSWERS ARE ALLOWED] [INSTRUCTION TO THE INTERVIEWER: RECORD THE COVERED SERVICES AS PER THE RESPONDENTS ANSWER]
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If Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.] = 1 Yes 2 No Go to HC109  »
 
   
 
HC105

[Ask only if HC102=1] In which month and year did you first purchase/enroll in the health insurance policy which provides? _______Month [Hard check: if < 1or >12] _________Year [Hard check: if < 1954]

[ASK ONLY IF HC102=1] IN WHICH MONTH AND YEAR DID YOU FIRST PURCHASE/ENROLL IN THE HEALTH INSURANCE POLICY WHICH PROVIDES? _______MONTH [HARD CHECK: IF < 1OR >12] _________YEAR [HARD CHECK: IF < 1954]
   
 
HC106

[Ask only if HC102=1] When did this health insurance benefit begin? _______Month [Hard check: if < 1or >12] _________Year [Hard check: if < 1954]

[ASK ONLY IF HC102=1] WHEN DID THIS HEALTH INSURANCE BENEFIT BEGIN? _______MONTH [HARD CHECK: IF < 1OR >12] _________YEAR [HARD CHECK: IF < 1954]
   
 
HC107

[Ask only if HC102=1] What was the amount of last premium(per year) paid for this policy (In rupees)? [Instruction for the interviewer: Enter 0 if no premium paid per year] __________Rs/year [Soft check: > 35,000 Rs.]

[ASK ONLY IF HC102=1] WHAT WAS THE AMOUNT OF LAST PREMIUM(PER YEAR) PAID FOR THIS POLICY (IN RUPEES)? [INSTRUCTION FOR THE INTERVIEWER: ENTER 0 IF NO PREMIUM PAID PER YEAR] __________RS/YEAR [SOFT CHECK: > 35,000 RS.]
   
 
HC108

[Ask only if HC102=1] What is the maximum amount of insurance coverage (in rupees)? [Instruction for the interviewer: Enter 9 if total amount will be reimbursed by the organization/company where he/she works] _____________Rs. [Soft check: > 50, 00, 000 Rs.]

[ASK ONLY IF HC102=1] WHAT IS THE MAXIMUM AMOUNT OF INSURANCE COVERAGE (IN RUPEES)? [INSTRUCTION FOR THE INTERVIEWER: ENTER 9 IF TOTAL AMOUNT WILL BE REIMBURSED BY THE ORGANIZATION/COMPANY WHERE HE/SHE WORKS] _____________RS. [SOFT CHECK: > 50, 00, 000 RS.]
   
If Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.] = 2 »
 
   
 
HC109

[Ask only if HC102=2] What is the main reason for not having health insurance?

[ASK ONLY IF HC102=2] WHAT IS THE MAIN REASON FOR NOT HAVING HEALTH INSURANCE?
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If In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options] = b to j »
 
   
 
HC201

[Ask only if HC002= b to j] The following questions pertain to hospitalization (inpatient care) that you have had during the past 12 months.

[ASK ONLY IF HC002= B TO J] THE FOLLOWING QUESTIONS PERTAIN TO HOSPITALIZATION (INPATIENT CARE) THAT YOU HAVE HAD DURING THE PAST 12 MONTHS.
   
 
HC202

[Ask only if HC002=b to j] Over the last 12 months, how many times you were admitted as patient to a hospital/long-term care facility for at least one night? [[Instruction for the interviewer: If R did not stay at hospital, enter ‘0’ for none] ________Tim

[ASK ONLY IF HC002=B TO J] OVER THE LAST 12 MONTHS, HOW MANY TIMES YOU WERE ADMITTED AS PATIENT TO A HOSPITAL/LONG-TERM CARE FACILITY FOR AT LEAST ONE NIGHT? [[INSTRUCTION FOR THE INTERVIEWER: IF R DID NOT STAY AT HOSPITAL, ENTER ‘0’ FOR NONE] ________TIMES [SOFT CHECK: >10] [INSTRUCTION FOR CAPI: IF HC202 =0 GO TO → HC301_INTRO.]
   
 
If [Ask only if HC002=b to j] Over the last 12 months, how many times you were admitted as patient to a hospital/long-term care facility for at least one night? [[Instruction for the interviewer: If R did not stay at hospital, enter ‘0’ for none] ________Tim >= 1 »
 
     
   
HC203

[Ask only if HC202. 1] How many nights have you spent in the hospital during the past 12 months? Number of nights ____ [Hard check: <1]

[ASK ONLY IF HC202. 1] HOW MANY NIGHTS HAVE YOU SPENT IN THE HOSPITAL DURING THE PAST 12 MONTHS? NUMBER OF NIGHTS ____ [HARD CHECK: <1]
     
   
HC204

[Ask only if HC202>=1] For the last hospitalization, how many months ago were you admitted to the hospital? [Instruction for the interviewer: This question asks how many months ago and not in which month the respondent was admitted. Please be careful while filling the answer, enter 0if less than one month ] Months ago ____ [Hard check: if < 1or >12] [Hard check: if < 1or >=53]

[ASK ONLY IF HC202>=1] FOR THE LAST HOSPITALIZATION, HOW MANY MONTHS AGO WERE YOU ADMITTED TO THE HOSPITAL? [INSTRUCTION FOR THE INTERVIEWER: THIS QUESTION ASKS HOW MANY MONTHS AGO AND NOT IN WHICH MONTH THE RESPONDENT WAS ADMITTED. PLEASE BE CAREFUL WHILE FILLING THE ANSWER, ENTER 0IF LESS THAN ONE MONTH ] MONTHS AGO ____ [HARD CHECK: IF < 1OR >12] [HARD CHECK: IF < 1OR >=53]
     
   
HC205

[Ask only if HC202 . 1] Which type of facility did you visit during your last hospitalization?

[ASK ONLY IF HC202 . 1] WHICH TYPE OF FACILITY DID YOU VISIT DURING YOUR LAST HOSPITALIZATION?
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HC206

[Ask only if HC202 . 1] How many nights did you spend in the hospital during your last hospitalization? Number of nights ____ [Hard check: > 1]

[ASK ONLY IF HC202 . 1] HOW MANY NIGHTS DID YOU SPEND IN THE HOSPITAL DURING YOUR LAST HOSPITALIZATION? NUMBER OF NIGHTS ____ [HARD CHECK: > 1]
     
   
If [Ask only if HC202 . 1] How many nights did you spend in the hospital during your last hospitalization? Number of nights ____ [Hard check: > 1] >= 1 »
 
       
     
HC207

[Ask only if HC206 . 1] Why were you hospitalized?

[ASK ONLY IF HC206 . 1] WHY WERE YOU HOSPITALIZED?
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If [Ask only if HC206 . 1] Why were you hospitalized? = 1 or 2 »
 
         
       
HC208

[Ask only if HC207=1 or 2] What is the main reason of your last hospitalization?

[ASK ONLY IF HC207=1 OR 2] WHAT IS THE MAIN REASON OF YOUR LAST HOSPITALIZATION?
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HC209

[Ask only if HC206.1] During your last hospitalization, what kind of treatment/services did you receive? [Multiple answers are allowed]

[ASK ONLY IF HC206.1] DURING YOUR LAST HOSPITALIZATION, WHAT KIND OF TREATMENT/SERVICES DID YOU RECEIVE? [MULTIPLE ANSWERS ARE ALLOWED]
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HC210

[Ask only if HC206.1] In your recent visit, how much did you or your household pay for: [Instruction for the Interviewer: Only one response for each category is possible. Either fill the amount or enter 0 if service is free or record dont know or not applicable.]

[ASK ONLY IF HC206.1] IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: [INSTRUCTION FOR THE INTERVIEWER: ONLY ONE RESPONSE FOR EACH CATEGORY IS POSSIBLE. EITHER FILL THE AMOUNT OR ENTER 0 IF SERVICE IS FREE OR RECORD DONT KNOW OR NOT APPLICABLE.]
       
     
HC210A1

In your recent visit, how much did you or your household pay for: Health care providers fees (consultation charges)

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: HEALTH CARE PROVIDERS FEES (CONSULTATION CHARGES)
       
     
HC210A2

In your recent visit, how much did you or your household pay for: Medicines from hospital

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: MEDICINES FROM HOSPITAL
       
     
HC210A3

In your recent visit, how much did you or your household pay for: Medicines from outside

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: MEDICINES FROM OUTSIDE
       
     
HC210A4

In your recent visit, how much did you or your household pay for: Tests/investigation

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: TESTS/INVESTIGATION
       
     
HC210A5

In your recent visit, how much did you or your household pay for: Hospital and nursing home charges including bed charges, food

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: HOSPITAL AND NURSING HOME CHARGES INCLUDING BED CHARGES, FOOD
       
     
HC210A6

In your recent visit, how much did you or your household pay for: Operation theater charges, surgery charges and related expenses

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: OPERATION THEATER CHARGES, SURGERY CHARGES AND RELATED EXPENSES
       
     
HC210A7

In your recent visit, how much did you or your household pay for: Blood, oxygen cylinder

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: BLOOD, OXYGEN CYLINDER
       
     
HC210A8

In your recent visit, how much did you or your household pay for: Transportation

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: TRANSPORTATION
       
     
HC210A9

In your recent visit, how much did you or your household pay for: Expenses of the accompanying person(s) (food / accommodation)

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: EXPENSES OF THE ACCOMPANYING PERSON(S) (FOOD / ACCOMMODATION)
       
     
HC210A10

In your recent visit, how much did you or your household pay for: Expenditure not elsewhere reported (others)

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: EXPENDITURE NOT ELSEWHERE REPORTED (OTHERS)
       
     
If HC210A = Don’t know’ or ‘Refused »
 
         
       
HC210B

[Ask if respondent answered Dont know or Refused to any of the category in HC210a] What was the total amount that you or your household spent on this visit? Total expenditure________ [Hard check: HC210b < sum of HC210a (1-10)]

[ASK IF RESPONDENT ANSWERED DONT KNOW OR REFUSED TO ANY OF THE CATEGORY IN HC210A] WHAT WAS THE TOTAL AMOUNT THAT YOU OR YOUR HOUSEHOLD SPENT ON THIS VISIT? TOTAL EXPENDITURE________ [HARD CHECK: HC210B < SUM OF HC210A (1-10)]
         
HC211A

What were the sources through which you met the expenses for health care and what is the amount covered? Personal income

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? PERSONAL INCOME
 
HC211B

What were the sources through which you met the expenses for health care and what is the amount covered? Household income excluding personal income

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? HOUSEHOLD INCOME EXCLUDING PERSONAL INCOME
 
HC211C

What were the sources through which you met the expenses for health care and what is the amount covered? Savings

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? SAVINGS
 
HC211D

What were the sources through which you met the expenses for health care and what is the amount covered? Loans (bank/friends/relatives)

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? LOANS (BANK/FRIENDS/RELATIVES)
 
HC211E

What were the sources through which you met the expenses for health care and what is the amount covered? Contribution from friends/relatives

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? CONTRIBUTION FROM FRIENDS/RELATIVES
 
HC211F

What were the sources through which you met the expenses for health care and what is the amount covered? Selling assets/property

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? SELLING ASSETS/PROPERTY
 
HC211G

What were the sources through which you met the expenses for health care and what is the amount covered? Insurance coverage

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? INSURANCE COVERAGE
 
HC211H

What were the sources through which you met the expenses for health care and what is the amount covered? Reimbursement from employer

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? REIMBURSEMENT FROM EMPLOYER
 
HC211I

What were the sources through which you met the expenses for health care and what is the amount covered? Other, please specify _______

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? OTHER, PLEASE SPECIFY _______
 
HC212

Who took care of you most of the time when you were admitted in the hospital?

WHO TOOK CARE OF YOU MOST OF THE TIME WHEN YOU WERE ADMITTED IN THE HOSPITAL?
expand
 
If [Ask only if HC202 . 1] How many nights did you spend in the hospital during your last hospitalization? Number of nights ____ [Hard check: > 1] >= 1 »
 
   
 
HC213

[Ask only if HC206.1] Were you working at the time when you were last hospitalized?

[ASK ONLY IF HC206.1] WERE YOU WORKING AT THE TIME WHEN YOU WERE LAST HOSPITALIZED?
expand
   
HC214

Could you say how many person (work) days you and the person(s) accompanying you lost due to sickness? [Enter 0if the respondent did not miss any working days] (Ask only if HC213=1) Yours _______ (Ask only if HC 212<16) Accompanying person(s)______

COULD YOU SAY HOW MANY PERSON (WORK) DAYS YOU AND THE PERSON(S) ACCOMPANYING YOU LOST DUE TO SICKNESS? [ENTER 0IF THE RESPONDENT DID NOT MISS ANY WORKING DAYS] (ASK ONLY IF HC213=1) YOURS _______ (ASK ONLY IF HC 212<16) ACCOMPANYING PERSON(S)______
 
If [Ask only if HC202 . 1] How many nights did you spend in the hospital during your last hospitalization? Number of nights ____ [Hard check: > 1] >= 1 »
 
   
 
HC215

[Ask only if HC206.1] What was your health status when you left the hospital?

[ASK ONLY IF HC206.1] WHAT WAS YOUR HEALTH STATUS WHEN YOU LEFT THE HOSPITAL?
expand
   
 
If [Ask only if HC202 . 1] Which type of facility did you visit during your last hospitalization? != 1 or 4 »
 
     
   
HC216

[Ask only if HC215!= 1 or 4] Why did you want to leave the hospital before you were recovered? [Multiple answers are allowed]

[ASK ONLY IF HC215!= 1 OR 4] WHY DID YOU WANT TO LEAVE THE HOSPITAL BEFORE YOU WERE RECOVERED? [MULTIPLE ANSWERS ARE ALLOWED]
expand
     
 
HC217

[Ask only if HC206.1] Do you still suffer from the ailment you originally sought treatment for?

[ASK ONLY IF HC206.1] DO YOU STILL SUFFER FROM THE AILMENT YOU ORIGINALLY SOUGHT TREATMENT FOR?
expand
   
HC218

Did your treatment continue after discharge?

DID YOUR TREATMENT CONTINUE AFTER DISCHARGE?
expand
 
If Did your treatment continue after discharge? >= 1 Yes 2 No Go to HC220  »
 
   
 
HC219

[Ask only if HC218=1] How long was the duration of treatment after discharge? [Hard check: Allow to enter number only for one option and at the same time freeze remaining options]

[ASK ONLY IF HC218=1] HOW LONG WAS THE DURATION OF TREATMENT AFTER DISCHARGE? [HARD CHECK: ALLOW TO ENTER NUMBER ONLY FOR ONE OPTION AND AT THE SAME TIME FREEZE REMAINING OPTIONS]
expand
   
HC220

How many kilometers from your residence is the health care facility in which you were most recently admitted? Distance to health care facility: ________km [Soft check: >1000 km]

HOW MANY KILOMETERS FROM YOUR RESIDENCE IS THE HEALTH CARE FACILITY IN WHICH YOU WERE MOST RECENTLY ADMITTED? DISTANCE TO HEALTH CARE FACILITY: ________KM [SOFT CHECK: >1000 KM]
 
HC221

What is your travel time (one-way) to that facility? ______Hours AND ___ minutes [Hard check (For Minutes): Should not be >59 minutes]

WHAT IS YOUR TRAVEL TIME (ONE-WAY) TO THAT FACILITY? ______HOURS AND ___ MINUTES [HARD CHECK (FOR MINUTES): SHOULD NOT BE >59 MINUTES]
 
HC222

What was the main transportation mode you used last time when you visited that facility?

WHAT WAS THE MAIN TRANSPORTATION MODE YOU USED LAST TIME WHEN YOU VISITED THAT FACILITY?
expand
 
If [Ask only if HC202 . 1] How many nights did you spend in the hospital during your last hospitalization? Number of nights ____ [Hard check: > 1] >= 1 »
 
   
 
HC223

[Ask only if HC206.1]After hospitalization, what was the change in your health condition? [Instruction for the interviewer: Read options to respondent]

[ASK ONLY IF HC206.1]AFTER HOSPITALIZATION, WHAT WAS THE CHANGE IN YOUR HEALTH CONDITION? [INSTRUCTION FOR THE INTERVIEWER: READ OPTIONS TO RESPONDENT]
expand
   
 
HC224

For your last hospitalization or stay at long-term care facility, how would you rate the following: ....your experience about the length of the time you waited before being attended to

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ....YOUR EXPERIENCE ABOUT THE LENGTH OF THE TIME YOU WAITED BEFORE BEING ATTENDED TO
expand
   
 
HC225

For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of being treated respectfully

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF BEING TREATED RESPECTFULLY
expand
   
 
HC226

For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of how clearly health care providers explained things to you

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF HOW CLEARLY HEALTH CARE PROVIDERS EXPLAINED THINGS TO YOU
expand
   
 
HC227

For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience the way the health care staff ensured that you could talk privately to providers

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE THE WAY THE HEALTH CARE STAFF ENSURED THAT YOU COULD TALK PRIVATELY TO PROVIDERS
expand
   
 
HC228

For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of seeing a health care provider of your choice

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF SEEING A HEALTH CARE PROVIDER OF YOUR CHOICE
expand
   
 
HC229

For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of the cleanliness in the health facility

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF THE CLEANLINESS IN THE HEALTH FACILITY
expand
   
 
HC230

[Ask only if HC206.1] Overall, how satisfied were you with healthcare you received during the hospital stay?

[ASK ONLY IF HC206.1] OVERALL, HOW SATISFIED WERE YOU WITH HEALTHCARE YOU RECEIVED DURING THE HOSPITAL STAY?
expand
   
If In the past 12 months, have you consulted any health care provider? [Please identify ALL healthcare providers that you have visited] [Instruction for CAPI: If response is i, freeze all other options] < i »
 
   
 
HC301

[Ask only if HC003 < i] I would like to ask you some questions about your consultation with a healthcare provider including folk healers (outpatient) in the past 12 months.

[ASK ONLY IF HC003 < I] I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT YOUR CONSULTATION WITH A HEALTHCARE PROVIDER INCLUDING FOLK HEALERS (OUTPATIENT) IN THE PAST 12 MONTHS.
   
 
HC302

[Ask only if HC00310 times]

[ASK ONLY IF HC00310 TIMES]
   
 
If [Ask only if HC00310 times] > 0 »
 
     
   
HC303

[Ask only if HC302>0] In which month and year was your most recent visit? Month: ____ [Hard check: 1-12] Year: ______ [2015-2016]

[ASK ONLY IF HC302>0] IN WHICH MONTH AND YEAR WAS YOUR MOST RECENT VISIT? MONTH: ____ [HARD CHECK: 1-12] YEAR: ______ [2015-2016]
     
   
HC304

[Ask only if HC302>0] Which type of health care provider did you visit, or came to visit you, most recently in the past 12 months?

[ASK ONLY IF HC302>0] WHICH TYPE OF HEALTH CARE PROVIDER DID YOU VISIT, OR CAME TO VISIT YOU, MOST RECENTLY IN THE PAST 12 MONTHS?
expand
     
   
HC305

[Ask only if HC302>0] Which type of facility did you last visit to see that healthcare provider?

[ASK ONLY IF HC302>0] WHICH TYPE OF FACILITY DID YOU LAST VISIT TO SEE THAT HEALTHCARE PROVIDER?
expand
     
   
HC306

[Ask only if HC302>0] What was the main purpose of your visit?

[ASK ONLY IF HC302>0] WHAT WAS THE MAIN PURPOSE OF YOUR VISIT?
expand
     
   
If [Ask only if HC302>0] What was the main purpose of your visit? = d or e »
 
       
     
HC307

[Ask only if HC306=d or e] What is the main reason of your recent outpatient visit? [Instruction for the interviewer: Please ask to see the medical records if available]

[ASK ONLY IF HC306=D OR E] WHAT IS THE MAIN REASON OF YOUR RECENT OUTPATIENT VISIT? [INSTRUCTION FOR THE INTERVIEWER: PLEASE ASK TO SEE THE MEDICAL RECORDS IF AVAILABLE]
expand
       
     
HC308

[Ask only if HC306=d or e]What kind of treatment and/or diagnostics did you receive? [Multiple answers are allowed]

[ASK ONLY IF HC306=D OR E]WHAT KIND OF TREATMENT AND/OR DIAGNOSTICS DID YOU RECEIVE? [MULTIPLE ANSWERS ARE ALLOWED]
expand
       
   
HC309
     
   
HC309a1
     
   
HC309a2
     
   
HC309a3
     
   
HC309a4
     
   
HC309a5
     
   
HC309a6
     
   
HC309a7
     
   
HC309a8
     
   
HC309a9
     
   
HC309a10
     
   
If HC309A = Don’t know’ or ‘Refused »
 
       
     
HC309B

[Ask if respondent Dont know or Refused to answer any of the category in HC309a] What was the total amount that you or your household spent on this visit? Total expenditure____________ Hard check: HC309b < sum of HC309a (1-10)]

[ASK IF RESPONDENT DONT KNOW OR REFUSED TO ANSWER ANY OF THE CATEGORY IN HC309A] WHAT WAS THE TOTAL AMOUNT THAT YOU OR YOUR HOUSEHOLD SPENT ON THIS VISIT? TOTAL EXPENDITURE____________ HARD CHECK: HC309B < SUM OF HC309A (1-10)]
       
   
HC310
     
   
HC311

[Ask only if HC302>0] Could you say how many person (work) hours you and the person(s) accompanying you lost due to the sickness associated with your last hospital visit? [Instruction for the interviewer: Please enter 0 if the respondent did not miss any working hour] Yours__________ Accompanying person(s)____________

[ASK ONLY IF HC302>0] COULD YOU SAY HOW MANY PERSON (WORK) HOURS YOU AND THE PERSON(S) ACCOMPANYING YOU LOST DUE TO THE SICKNESS ASSOCIATED WITH YOUR LAST HOSPITAL VISIT? [INSTRUCTION FOR THE INTERVIEWER: PLEASE ENTER 0 IF THE RESPONDENT DID NOT MISS ANY WORKING HOUR] YOURS__________ ACCOMPANYING PERSON(S)____________
     
HC312

Who accompanied you during your most recent outpatient visit?

WHO ACCOMPANIED YOU DURING YOUR MOST RECENT OUTPATIENT VISIT?
expand
 
If [Ask only if HC302>0] What was the main purpose of your visit? != a »
 
   
 
HC313

[Ask only if HC306!=a] Do you still suffer from the ailment you originally sought treatment for?

[ASK ONLY IF HC306!=A] DO YOU STILL SUFFER FROM THE AILMENT YOU ORIGINALLY SOUGHT TREATMENT FOR?
expand
   
If [Ask only if HC302>0] Which type of facility did you last visit to see that healthcare provider? != 14 »
 
   
 
HC314

[Ask only if HC305 != 14] How many kilometers is the health care facility from your residence? Distance to medical facility: ____________km [Soft check: >50 Km]

[ASK ONLY IF HC305 != 14] HOW MANY KILOMETERS IS THE HEALTH CARE FACILITY FROM YOUR RESIDENCE? DISTANCE TO MEDICAL FACILITY: ____________KM [SOFT CHECK: >50 KM]
   
 
HC315

[Ask only if HC305 != 14] What was your travel time (one-way) to that facility? ______Hours AND ___ minutes [Hard check (For Minutes): Should not be >60 minutes]

[ASK ONLY IF HC305 != 14] WHAT WAS YOUR TRAVEL TIME (ONE-WAY) TO THAT FACILITY? ______HOURS AND ___ MINUTES [HARD CHECK (FOR MINUTES): SHOULD NOT BE >60 MINUTES]
   
 
HC316

[Ask only if HC305 != 14] What was the main transportation mode you used last time you visited that facility?

[ASK ONLY IF HC305 != 14] WHAT WAS THE MAIN TRANSPORTATION MODE YOU USED LAST TIME YOU VISITED THAT FACILITY?
expand
   
If [Ask only if HC302>0] What was the main purpose of your visit? != a »
 
   
 
HC317

[Ask only if HC306!=a] What was the outcome of your most recent visit to the health care provider? [Instruction for the interviewer: Read options to respondent]

[ASK ONLY IF HC306!=A] WHAT WAS THE OUTCOME OF YOUR MOST RECENT VISIT TO THE HEALTH CARE PROVIDER? [INSTRUCTION FOR THE INTERVIEWER: READ OPTIONS TO RESPONDENT]
expand
   
If [Ask only if HC00310 times] > 0 »
 
   
 
HC318

For your last visit to a hospital or health care facility, how would you rate the following: ...your experience about the length of time you waited before being attended to

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE ABOUT THE LENGTH OF TIME YOU WAITED BEFORE BEING ATTENDED TO
expand
   
 
HC319

For your last visit to a hospital or health care facility, how would you rate the following: ...your experience of being treated respectfully

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF BEING TREATED RESPECTFULLY
expand
   
 
HC320

For your last visit to a hospital or health care facility, how would you rate the following: your experience how clearly health care providers explained things to you

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: YOUR EXPERIENCE HOW CLEARLY HEALTH CARE PROVIDERS EXPLAINED THINGS TO YOU
expand
   
 
HC321

For your last visit to a hospital or health care facility, how would you rate the following: ...your experience of the way the health care staff is ensured that you could talk privately to providers

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF THE WAY THE HEALTH CARE STAFF IS ENSURED THAT YOU COULD TALK PRIVATELY TO PROVIDERS
expand
   
 
HC322

For your last visit to a hospital or health care facility, how would you rate the following: your experience of getting a health care provider of your choice

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: YOUR EXPERIENCE OF GETTING A HEALTH CARE PROVIDER OF YOUR CHOICE
expand
   
 
HC323

For your last visit to a hospital or health care facility, how would you rate the following: ...your experience about the cleanliness in the health facility

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE ABOUT THE CLEANLINESS IN THE HEALTH FACILITY
expand
   
 
HC324

[Ask only if HC302>0]Overall, how satisfied were you with health care you received at this visit?

[ASK ONLY IF HC302>0]OVERALL, HOW SATISFIED WERE YOU WITH HEALTH CARE YOU RECEIVED AT THIS VISIT?
expand
   
 
HC325

[Ask only if HC302>0] How much in total did you spend on all your outpatient visits to health care facilities/providers (including your most recent visit) during last 12 months? ______Rs. (total amount spent) [Soft check: > 5000 Rs.] [Hard check:

[ASK ONLY IF HC302>0] HOW MUCH IN TOTAL DID YOU SPEND ON ALL YOUR OUTPATIENT VISITS TO HEALTH CARE FACILITIES/PROVIDERS (INCLUDING YOUR MOST RECENT VISIT) DURING LAST 12 MONTHS? ______RS. (TOTAL AMOUNT SPENT) [SOFT CHECK: > 5000 RS.] [HARD CHECK:
   
HC326

During the past 12 months, have you used any of the following medications or health supplements without consulting a healthcare provider? Do not include the medicines you have already mentioned earlier in inpatient and outpatient sections. [Multiple answers are allowed] [Instruction for CAPI: If response is d, freeze all other options]

DURING THE PAST 12 MONTHS, HAVE YOU USED ANY OF THE FOLLOWING MEDICATIONS OR HEALTH SUPPLEMENTS WITHOUT CONSULTING A HEALTHCARE PROVIDER? DO NOT INCLUDE THE MEDICINES YOU HAVE ALREADY MENTIONED EARLIER IN INPATIENT AND OUTPATIENT SECTIONS. [MULTIPLE ANSWERS ARE ALLOWED] [INSTRUCTION FOR CAPI: IF RESPONSE IS D, FREEZE ALL OTHER OPTIONS]
expand
 
If For your last visit to a hospital or health care facility, how would you rate the following: your experience how clearly health care providers explained things to you < s »
 
   
 
HC327

[Ask only if HC326 5000 Rs.]

[ASK ONLY IF HC326 5000 RS.]
   
 
If [Ask only if HC326 5000 Rs.] > 0 »
 
     
   
HC328A

How much of this amount was reimbursed by Government employer

HOW MUCH OF THIS AMOUNT WAS REIMBURSED BY GOVERNMENT EMPLOYER
     
   
HC328B

How much of this amount was reimbursed by Private Employer

HOW MUCH OF THIS AMOUNT WAS REIMBURSED BY PRIVATE EMPLOYER
     
   
HC328X
     
   
HC328D

How much of this amount was reimbursed by Other Agencies

HOW MUCH OF THIS AMOUNT WAS REIMBURSED BY OTHER AGENCIES
     
   
HC328E

How much of this amount was reimbursed by None [For the Interviewer]

HOW MUCH OF THIS AMOUNT WAS REIMBURSED BY NONE [FOR THE INTERVIEWER]
     
 
HC329

How often did the respondent receive assistance in answering this section?

HOW OFTEN DID THE RESPONDENT RECEIVE ASSISTANCE IN ANSWERING THIS SECTION?
expand
   
 
HC331

[Ask only if HC329>1]=1] What is his/her relationship to [R]? [Instruction for the interviewer: If unknown, please ask to the proxy.]

[ASK ONLY IF HC329>1]=1] WHAT IS HIS/HER RELATIONSHIP TO [R]? [INSTRUCTION FOR THE INTERVIEWER: IF UNKNOWN, PLEASE ASK TO THE PROXY.]
expand
   
 
End of I_D. Health Care Access and Utilization (HC)
Start of I_D. Health Care Access and Utilization (HC)

========================================================================
HC001
The next questions pertain to medical facilities or medical providers you may have visited for care during the last 12 months.

THE NEXT QUESTIONS PERTAIN TO MEDICAL FACILITIES OR MEDICAL PROVIDERS YOU MAY HAVE VISITED FOR CARE DURING THE LAST 12 MONTHS.

========================================================================
HC002
In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options]

IN THE PAST 12 MONTHS, HAVE YOU VISITED ANY HEALTH CARE FACILITY OR ANY HEALTH PROFESSIONAL HAS VISITED YOU? [PLEASE IDENTIFY ALL THE FACILITIES THAT YOU HAVE VISITED] [INSTRUCTION FOR CAPI: IF RESPONSE IS P FREEZE ALL OTHER OPTIONS]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Health post/sub centers
b Primary health center/Urban Health Center
c Community health center
d District / Sub-district hospital
e Government/tertiary hospital
f Govt
g Private hospital/nursing home
h Private clinic (OPD based services)
i NGO/Charity/Trust/Church-run hospital
j Private AYUSH hospital
k Health camp
l Mobile healthcare unit
m Pharmacy/drugstore
n Home visit
o Other, please specify _______
p None


========================================================================
HC003
In the past 12 months, have you consulted any health care provider? [Please identify ALL healthcare providers that you have visited] [Instruction for CAPI: If response is i, freeze all other options]

IN THE PAST 12 MONTHS, HAVE YOU CONSULTED ANY HEALTH CARE PROVIDER? [PLEASE IDENTIFY ALL HEALTHCARE PROVIDERS THAT YOU HAVE VISITED] [INSTRUCTION FOR CAPI: IF RESPONSE IS I, FREEZE ALL OTHER OPTIONS]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Doctor (with MBBS, including surgeon, physician, gynecologist, psychiatrist, ophthalmologist and orthopedician)
b AYUSH practitioner ( : Ayurveda /unani/ siddha /homeopathy)
c Dentist
d Nurse/midwife
e Physiotherapist
f Pharmacist
g Traditional /Folk healers (tribal medicine/bhopa/jhaad-fook/black magic)
h Other, please specify _______
i None


If HC002 <= 0 or HC003 <= h »

|  ========================================================================
HC004
[Ask only if HC002 <= o or HC003 <= h] What were the reasons of your last visit to the healthcare facility? [Multiple answers are allowed]

[ASK ONLY IF HC002 <= O OR HC003 <= H] WHAT WERE THE REASONS OF YOUR LAST VISIT TO THE HEALTHCARE FACILITY? [MULTIPLE ANSWERS ARE ALLOWED]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Preventive checkup
b Regular treatment/checkup/routine follow-up visit
c Sickness
d Injury/Violence
e Others, please specify _______


If In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options] (HC002) = p or HC003 = j »

|  ========================================================================
HC005
[Ask if HC002=p and HC003= j] What was your main reason for not seeking a visit?

[ASK IF HC002=P AND HC003= J] WHAT WAS YOUR MAIN REASON FOR NOT SEEKING A VISIT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Did not get sick
2 Needed to work
3 Didnt want to give up a days work
4 Not enough money or cost was too high
5 Treatment was unlikely to be effective
6 Illness was not serious
7 Nobody to accompany
8 No quality facilities available nearby
9 Had medicine at home
10 Family member(s) decided it wasnt required
11 No healthcare facility nearby
12 Other, please specify ________


If In the past 12 months, have you consulted any health care provider? [Please identify ALL healthcare providers that you have visited] [Instruction for CAPI: If response is i, freeze all other options] (HC003) < i »

|  ========================================================================
HC006
[Ask only if HC003 < i] In the past 12 months, did a health care provider ever recommend you to go to the hospital?

[ASK ONLY IF HC003 < I] IN THE PAST 12 MONTHS, DID A HEALTH CARE PROVIDER EVER RECOMMEND YOU TO GO TO THE HOSPITAL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
2 No


If In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options] (HC002) = a, k, l, m, n, o and HC006 =1 »

| |  ========================================================================
| | 
HC007
[Ask if HC002=a, k,l,m,n,o and HC006=1 ]What were the reasons you decided against going to a hospital? [Multiple answers are allowed]

[ASK IF HC002=A, K,L,M,N,O AND HC006=1 ]WHAT WERE THE REASONS YOU DECIDED AGAINST GOING TO A HOSPITAL? [MULTIPLE ANSWERS ARE ALLOWED]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Needed to work
b Didnt want to give up a days work
c Not enough money or cost was too high
d Treatment was unlikely to be effective
e Illness was not serious
f Nobody to accompany
g No quality facilities available nearby
h Had medicine at home
i Family member(s) decided it wasnt required
j Difficult to get to the health care provider
k Other, please specify ________


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HC101
I am going to ask you some questions on how you would pay for expenses incurred for health care if you were to fall ill or sustain an injury.

I AM GOING TO ASK YOU SOME QUESTIONS ON HOW YOU WOULD PAY FOR EXPENSES INCURRED FOR HEALTH CARE IF YOU WERE TO FALL ILL OR SUSTAIN AN INJURY.

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HC102
Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.]

ARE YOU COVERED BY HEALTH INSURANCE? [INSTRUCTION FOR THE INTERVIEWER: INTERVIEWER SHOULD EXPLAIN ABOUT HEALTH INSURANCE AS A TYPE OF INSURANCE COVERAGE THAT PAYS FOR MEDICAL AND SURGICAL EXPENSES THAT ARE INCURRED BY THE INSURED. HEALTH INSURANCE CAN EITHER REIMBURSE THE INSURED FOR EXPENSES INCURRED FROM ILLNESS OR INJURY OR PAY THE CARE PROVIDER DIRECTLY.]
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
2 No Go to HC109


If Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.] (HC102) = 1 Yes 2 No Go to HC109  »

|  ========================================================================
HC103
[Ask only if HC102=1] What types of health insurance are you covered by? [Multiple answers are allowed]

[ASK ONLY IF HC102=1] WHAT TYPES OF HEALTH INSURANCE ARE YOU COVERED BY? [MULTIPLE ANSWERS ARE ALLOWED]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Central Government Health Scheme (CGHS)
b Employees State Insurance Scheme (ESIS)
c Rashtriya Swasthya Bima Yojana (RSBY)
d Other Central government health insurance schemes, please specify
e State health government health insurance schemes, please specify [ instruction for CAPI: Preload customized drop downlist of insurance schemes based on state]
f Community/cooperative health insurance schemes, please specify
g Medical reimbursement from an employer
h Health insurance through an employer, please specify
i Privately purchased commercial health insurance, please specify
j Others, please specify _________


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HC104
[Ask only if HC102=1] What does this health insurance cover ()? [Multiple answers are allowed] [Instruction to the Interviewer: Record the covered services as per the respondents answer]

[ASK ONLY IF HC102=1] WHAT DOES THIS HEALTH INSURANCE COVER ()? [MULTIPLE ANSWERS ARE ALLOWED] [INSTRUCTION TO THE INTERVIEWER: RECORD THE COVERED SERVICES AS PER THE RESPONDENTS ANSWER]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Surgery
b Tests ( e.g
c Doctor visits
d Medicines
e Dental care
f In-home care
g Hospitalization charges
h Other, please specify ______


If Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.] (HC102) = 1 Yes 2 No Go to HC109  »

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HC105
[Ask only if HC102=1] In which month and year did you first purchase/enroll in the health insurance policy which provides? _______Month [Hard check: if < 1or >12] _________Year [Hard check: if < 1954]

[ASK ONLY IF HC102=1] IN WHICH MONTH AND YEAR DID YOU FIRST PURCHASE/ENROLL IN THE HEALTH INSURANCE POLICY WHICH PROVIDES? _______MONTH [HARD CHECK: IF < 1OR >12] _________YEAR [HARD CHECK: IF < 1954]

|  ========================================================================
HC106
[Ask only if HC102=1] When did this health insurance benefit begin? _______Month [Hard check: if < 1or >12] _________Year [Hard check: if < 1954]

[ASK ONLY IF HC102=1] WHEN DID THIS HEALTH INSURANCE BENEFIT BEGIN? _______MONTH [HARD CHECK: IF < 1OR >12] _________YEAR [HARD CHECK: IF < 1954]

|  ========================================================================
HC107
[Ask only if HC102=1] What was the amount of last premium(per year) paid for this policy (In rupees)? [Instruction for the interviewer: Enter 0 if no premium paid per year] __________Rs/year [Soft check: > 35,000 Rs.]

[ASK ONLY IF HC102=1] WHAT WAS THE AMOUNT OF LAST PREMIUM(PER YEAR) PAID FOR THIS POLICY (IN RUPEES)? [INSTRUCTION FOR THE INTERVIEWER: ENTER 0 IF NO PREMIUM PAID PER YEAR] __________RS/YEAR [SOFT CHECK: > 35,000 RS.]

|  ========================================================================
HC108
[Ask only if HC102=1] What is the maximum amount of insurance coverage (in rupees)? [Instruction for the interviewer: Enter 9 if total amount will be reimbursed by the organization/company where he/she works] _____________Rs. [Soft check: > 50, 00, 000 Rs.]

[ASK ONLY IF HC102=1] WHAT IS THE MAXIMUM AMOUNT OF INSURANCE COVERAGE (IN RUPEES)? [INSTRUCTION FOR THE INTERVIEWER: ENTER 9 IF TOTAL AMOUNT WILL BE REIMBURSED BY THE ORGANIZATION/COMPANY WHERE HE/SHE WORKS] _____________RS. [SOFT CHECK: > 50, 00, 000 RS.]

If Are you covered by health insurance? [Instruction for the interviewer: Interviewer should explain about health insurance as a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.] (HC102) = 2 »

|  ========================================================================
HC109
[Ask only if HC102=2] What is the main reason for not having health insurance?

[ASK ONLY IF HC102=2] WHAT IS THE MAIN REASON FOR NOT HAVING HEALTH INSURANCE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 I am not aware about health insurance
2 I cannot afford it
3 I do not need it
4 I do not know where to purchase it
5 I tried to get health insurance but was denied it
6 My family decided not to purchase it
7 Other, please specify ___________


If In the past 12 months, have you visited any health care facility or any health professional has visited you? [Please identify ALL the facilities that you have visited] [Instruction for CAPI: If response is p freeze all other options] (HC002) = b to j »

|  ========================================================================
HC201
[Ask only if HC002= b to j] The following questions pertain to hospitalization (inpatient care) that you have had during the past 12 months.

[ASK ONLY IF HC002= B TO J] THE FOLLOWING QUESTIONS PERTAIN TO HOSPITALIZATION (INPATIENT CARE) THAT YOU HAVE HAD DURING THE PAST 12 MONTHS.

|  ========================================================================
HC202
[Ask only if HC002=b to j] Over the last 12 months, how many times you were admitted as patient to a hospital/long-term care facility for at least one night? [[Instruction for the interviewer: If R did not stay at hospital, enter ‘0’ for none] ________Tim

[ASK ONLY IF HC002=B TO J] OVER THE LAST 12 MONTHS, HOW MANY TIMES YOU WERE ADMITTED AS PATIENT TO A HOSPITAL/LONG-TERM CARE FACILITY FOR AT LEAST ONE NIGHT? [[INSTRUCTION FOR THE INTERVIEWER: IF R DID NOT STAY AT HOSPITAL, ENTER ‘0’ FOR NONE] ________TIMES [SOFT CHECK: >10] [INSTRUCTION FOR CAPI: IF HC202 =0 GO TO → HC301_INTRO.]

If HC202 >= 1 »

| |  ========================================================================
| | 
HC203
[Ask only if HC202. 1] How many nights have you spent in the hospital during the past 12 months? Number of nights ____ [Hard check: <1]

[ASK ONLY IF HC202. 1] HOW MANY NIGHTS HAVE YOU SPENT IN THE HOSPITAL DURING THE PAST 12 MONTHS? NUMBER OF NIGHTS ____ [HARD CHECK: <1]

| |  ========================================================================
| | 
HC204
[Ask only if HC202>=1] For the last hospitalization, how many months ago were you admitted to the hospital? [Instruction for the interviewer: This question asks how many months ago and not in which month the respondent was admitted. Please be careful while filling the answer, enter 0if less than one month ] Months ago ____ [Hard check: if < 1or >12] [Hard check: if < 1or >=53]

[ASK ONLY IF HC202>=1] FOR THE LAST HOSPITALIZATION, HOW MANY MONTHS AGO WERE YOU ADMITTED TO THE HOSPITAL? [INSTRUCTION FOR THE INTERVIEWER: THIS QUESTION ASKS HOW MANY MONTHS AGO AND NOT IN WHICH MONTH THE RESPONDENT WAS ADMITTED. PLEASE BE CAREFUL WHILE FILLING THE ANSWER, ENTER 0IF LESS THAN ONE MONTH ] MONTHS AGO ____ [HARD CHECK: IF < 1OR >12] [HARD CHECK: IF < 1OR >=53]

| |  ========================================================================
| | 
HC205
[Ask only if HC202 . 1] Which type of facility did you visit during your last hospitalization?

[ASK ONLY IF HC202 . 1] WHICH TYPE OF FACILITY DID YOU VISIT DURING YOUR LAST HOSPITALIZATION?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Government hospital
2 Private hospital Nursing home
3 NGO/Charity/Trust/Church-run hospital
4 Private (partial) and /Government (partial)/NGO (partial)
5 Other, please specify _______


| |  ========================================================================
| | 
HC206
[Ask only if HC202 . 1] How many nights did you spend in the hospital during your last hospitalization? Number of nights ____ [Hard check: > 1]

[ASK ONLY IF HC202 . 1] HOW MANY NIGHTS DID YOU SPEND IN THE HOSPITAL DURING YOUR LAST HOSPITALIZATION? NUMBER OF NIGHTS ____ [HARD CHECK: > 1]

| |  If HC206 >= 1 »

| | |  ========================================================================
| | | 
HC207
[Ask only if HC206 . 1] Why were you hospitalized?

[ASK ONLY IF HC206 . 1] WHY WERE YOU HOSPITALIZED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Sickness
2 Injury/accident
3 Violence
4 Other, please specify ______


| | |  If [Ask only if HC206 . 1] Why were you hospitalized? (HC207) = 1 or 2 »

| | | |  ========================================================================
| | | | 
HC208
[Ask only if HC207=1 or 2] What is the main reason of your last hospitalization?

[ASK ONLY IF HC207=1 OR 2] WHAT IS THE MAIN REASON OF YOUR LAST HOSPITALIZATION?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Cancer
2 Chronic pain in your joints/arthritis/rheumatism/osteoporosis (joints, back, neck)
3 Dengue or other vector-born disease (Chikungunya, Filariasis )
4 Depression or anxiety/tension/sleep problem
5 Diabetes or related complications
6 Fever/Pyrexia of unknown reason
7 Fracture/Muscle rupture
8 Gastroenteritis or other diarrheal illness
9 High blood pressure (hypertension)
10 HIV/AIDS
11 Injury/accident (non-occupational)
12 Liver diseases (hepatitis, alcoholic liver disease, cirrhosis)
13 Malaria
14 Maternal or Prenatal Conditions (pregnancy-related problem or gynecological problems)
15 Occupation/work-related accident/injury
16 Other acute/chronic communicable diseases
17 Problems with your breathing (asthma/chronic obstructive pulmonary disease [COPD])
18 Problems with your heart, including unexplained pain in chest (angina, myocardial infarction [M.I.], heart-related surgery)
19 Stroke/sudden paralysis of one side of body
20 Surgery for abdominal causes (appendix, hernia, gall bladder, kidney)
21 Surgery for genitourinary (prostate, piles, incontinence)
22 Surgery for ophthalmic cause (cataract, glaucoma, retina, cornea)
23 Surgery for other causes
24 Tuberculosis
25 Upper Respiratory Tract Infection (URTI/URI) or Lower Respiratory Tract Infection (LRTI)
26 Urinary Tract Infection (UTI) / Reproductive Tract Infection (RTI)
27 Other, please specify ____________


| | |  ========================================================================
| | | 
HC209
[Ask only if HC206.1] During your last hospitalization, what kind of treatment/services did you receive? [Multiple answers are allowed]

[ASK ONLY IF HC206.1] DURING YOUR LAST HOSPITALIZATION, WHAT KIND OF TREATMENT/SERVICES DID YOU RECEIVE? [MULTIPLE ANSWERS ARE ALLOWED]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Medical check-up (under observation/routine checkup)
b Injection & IV (drip infusion)
c Laboratory test (Blood/Urine/Stool/Sputum/Saliva)
d Endoscopy or colonoscopy
e Surgery
f X-ray, CT scan, B ultrasonic, MRI
g Medications (allopathic)
h Medications (AYUSH)
i Traditional treatment (massage, acupuncture)
j Other, please specify________


| | |  ========================================================================
| | | 
HC210
[Ask only if HC206.1] In your recent visit, how much did you or your household pay for: [Instruction for the Interviewer: Only one response for each category is possible. Either fill the amount or enter 0 if service is free or record dont know or not applicable.]

[ASK ONLY IF HC206.1] IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: [INSTRUCTION FOR THE INTERVIEWER: ONLY ONE RESPONSE FOR EACH CATEGORY IS POSSIBLE. EITHER FILL THE AMOUNT OR ENTER 0 IF SERVICE IS FREE OR RECORD DONT KNOW OR NOT APPLICABLE.]

| | |  ========================================================================
| | | 
HC210A1
In your recent visit, how much did you or your household pay for: Health care providers fees (consultation charges)

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: HEALTH CARE PROVIDERS FEES (CONSULTATION CHARGES)

| | |  ========================================================================
| | | 
HC210A2
In your recent visit, how much did you or your household pay for: Medicines from hospital

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: MEDICINES FROM HOSPITAL

| | |  ========================================================================
| | | 
HC210A3
In your recent visit, how much did you or your household pay for: Medicines from outside

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: MEDICINES FROM OUTSIDE

| | |  ========================================================================
| | | 
HC210A4
In your recent visit, how much did you or your household pay for: Tests/investigation

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: TESTS/INVESTIGATION

| | |  ========================================================================
| | | 
HC210A5
In your recent visit, how much did you or your household pay for: Hospital and nursing home charges including bed charges, food

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: HOSPITAL AND NURSING HOME CHARGES INCLUDING BED CHARGES, FOOD

| | |  ========================================================================
| | | 
HC210A6
In your recent visit, how much did you or your household pay for: Operation theater charges, surgery charges and related expenses

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: OPERATION THEATER CHARGES, SURGERY CHARGES AND RELATED EXPENSES

| | |  ========================================================================
| | | 
HC210A7
In your recent visit, how much did you or your household pay for: Blood, oxygen cylinder

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: BLOOD, OXYGEN CYLINDER

| | |  ========================================================================
| | | 
HC210A8
In your recent visit, how much did you or your household pay for: Transportation

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: TRANSPORTATION

| | |  ========================================================================
| | | 
HC210A9
In your recent visit, how much did you or your household pay for: Expenses of the accompanying person(s) (food / accommodation)

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: EXPENSES OF THE ACCOMPANYING PERSON(S) (FOOD / ACCOMMODATION)

| | |  ========================================================================
| | | 
HC210A10
In your recent visit, how much did you or your household pay for: Expenditure not elsewhere reported (others)

IN YOUR RECENT VISIT, HOW MUCH DID YOU OR YOUR HOUSEHOLD PAY FOR: EXPENDITURE NOT ELSEWHERE REPORTED (OTHERS)

| | |  If HC210A = Don’t know’ or ‘Refused »

| | | |  ========================================================================
| | | | 
HC210B
[Ask if respondent answered Dont know or Refused to any of the category in HC210a] What was the total amount that you or your household spent on this visit? Total expenditure________ [Hard check: HC210b < sum of HC210a (1-10)]

[ASK IF RESPONDENT ANSWERED DONT KNOW OR REFUSED TO ANY OF THE CATEGORY IN HC210A] WHAT WAS THE TOTAL AMOUNT THAT YOU OR YOUR HOUSEHOLD SPENT ON THIS VISIT? TOTAL EXPENDITURE________ [HARD CHECK: HC210B < SUM OF HC210A (1-10)]

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HC211A
What were the sources through which you met the expenses for health care and what is the amount covered? Personal income

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? PERSONAL INCOME

========================================================================
HC211B
What were the sources through which you met the expenses for health care and what is the amount covered? Household income excluding personal income

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? HOUSEHOLD INCOME EXCLUDING PERSONAL INCOME

========================================================================
HC211C
What were the sources through which you met the expenses for health care and what is the amount covered? Savings

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? SAVINGS

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HC211D
What were the sources through which you met the expenses for health care and what is the amount covered? Loans (bank/friends/relatives)

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? LOANS (BANK/FRIENDS/RELATIVES)

========================================================================
HC211E
What were the sources through which you met the expenses for health care and what is the amount covered? Contribution from friends/relatives

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? CONTRIBUTION FROM FRIENDS/RELATIVES

========================================================================
HC211F
What were the sources through which you met the expenses for health care and what is the amount covered? Selling assets/property

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? SELLING ASSETS/PROPERTY

========================================================================
HC211G
What were the sources through which you met the expenses for health care and what is the amount covered? Insurance coverage

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? INSURANCE COVERAGE

========================================================================
HC211H
What were the sources through which you met the expenses for health care and what is the amount covered? Reimbursement from employer

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? REIMBURSEMENT FROM EMPLOYER

========================================================================
HC211I
What were the sources through which you met the expenses for health care and what is the amount covered? Other, please specify _______

WHAT WERE THE SOURCES THROUGH WHICH YOU MET THE EXPENSES FOR HEALTH CARE AND WHAT IS THE AMOUNT COVERED? OTHER, PLEASE SPECIFY _______

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HC212
Who took care of you most of the time when you were admitted in the hospital?

WHO TOOK CARE OF YOU MOST OF THE TIME WHEN YOU WERE ADMITTED IN THE HOSPITAL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Spouse
2 Son
3 Daughter
4 Son-in-law
5 Daughter-in-law
6 Grandchild
7 Parent
8 Parent-in-law
9 Brother
10 Sister
11 Grandparent
12 Other relative
13 Friends
14 Caregivers
15 Other, please specify
16 No one___________


If HC206 >= 1 »

|  ========================================================================
HC213
[Ask only if HC206.1] Were you working at the time when you were last hospitalized?

[ASK ONLY IF HC206.1] WERE YOU WORKING AT THE TIME WHEN YOU WERE LAST HOSPITALIZED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
2 No


========================================================================
HC214
Could you say how many person (work) days you and the person(s) accompanying you lost due to sickness? [Enter 0if the respondent did not miss any working days] (Ask only if HC213=1) Yours _______ (Ask only if HC 212<16) Accompanying person(s)______

COULD YOU SAY HOW MANY PERSON (WORK) DAYS YOU AND THE PERSON(S) ACCOMPANYING YOU LOST DUE TO SICKNESS? [ENTER 0IF THE RESPONDENT DID NOT MISS ANY WORKING DAYS] (ASK ONLY IF HC213=1) YOURS _______ (ASK ONLY IF HC 212<16) ACCOMPANYING PERSON(S)______

If HC206 >= 1 »

|  ========================================================================
HC215
[Ask only if HC206.1] What was your health status when you left the hospital?

[ASK ONLY IF HC206.1] WHAT WAS YOUR HEALTH STATUS WHEN YOU LEFT THE HOSPITAL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Recovered from illness, received doctors approval
2 Did not recover from illness, but received doctors approval
3 Did not recover from illness, requested to leave without doctors approval
4 Patients condition can be managed on OPD
5 Other, please specify___________


If [Ask only if HC202 . 1] Which type of facility did you visit during your last hospitalization? (HC205) != 1 or 4 »

| |  ========================================================================
| | 
HC216
[Ask only if HC215!= 1 or 4] Why did you want to leave the hospital before you were recovered? [Multiple answers are allowed]

[ASK ONLY IF HC215!= 1 OR 4] WHY DID YOU WANT TO LEAVE THE HOSPITAL BEFORE YOU WERE RECOVERED? [MULTIPLE ANSWERS ARE ALLOWED]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Couldnt recover from illness
b Ran out of money; couldnt afford anymore
c Pushed out; no space in the hospital
d Poor quality and service from health care providers
e Other, please specify _______


|  ========================================================================
HC217
[Ask only if HC206.1] Do you still suffer from the ailment you originally sought treatment for?

[ASK ONLY IF HC206.1] DO YOU STILL SUFFER FROM THE AILMENT YOU ORIGINALLY SOUGHT TREATMENT FOR?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
2 No


========================================================================
HC218
Did your treatment continue after discharge?

DID YOUR TREATMENT CONTINUE AFTER DISCHARGE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
2 No Go to HC220


If HC218 >= 1 »

|  ========================================================================
HC219
[Ask only if HC218=1] How long was the duration of treatment after discharge? [Hard check: Allow to enter number only for one option and at the same time freeze remaining options]

[ASK ONLY IF HC218=1] HOW LONG WAS THE DURATION OF TREATMENT AFTER DISCHARGE? [HARD CHECK: ALLOW TO ENTER NUMBER ONLY FOR ONE OPTION AND AT THE SAME TIME FREEZE REMAINING OPTIONS]
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Days completed _____ [Hard check: It should not be greater than 365 days]
2 Days to be continued ____
3 Continuing for lifelong


========================================================================
HC220
How many kilometers from your residence is the health care facility in which you were most recently admitted? Distance to health care facility: ________km [Soft check: >1000 km]

HOW MANY KILOMETERS FROM YOUR RESIDENCE IS THE HEALTH CARE FACILITY IN WHICH YOU WERE MOST RECENTLY ADMITTED? DISTANCE TO HEALTH CARE FACILITY: ________KM [SOFT CHECK: >1000 KM]

========================================================================
HC221
What is your travel time (one-way) to that facility? ______Hours AND ___ minutes [Hard check (For Minutes): Should not be >59 minutes]

WHAT IS YOUR TRAVEL TIME (ONE-WAY) TO THAT FACILITY? ______HOURS AND ___ MINUTES [HARD CHECK (FOR MINUTES): SHOULD NOT BE >59 MINUTES]

========================================================================
HC222
What was the main transportation mode you used last time when you visited that facility?

WHAT WAS THE MAIN TRANSPORTATION MODE YOU USED LAST TIME WHEN YOU VISITED THAT FACILITY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Walk
2 Auto-rickshaw
3 Bus
4 Car
5 Ambulance
6 Bicycle or other manual vehicles
7 Motorcycle or scooter
8 Train
9 Flight
10 Animal or animal-pulled cart
11 Boat/ship
12 Other, please specify__________


If HC206 >= 1 »

|  ========================================================================
HC223
[Ask only if HC206.1]After hospitalization, what was the change in your health condition? [Instruction for the interviewer: Read options to respondent]

[ASK ONLY IF HC206.1]AFTER HOSPITALIZATION, WHAT WAS THE CHANGE IN YOUR HEALTH CONDITION? [INSTRUCTION FOR THE INTERVIEWER: READ OPTIONS TO RESPONDENT]
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Got much better
2 Got better
3 Have no change
4 Got worse
5 Got much worse


|  ========================================================================
HC224
For your last hospitalization or stay at long-term care facility, how would you rate the following: ....your experience about the length of the time you waited before being attended to

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ....YOUR EXPERIENCE ABOUT THE LENGTH OF THE TIME YOU WAITED BEFORE BEING ATTENDED TO
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERYGOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC225
For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of being treated respectfully

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF BEING TREATED RESPECTFULLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERYGOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC226
For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of how clearly health care providers explained things to you

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF HOW CLEARLY HEALTH CARE PROVIDERS EXPLAINED THINGS TO YOU
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERY GOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC227
For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience the way the health care staff ensured that you could talk privately to providers

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE THE WAY THE HEALTH CARE STAFF ENSURED THAT YOU COULD TALK PRIVATELY TO PROVIDERS
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERYGOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC228
For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of seeing a health care provider of your choice

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF SEEING A HEALTH CARE PROVIDER OF YOUR CHOICE
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERYGOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC229
For your last hospitalization or stay at long-term care facility, how would you rate the following: ...your experience of the cleanliness in the health facility

FOR YOUR LAST HOSPITALIZATION OR STAY AT LONG-TERM CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF THE CLEANLINESS IN THE HEALTH FACILITY
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERYGOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC230
[Ask only if HC206.1] Overall, how satisfied were you with healthcare you received during the hospital stay?

[ASK ONLY IF HC206.1] OVERALL, HOW SATISFIED WERE YOU WITH HEALTHCARE YOU RECEIVED DURING THE HOSPITAL STAY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Very satisfied
2 Satisfied
3 Neither satisfied nor dissatisfied
4 Dissatisfied
5 Very dissatisfied


If In the past 12 months, have you consulted any health care provider? [Please identify ALL healthcare providers that you have visited] [Instruction for CAPI: If response is i, freeze all other options] (HC003) < i »

|  ========================================================================
HC301
[Ask only if HC003 < i] I would like to ask you some questions about your consultation with a healthcare provider including folk healers (outpatient) in the past 12 months.

[ASK ONLY IF HC003 < I] I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT YOUR CONSULTATION WITH A HEALTHCARE PROVIDER INCLUDING FOLK HEALERS (OUTPATIENT) IN THE PAST 12 MONTHS.

|  ========================================================================
HC302
[Ask only if HC00310 times]

[ASK ONLY IF HC00310 TIMES]

If [Ask only if HC00310 times] (HC302) > 0 »

| |  ========================================================================
| | 
HC303
[Ask only if HC302>0] In which month and year was your most recent visit? Month: ____ [Hard check: 1-12] Year: ______ [2015-2016]

[ASK ONLY IF HC302>0] IN WHICH MONTH AND YEAR WAS YOUR MOST RECENT VISIT? MONTH: ____ [HARD CHECK: 1-12] YEAR: ______ [2015-2016]

| |  ========================================================================
| | 
HC304
[Ask only if HC302>0] Which type of health care provider did you visit, or came to visit you, most recently in the past 12 months?

[ASK ONLY IF HC302>0] WHICH TYPE OF HEALTH CARE PROVIDER DID YOU VISIT, OR CAME TO VISIT YOU, MOST RECENTLY IN THE PAST 12 MONTHS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Doctor (with MBBS, including surgeon, physician,gynecologist, psychiatrist, and ophthalmologist)
2 Dentist
3 AYUSH practitioner (ayurvedic/yoga/siddha/unani /homeopathy)
4 Nurse/midwife
5 Physiotherapist
6 Pharmacist
7 Traditional/Folk healers (tribalmedicine/bhopa/jhaad-fook/Black magic)
8 Other, please specify ______


| |  ========================================================================
| | 
HC305
[Ask only if HC302>0] Which type of facility did you last visit to see that healthcare provider?

[ASK ONLY IF HC302>0] WHICH TYPE OF FACILITY DID YOU LAST VISIT TO SEE THAT HEALTHCARE PROVIDER?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Health post/sub centers
2 Primary health center
3 Community health center
4 District hospital/ Sub-district hospital
5 Government/tertiary hospital
6 Govt
7 Private hospital/Nursing home
8 Private clinic (OPD based service)
9 NGO/Charity/Trust/Church-run hospital
10 Private AYUSH hospital
11 Health camp
12 Mobile healthcare unit
13 Pharmacy/drugstore
14 Home visit
15 Other, please specify _______


| |  ========================================================================
| | 
HC306
[Ask only if HC302>0] What was the main purpose of your visit?

[ASK ONLY IF HC302>0] WHAT WAS THE MAIN PURPOSE OF YOUR VISIT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Immunization
2 Consultation
3 Medical check-up (under observation/routine checkup)
4 Treatment for illness
5 Treatment for injury/ accident
6 Other, please specify ________


| |  If [Ask only if HC302>0] What was the main purpose of your visit? (HC306) = d or e »

| | |  ========================================================================
| | | 
HC307
[Ask only if HC306=d or e] What is the main reason of your recent outpatient visit? [Instruction for the interviewer: Please ask to see the medical records if available]

[ASK ONLY IF HC306=D OR E] WHAT IS THE MAIN REASON OF YOUR RECENT OUTPATIENT VISIT? [INSTRUCTION FOR THE INTERVIEWER: PLEASE ASK TO SEE THE MEDICAL RECORDS IF AVAILABLE]
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Cancer
2 Chronic pain in yourjoints/arthritis/rheumatism/osteoporosis (joints,back, neck, muscle)
3 Dengue or other vector-born disease(Chikungunya, Filariasis )
4 Depression or anxiety/tension/sleep problem
5 Diabetes or related complications
6 Fever/pyrexia of unknown cause
7 Follow-up for any surgery
8 Gastroenteritis or other diarrheal illness
9 Generalized pain (stomach, headache, migraine,or other nonspecific pain)
10 High blood pressure (hypertension)
11 HIV/AIDS
12 Injury/accident (non-occupational)
13 Liver diseases (hepatitis, alcoholic liver disease,cirrhosis)
14 Malaria
15 Maternal or prenatal conditions (pregnancy-related problem or gynecological problems)
16 Nutritional malfunctions
17 Occupation/work-related accident/injury
18 Other acute/chronic communicable diseases
19 Problems with your breathing
20 Problems with your ears
21 Problems with your eyes
22 Problems with your heart, including unexplainedpain in chest (angina, Myocardial Infarction[M.I.], heart-related surgery)
23 Problems with yourmouth/teeth/gum/lips/swallowing/throat
24 Skin diseases
25 Stroke/sudden paralysis of one side of body
26 Tuberculosis
27 Upper respiratory tract infection (URI/URTI) orlower respiratory tract infection (LRTI)
28 Urinary tract infection (UTI)
29 Gastritis/acidity
30 Other, please specify __________


| | |  ========================================================================
| | | 
HC308
[Ask only if HC306=d or e]What kind of treatment and/or diagnostics did you receive? [Multiple answers are allowed]

[ASK ONLY IF HC306=D OR E]WHAT KIND OF TREATMENT AND/OR DIAGNOSTICS DID YOU RECEIVE? [MULTIPLE ANSWERS ARE ALLOWED]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Medical check-up (under observation/routinecheckup)
b Injection, IV (saline)
c Laboratory test(Blood/Urine/Stool/Sputum/Saliva)
d X-ray, CT scan, B ultrasonic, MRI
e Endoscopy or colonoscopy
f Surgery
g Medications or received prescription
h Ayurvedic or herbal medication
i Traditional treatment (e.g
j Other, please specify __________


| |  ========================================================================
| | 
HC309
HC309

| |  ========================================================================
| | 
HC309a1
HC309a1

| |  ========================================================================
| | 
HC309a2
HC309a2

| |  ========================================================================
| | 
HC309a3
HC309a3

| |  ========================================================================
| | 
HC309a4
HC309a4

| |  ========================================================================
| | 
HC309a5
HC309a5

| |  ========================================================================
| | 
HC309a6
HC309a6

| |  ========================================================================
| | 
HC309a7
HC309a7

| |  ========================================================================
| | 
HC309a8
HC309a8

| |  ========================================================================
| | 
HC309a9
HC309a9

| |  ========================================================================
| | 
HC309a10
HC309a10

| |  If HC309A = Don’t know’ or ‘Refused »

| | |  ========================================================================
| | | 
HC309B
[Ask if respondent Dont know or Refused to answer any of the category in HC309a] What was the total amount that you or your household spent on this visit? Total expenditure____________ Hard check: HC309b < sum of HC309a (1-10)]

[ASK IF RESPONDENT DONT KNOW OR REFUSED TO ANSWER ANY OF THE CATEGORY IN HC309A] WHAT WAS THE TOTAL AMOUNT THAT YOU OR YOUR HOUSEHOLD SPENT ON THIS VISIT? TOTAL EXPENDITURE____________ HARD CHECK: HC309B < SUM OF HC309A (1-10)]

| |  ========================================================================
| | 
HC310
HC310

| |  ========================================================================
| | 
HC311
[Ask only if HC302>0] Could you say how many person (work) hours you and the person(s) accompanying you lost due to the sickness associated with your last hospital visit? [Instruction for the interviewer: Please enter 0 if the respondent did not miss any working hour] Yours__________ Accompanying person(s)____________

[ASK ONLY IF HC302>0] COULD YOU SAY HOW MANY PERSON (WORK) HOURS YOU AND THE PERSON(S) ACCOMPANYING YOU LOST DUE TO THE SICKNESS ASSOCIATED WITH YOUR LAST HOSPITAL VISIT? [INSTRUCTION FOR THE INTERVIEWER: PLEASE ENTER 0 IF THE RESPONDENT DID NOT MISS ANY WORKING HOUR] YOURS__________ ACCOMPANYING PERSON(S)____________

========================================================================
HC312
Who accompanied you during your most recent outpatient visit?

WHO ACCOMPANIED YOU DURING YOUR MOST RECENT OUTPATIENT VISIT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Spouse
2 Son
3 Daughter
4 Son-in-law
5 Daughter-in-law
6 Grandchild
7 Parent
8 Parent-in-law
9 Brother
10 Sister
11 Grandparent
12 Other relative
13 Friends
14 Caregivers
15 Other, please specify __________
16 No one


If [Ask only if HC302>0] What was the main purpose of your visit? (HC306) != a »

|  ========================================================================
HC313
[Ask only if HC306!=a] Do you still suffer from the ailment you originally sought treatment for?

[ASK ONLY IF HC306!=A] DO YOU STILL SUFFER FROM THE AILMENT YOU ORIGINALLY SOUGHT TREATMENT FOR?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
2 No


If [Ask only if HC302>0] Which type of facility did you last visit to see that healthcare provider? (HC305) != 14 »

|  ========================================================================
HC314
[Ask only if HC305 != 14] How many kilometers is the health care facility from your residence? Distance to medical facility: ____________km [Soft check: >50 Km]

[ASK ONLY IF HC305 != 14] HOW MANY KILOMETERS IS THE HEALTH CARE FACILITY FROM YOUR RESIDENCE? DISTANCE TO MEDICAL FACILITY: ____________KM [SOFT CHECK: >50 KM]

|  ========================================================================
HC315
[Ask only if HC305 != 14] What was your travel time (one-way) to that facility? ______Hours AND ___ minutes [Hard check (For Minutes): Should not be >60 minutes]

[ASK ONLY IF HC305 != 14] WHAT WAS YOUR TRAVEL TIME (ONE-WAY) TO THAT FACILITY? ______HOURS AND ___ MINUTES [HARD CHECK (FOR MINUTES): SHOULD NOT BE >60 MINUTES]

|  ========================================================================
HC316
[Ask only if HC305 != 14] What was the main transportation mode you used last time you visited that facility?

[ASK ONLY IF HC305 != 14] WHAT WAS THE MAIN TRANSPORTATION MODE YOU USED LAST TIME YOU VISITED THAT FACILITY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Walk
2 Auto-rickshaw
3 Bus
4 Car
5 Ambulance
6 Bicycle or other manual vehicles
7 Motorcycle or scooter
8 Train
9 Flight
10 Animal or animal-pulled cart
11 Boat/ Ship
12 Other, please specify ________


If [Ask only if HC302>0] What was the main purpose of your visit? (HC306) != a »

|  ========================================================================
HC317
[Ask only if HC306!=a] What was the outcome of your most recent visit to the health care provider? [Instruction for the interviewer: Read options to respondent]

[ASK ONLY IF HC306!=A] WHAT WAS THE OUTCOME OF YOUR MOST RECENT VISIT TO THE HEALTH CARE PROVIDER? [INSTRUCTION FOR THE INTERVIEWER: READ OPTIONS TO RESPONDENT]
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Got much better
2 Got better
3 Had no change
4 Got worse
5 Got much worse


If [Ask only if HC00310 times] (HC302) > 0 »

|  ========================================================================
HC318
For your last visit to a hospital or health care facility, how would you rate the following: ...your experience about the length of time you waited before being attended to

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE ABOUT THE LENGTH OF TIME YOU WAITED BEFORE BEING ATTENDED TO
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERY GOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC319
For your last visit to a hospital or health care facility, how would you rate the following: ...your experience of being treated respectfully

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF BEING TREATED RESPECTFULLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERY GOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC320
For your last visit to a hospital or health care facility, how would you rate the following: your experience how clearly health care providers explained things to you

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: YOUR EXPERIENCE HOW CLEARLY HEALTH CARE PROVIDERS EXPLAINED THINGS TO YOU
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERY GOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC321
For your last visit to a hospital or health care facility, how would you rate the following: ...your experience of the way the health care staff is ensured that you could talk privately to providers

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE OF THE WAY THE HEALTH CARE STAFF IS ENSURED THAT YOU COULD TALK PRIVATELY TO PROVIDERS
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERY GOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC322
For your last visit to a hospital or health care facility, how would you rate the following: your experience of getting a health care provider of your choice

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: YOUR EXPERIENCE OF GETTING A HEALTH CARE PROVIDER OF YOUR CHOICE
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERY GOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC323
For your last visit to a hospital or health care facility, how would you rate the following: ...your experience about the cleanliness in the health facility

FOR YOUR LAST VISIT TO A HOSPITAL OR HEALTH CARE FACILITY, HOW WOULD YOU RATE THE FOLLOWING: ...YOUR EXPERIENCE ABOUT THE CLEANLINESS IN THE HEALTH FACILITY
- - - - - - - - - - - - - - - - - - - - - - - - -
1 VERY GOOD
2 GOOD
3 MODERATE
4 BAD
5 VERY BAD


|  ========================================================================
HC324
[Ask only if HC302>0]Overall, how satisfied were you with health care you received at this visit?

[ASK ONLY IF HC302>0]OVERALL, HOW SATISFIED WERE YOU WITH HEALTH CARE YOU RECEIVED AT THIS VISIT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Very Satisfied
2 Satisfied
3 Neither satisfied nor dissatisfied
4 Dissatisfied
5 Very dissatisfied


|  ========================================================================
========================================================================
HC326
During the past 12 months, have you used any of the following medications or health supplements without consulting a healthcare provider? Do not include the medicines you have already mentioned earlier in inpatient and outpatient sections. [Multiple answers are allowed] [Instruction for CAPI: If response is d, freeze all other options]

DURING THE PAST 12 MONTHS, HAVE YOU USED ANY OF THE FOLLOWING MEDICATIONS OR HEALTH SUPPLEMENTS WITHOUT CONSULTING A HEALTHCARE PROVIDER? DO NOT INCLUDE THE MEDICINES YOU HAVE ALREADY MENTIONED EARLIER IN INPATIENT AND OUTPATIENT SECTIONS. [MULTIPLE ANSWERS ARE ALLOWED] [INSTRUCTION FOR CAPI: IF RESPONSE IS D, FREEZE ALL OTHER OPTIONS]
- - - - - - - - - - - - - - - - - - - - - - - - -
a Modern medicines/Allopathic medicine
b AYUSH medicines/Traditional herbs or medicines
c Other health supplements
d None


If For your last visit to a hospital or health care facility, how would you rate the following: your experience how clearly health care providers explained things to you (HC320) < s »

|  ========================================================================
HC327
[Ask only if HC326 5000 Rs.]

[ASK ONLY IF HC326 5000 RS.]

If [Ask only if HC326 5000 Rs.] (HC327) > 0 »

| |  ========================================================================
| | 
HC328A
How much of this amount was reimbursed by Government employer

HOW MUCH OF THIS AMOUNT WAS REIMBURSED BY GOVERNMENT EMPLOYER

| |  ========================================================================
| | 
HC328B
How much of this amount was reimbursed by Private Employer

HOW MUCH OF THIS AMOUNT WAS REIMBURSED BY PRIVATE EMPLOYER

| |  ========================================================================
| | 
HC328X
HC328X

| |  ========================================================================
| | 
HC328D
How much of this amount was reimbursed by Other Agencies

HOW MUCH OF THIS AMOUNT WAS REIMBURSED BY OTHER AGENCIES

| |  ========================================================================
| | 
HC328E
How much of this amount was reimbursed by None [For the Interviewer]

HOW MUCH OF THIS AMOUNT WAS REIMBURSED BY NONE [FOR THE INTERVIEWER]

|  ========================================================================
HC329
How often did the respondent receive assistance in answering this section?

HOW OFTEN DID THE RESPONDENT RECEIVE ASSISTANCE IN ANSWERING THIS SECTION?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Never
2 A few times
3 Most or all the time


|  ========================================================================
HC331
[Ask only if HC329>1]=1] What is his/her relationship to [R]? [Instruction for the interviewer: If unknown, please ask to the proxy.]

[ASK ONLY IF HC329>1]=1] WHAT IS HIS/HER RELATIONSHIP TO [R]? [INSTRUCTION FOR THE INTERVIEWER: IF UNKNOWN, PLEASE ASK TO THE PROXY.]
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Spouse/partner
2 Son
3 Daughter
4 Son-in-law
5 Daughter-in-law
6 Grandchild
7 Parent
8 Parent-in-law
9 Brother
10 Sister
11 Grandparent
12 Other relative
13 Servant
14 Friend
15 Other, please specify ______________


End of I_D. Health Care Access and Utilization (HC)