100%
First Unitarian Church of Portland Health Care Survey
 
The Economic Justice Action Group (EJAG) of the First Unitarian Church of Portland is concerned with health care access and afforability. We have developed this survey for our congregation to find out if there is significant interest to improve the current health care system. We plan to make the results availalble to our members.

Please take a few minutes to express your opinions about the availability and cost of health care in our community. Your answers are important to the success of this study and will help raise an awareness in our community of this important issue which affects us all.





Thank you so much for your time and your assistance.
 
 
What kind of medical insurance coverage do you and your family have? Check all that apply.
 
None
 
Purchased individually
 
Employer-sponsored
 
Medicaid
 
Medicare
 
Oregon Health Plan
 
Oregon Medical Insurance Pool (OMIP)
 
Other
   
Internal Data Structure Error
 
 

Quality and efficiency of the health care you and your family are receiving
 
Satisfied
 
Somewhat satisfied
 
Dissatisfied
 
 
How much is your monthly cost for your household's medical insurance premiums?
   
What are your average monthly out-of-pocket expenditures for health care, such as co-pays, prescriptions, lab fees, uncovered costs, etc.
   
 
 

Your share of the cost of healthcare
 
More than we can afford
 
Barely manageable
 
Easily manageable
 
Not sure
 
Comments
    
 
 
About how many times have you and members of your family been to a healthcare provider or medical facility in the past year?
   
How would you describe your experience?
   
 
 
Have you or a family member had to care for an elderly parent or spouse and was the health insurance coverage adequate? Please describe.
   
 
 
Have you or a family member ever been denied coverage? Please check all that apply.
 
I (or family member) have never been denied coverage.
 
I (or family member) took a job based on the coverage offered or wanted to change jobs but was unwilling to do so because we did not want to lose our medical coverage.
 
I (or family member) was denied coverage or was exempted from coverage for a chronic condition.
 
I (or family member) was denied coverage due to a pre-existing condition.
 
I (or family member) wanted a treatment or medication that was not covered by the insurance plan we have/had.
 
I (or family member) wanted to use a type of provider or a method of treatment that our plan would not cover (such as a therapist, chiropractor, specialist, or acupuncture
 
I (or family member) had to use a healthcare provider that was not one we would have selected or was not of our own chosing.
 
 

Do you have a health care or insurance coverage story that you would be willing to share with our congregation? Please check all that apply.
 
No
 
Yes, but anonymously
 
Yes, in writing
 
Yes, by talking within a small group
 
Yes, to a larger audience
 
If yes, please provide your name, email and/or phone contact information or contact info@ejag.org:
   
 
 
How shall health care be paid for? Are you in favor of:
 
Universal single-payer system similar to the Canadian or European models
 
Mandated expanded employer-sponsored insurance coverage
 
Mandated individual private insurance coverage
 
A mixture of employer and government-sponsored insurance pools
 
Choice between private insurance and government-sponsored universal health care
 
Leave the system as is
 
I don't know yet
 
Other
   
 
 

YesNoDon't know
Do you support Measure 50 (tobacco tax to cover all Oregon children)?
 
 

These questions will remain anonymous and are optional, but your response will help us establish the affordability of health care in our community.

What was your total household income (approximately) from all sources before taxes for the year 2006.
 
$25,000 or less
 
$25,000-$49,999
 
$50,000-$74,999
 
$75,000-$99,999
 
$100,000-$124,999
 
$125,000-$149,999
 
$150,000 or over
 
Don't know
 
 
Age of person completing this questionnaire:
   
Number of family members aged 17 and under (not including yourself).
   
Number of family members over 18 and under 65 (not including yourself).
   
Number of family members over 65 (not including yourself).
   
 
 
Thank you for taking the time to complete this survey. We appreciate your input!
 
Please contact info@ejag.org if you have any questions regarding this survey.