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About
RU/AMU Demographic Survey
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Healthcare Access
Do you have health insurance currently?
Do you have health insurance currently?
Yes
No
Does your health insurance include dental and/or vision?
Does your health insurance include dental and/or vision?
Yes
No
Did you get health insurance through an employer?
Did you get health insurance through an employer?
Yes
No
Are you under Medicare or Medicaid?
Are you under Medicare or Medicaid?
Yes
No
Do you plan on getting health insurance?
Do you plan on getting health insurance?
Yes
No
On a scale of 1 to 10, how difficult is/was it to find health insurance?
1-Easy 10-Difficult
1
2
3
4
5
6
7
8
9
10
Please select which of the following reasons that health insurance is hard for you to access:
Please select which of the following reasons that health insurance is hard for you to access:
Immigration status/lack of documentation
High cost of insurance
Unemployment
Difficult to understand insurance policies
N/A
How long has it been since you saw a doctor?
How long has it been since you saw a doctor?
1 month
3 months
6 months
1 year
2 years
More than 2 years
On a scale of 1 to 10, how financially secure do you feel?
1-Least secure 10-Very secure
1
2
3
4
5
6
7
8
9
10
On a scale of 1 to 10, how easy is it for you to get health care in Kansas City?
1-Hard 10-Easy
1
2
3
4
5
6
7
8
9
10
Please select which of the following reasons that it is difficult to get healthcare:
Please select which of the following reasons that it is difficult to get healthcare:
Lack of insurance
Communication/Language Barrier
Difficulty Finding Specialized Care
Lack of Transportation
N/A
Were you born/raised in the United States?
Were you born/raised in the United States?
Yes
No
Is English your second language?
Is English your second language?
Yes
No
Do you feel that it is hard to express your concerns with healthcare professionals?
Do you feel that it is hard to express your concerns with healthcare professionals?
Yes
No
On a scale of 1 to 10, how hard is it to express your concerns with healthcare professionals?
1-Hard 10-Easy
1
2
3
4
5
6
7
8
9
10
What changes do you want to see in the healthcare system to make it more accessible to you? (Optional)
Additional Information
Age:
Zip code:
What is your gender?
What is your gender?
Male
Female
Which of the following do you identify with?
Which of the following do you identify with?
Cisgender Man
Cisgender Woman
Genderqueer
Transgender Man
Transgender Women
Other
Prefer not to say
Which of the following racial or ethnic groups describe you?
Which of the following racial or ethnic groups describe you?
White
Black or African American
American Indian and Alaskan Native
Asian
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Other
Do you have a spouse?
Do you have a spouse?
Yes
No
How many children do you have?
How many children do you have?
0
1
2
3
4
5+
What is your education level?
What is your education level?
Not Completed High School
High School Diploma
College Degree
Graduate School Degree
Are you employed?
Are you employed?
Yes
No
Have you filed for taxes?
Have you filed for taxes?
Yes
No
What is your yearly income?
What is your yearly income?
Less than $25,000
$25,000-$50,000
$50,000-$75,000
$75,000-$100,000
More than $100,000
How did you find out about our survey?
How did you find out about our survey?
Family/Friend/acquaintance
Flyer
Radio station
School
Clinic/Hospital
Other
Submit
