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    AFM Questionnaire

    Uploaded by

    Muskan Valbani
    The document contains a 13 question questionnaire regarding demographics, family income, healthcare spending habits, awareness and usage of health insurance plans and government healthcare schemes. Respondents are asked to select from multiple choice answers for questions regarding their name, age, gender, family size, annual income, how they pay for healthcare, healthcare spending, education level, awareness of insurance and government schemes, and ratings of government initiative parameters.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    AFM Questionnaire

    Uploaded by

    Muskan Valbani
    13 views2 pages
    The document contains a 13 question questionnaire regarding demographics, family income, healthcare spending habits, awareness and usage of health insurance plans and government healthcare schemes. Respondents are asked to select from multiple choice answers for questions regarding their name, age, gender, family size, annual income, how they pay for healthcare, healthcare spending, education level, awareness of insurance and government schemes, and ratings of government initiative parameters.

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    The document contains a 13 question questionnaire regarding demographics, family income, healthcare spending habits, awareness and usage of health insurance plans and government healthcare schemes. Respondents are asked to select from multiple choice answers for questions regarding their name, age, gender, family size, annual income, how they pay for healthcare, healthcare spending, education level, awareness of insurance and government schemes, and ratings of government initiative parameters.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    13 views2 pages

    AFM Questionnaire

    Uploaded by

    Muskan Valbani
    The document contains a 13 question questionnaire regarding demographics, family income, healthcare spending habits, awareness and usage of health insurance plans and government healthcare schemes. Respondents are asked to select from multiple choice answers for questions regarding their name, age, gender, family size, annual income, how they pay for healthcare, healthcare spending, education level, awareness of insurance and government schemes, and ratings of government initiative parameters.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Questionnaire

    1. Name:

    2. Age:

    3. Gender:
    a. Male
    b. Female
    c. Others

    4. No. of members in the family:


    a. 1
    b. 2
    c. 3
    d. 4
    e. 5 & above

    5. No. of elders in the family: ( elders >= 60 years)


    a. 1
    b. 2
    c. 3
    d. 4
    e. 5 & above

    6. Annual family income:


    a. Below 50,000
    b. 50,000 – 2,00,000
    c. 2,00,000 – 3,50,000
    d. 3,50,000 – 5,00,000
    e. 5,00,000 & above (CAP 6,00,000)

    7. How do you pay for the facilities availed in a hospital?


    a. Cash (out of the pocket payment)
    b. Cash + Savings
    c. FD
    d. Health Insurance Cover
    e. Any government aid
    f. Others:

    8. How much do you spend in a year on health care out of the pocket?
    a. Below 2500
    b. 2500 – 5000
    c. 5000 – 7500
    d. 7500 & above

    Choose the appropriate answers for the following-


    9. Education level-
    a. Uneducated
    b. 10th pass
    c. 12th pass
    d. Graduate
    e. Post-Graduate

    10. Are you aware of health insurance?


    a. Yes
    b. No

    11. If yes, have you got yourself a health insurance cover?


    a. Yes
    b. No

    12. Are you aware of any government policies or schemes enforced for improving access to
    healthcare facilities?
    a. Yes
    b. No

    13. If yes, have you ever availed any of these schemes/policies?


    a. Yes
    b. No

    14. How would you rate the government initiatives on the following parameters:

    Parameters Very Happy Somewhat Neutral Not very Not at all


    Happy satisfied satisfied

    Convenience in
    availing/
    accessibility
    Transparency

    Relevance

    Benefits (in
    terms of
    reduction in out
    of pocket
    payments, risk
    covered and
    mortality)

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