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2016
June
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Exit Survey
What is your age?
18-24
25-31
32-38
39-45
46-52
52-59
60+
What is your gender?
Male
Female
What is your ethnicity? (Select all that apply)
American Indian or Alaska Native
Asian
Black/African American
Hispanic/Latino
Middle Eastern or Indian
Native Hawaiian or Pacific Islander
White/Caucasian
Other
What's the highest level of education you have achieved?
Elementary School
Middle School
High School
Some College
Bachelor's Degree
Masters or higher
Other
What is your household's annual income?
Less than $15,000
$15,001-$25,000
$25,001-$35,000
$35,001-$50,000
$50,001-$75,000
More than $75,000
What is your area of occupation?
Homemaker
Student
Government
Construction
Food or Service Industry
Retail, Sales or Marketing
Healthcare or Technology
Business Owner
Agriculture
Retired
Unemployed
Nonprofit or Education
Other
Do you have health insurance?
Yes
No
Does the fine associated with not having health insurance influence your decision to be insured or not?
Yes
No
I wasn't aware of the fine
Are you aware of the financial assistance available under Obamacare?
Yes
Sort of, but I'm not sure how it works
No
In thinking about what matters when selecting a health care provider or caregiver, to what extent are the following issues important? Please select your response for each item.
Not at all
Rarely
Somewhat
Very Much
Distance from my home or work
Issues of privacy or confidentiality
The provider or care team speaks my language
Out of pocket cost
Recommendations from friends, family or trusted sources
Range of benefits
Hours that care is available
Brand or provider is active or is supportive of my community
Agents and staff reflect the diversity of my community
The provider or care team is knowledgeable of my culture
Familiarity with name or brand
Relationship with provider or care team
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