모든 템플릿

Healthcare Costs & Financial Burden Survey

Measures how much people actually pay for healthcare, how financially burdensome those costs feel, and whether cost causes them to delay or skip care. Built for health plans, providers, employers, and benefits teams tracking affordability; the AI follow-up interview reconstructs the real story behind a specific delay-or-skip-care decision instead of a checkbox answer.

샘플 질문

템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.

질문 14개 · 약 7분
Q01
메시지

Thanks for taking a few minutes to talk about healthcare costs — your own experience, not general opinions. Nothing here is used to determine your coverage or bill you. Your responses are completely confidential and anonymized. About 8 minutes.

Q02
객관식필수

Which of these best describes your current health insurance coverage?

  • Employer-sponsored insurance
  • Marketplace/individual plan
  • Medicare
  • Medicaid
  • Uninsured
  • Other
Q03
숫자

Roughly how much did you personally pay out of pocket for healthcare in the last 12 months — premiums, copays, deductibles, and prescriptions combined (in USD)?

Q04
의견 척도필수

Overall, how much of a financial burden have your healthcare costs been over the past year?

척도: 17
최소:No burden at all최대:Overwhelming burden
Q05
객관식필수

In the past 12 months, did you delay or skip any medical care because of the cost?

  • No, I got all the care I needed
  • Yes, I delayed care but eventually got it
  • Yes, I skipped care entirely
  • Not sure / can't recall
Q06
매트릭스필수

How concerned are you about affording each of the following, if you needed it in the next year?

6개 행 × 5개 열
  • Prescription drugs
  • Doctor or specialist visits
  • Dental care
  • Mental health services
  • Emergency care
  • 외 1개
: Not at all concerned · Slightly concerned · Moderately concerned · Very concerned · Extremely concerned
Q07
최선·최악 선택형(MaxDiff)필수

Which of these changes would do the most, and the least, to ease your healthcare financial burden?

  • Lower monthly premiums
  • Lower deductibles before coverage kicks in
  • Clear pricing shown before treatment
  • Lower cost telehealth options
  • Cheaper prescription drugs
  • Simpler, easier-to-understand bills
  • More in-network provider choices
세트별 최선·최악 선택최선:Would ease my burden most최악:Would ease my burden least
Q08
가격 민감도(Van Westendorp)필수

Think about a routine, in-network visit to a primary care doctor, before any insurance reimbursement.

  • At what price for that visit would you start to question the quality of care being provided?
  • At what price for that visit would you consider it a bargain — great value for the money?
  • At what price for that visit would you start to feel it's expensive, though still worth paying?
  • At what price for that visit would you consider it too expensive to pay at all?
Q09
AI 인터뷰

Focus on the respondent's answer about delaying or skipping care due to cost. If they delayed or skipped care, reconstruct exactly what care was involved, what it would have cost, what happened to their health or plans as a result, and whether they've since gotten that care. If they said they got all needed care despite cost concerns, probe how they made that possible (borrowing, cutting other spending, payment plans) and whether that felt sustainable. Anchor on their reported financial burden level and their top-ranked cost-reduction change, and ask which single change would most have altered their actual decision.

Q10
평점 척도필수

How satisfied are you with how your insurance provider handles your healthcare costs (claims, coverage clarity, billing)?

범위: 15
최소:Very dissatisfied최대:Very satisfied
Q11
객관식

What is your age range?

  • Under 25
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65 or older
  • Prefer not to say
Q12
객관식

What is your total annual household income?

  • Under $25,000
  • $25,000-$49,999
  • $50,000-$74,999
  • $75,000-$99,999
  • $100,000-$149,999
  • $150,000 or more
  • Prefer not to say
Q13
객관식

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q14
메시지

Thank you for sharing this — it's genuinely useful. Your responses will be combined with others (never shared individually) to help identify where healthcare costs are creating the most real-world strain, and what changes would actually help.

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • Includes a dedicated AI follow-up interview that probes the specific delay-or-skip-care decision a respondent reports, reconstructing the real story instead of stopping at a checkbox
  • Combines hard cost data (out-of-pocket spend, Van Westendorp pricing on a routine primary care visit) with subjective burden and concern measures (opinion scale, matrix of concern-if-needed items)
  • Uses a MaxDiff exercise to rank which cost-relief changes would matter most/least, giving benefits teams and health plans prioritized, actionable levers rather than just descriptive stats
  • Automated per-response quality scoring and an auto-generated report mean health plans, providers, and employer benefits teams get analysis-ready output without manual coding of open-ends

SurveyMonkey

Healthcare Expenses Survey Template

A directly comparable, fielding-ready template focused on healthcare expenses, likely covering similar ground on out-of-pocket costs and coverage. It's a static questionnaire built on SurveyMonkey's established survey infrastructure and benchmarking tools, not an interview-style instrument. Good for quick deployment but leaves follow-up probing to manual analysis.

잘하는 점

  • Established, well-known survey platform with broad respondent panel and distribution options
  • Likely benefits from SurveyMonkey's built-in benchmarking and reporting dashboards
  • Purpose-built specifically around healthcare expenses, so questions are topically aligned

아쉬운 점

  • Static question set with no adaptive AI follow-up to dig into why someone delayed or skipped care
  • No voice AI interview or guided screen-share task option
  • No published methodology on how questions were validated or scored, unlike a transparent-prompt approach

Jotform

500+ Healthcare Assessment Forms

This is a broad category/library page listing hundreds of healthcare-related form templates (intake, assessment, consent, etc.), not a single fielding-ready cost-and-affordability survey. It's useful as a form-builder starting point but requires the researcher to assemble or heavily customize a cost-burden instrument themselves. The page itself does not demonstrate a purpose-built financial-burden or delay-of-care survey.

잘하는 점

  • Large library of pre-built healthcare form templates covering many use cases
  • Drag-and-drop form builder makes customization accessible to non-researchers
  • Supports general data collection features like conditional logic and integrations

아쉬운 점

  • No template specifically designed to measure cost burden, delayed/skipped care, or affordability
  • Static form fields only — no adaptive AI interview or voice AI follow-up to probe individual decisions
  • No automated quality scoring or narrative report generation from open-ended responses

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