Patient Medical Debt Survey

Patient Medical Debt Survey
The Patient Medical Debt Survey is open to persons residing in the UNITED STATES and its Territories.

Responses to this survey are anonymous and cannot be used to identify individuals, unless identifying information is shared at the end of the survey for the purposes of additional outreach.

This survey takes approximately [#] minutes to complete.
Are you a resident of the United States or its Territories?*

YesNo
Please enter your Zip/Postal Code:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Have you ever delayed or avoided medical care due to your inability to pay (excluding purchasing prescription drugs)?*

YesNo

Have you ever delayed or avoided purchasing prescription drugs due to your inability to afford them (excluding medical care)?*

YesNo

How would you rate the clarity of communication from healthcare providers regarding your medical bills (including any medical debt)?

Very UnclearSomewhat UnclearNeutralSomewhat ClearVery Clear

More specifically, are you concerned about how medical debt will impact your finances, credit score, or ability to borrow or take out a loan?*

YesNoI don't know

Your current medical debt is owed to which healthcare provider(s)? (select all that apply)*

HospitalPrimary care physicianSpecialty care physicianMental health care providerPhysical therapy care providerHome health care providerPharmacyMedical supply providerOther

Are you currently receiving any debt collection notices about your medical debt?

YesNo

How often do medical debt collectors contact you?*

Once a monthTwice a monthThree times a monthFour times a monthFive or more times a monthMedical debt collectors do no contact me

Do you feel like you have been making significant progress in paying off your debt?*

YesNoI don't know

Have you ever felt like your medical debt will never be paid off?*

YesNoI don't know

Has medical debt kept you from obtaining any of the following: (select all that apply)*

EmploymentHigher educationHousingLoan (e.g., auto, education, home)Medical careNot applicable

Has your relationship with medical debt affected any personal relationships with people in your life?*

YesNoI don't know

Have you ever considered getting another job or source of income to manage your medical debt?*

YesNo

Were/are you aware of any resources available to help manage your medical debt?*

YesNo

Have you tried seeking help from any organizations regarding medical debt?*

YesNo

Are you currently worried about incurring new or additional medical debt in the future?*

YesNoI don't know

Have you experienced emotional or psychological stress because of the inability to afford your healthcare or collection agency attempts to collect medical debt?*

Strongly AgreeAgreeNeither Agree Nor DisagreeDisagreeStrongly Disagree

If you couldn’t afford the medical care you received at a hospital, then were you advised if the healthcare received was eligible under the hospital’s charity care program?*

YesNoI don't remember

Have your medical bills (including any medical debt) caused you to seek prescription medications or medical supplies outside of the standard healthcare channels, such as purchasing them via online pharmacies, buyer’s clubs, traveling to Canada or Mexico, or buying prescription medications off the street?*

YesNo

Do you feel healthcare in the United States is looking out for your best interests?*

YesNoI don't know

Do you receive any support from family, friends, or community organizations to help with healthcare expenses (including any medical debt)?*

YesNo
If you answered "Yes" to the previous question, please feel free to share the type(s) of support you received:

Have you ever had to open a new credit card to pay for healthcare expenses (including any medical debt)?*

YesNo

Have you ever started a personal fundraising page on GoFundMe (or a similar platform) to help pay for healthcare expenses (including any medical debt)?*

YesNo

Have you ever had to help someone else pay off their medical debt?*

YesNoI don't remember

About how many other people do you know have or once had medical debt?*

0-2 individuals2-4 individuals5-10 individuals10+ individuals

Demographic Questions

The questions in this section ask basic questions about age range, gender expression, race/ethnicity, and income. None of the questions asked in this section can be used to identify the person answering them.
Please select your age range:*

Under 1818-2526-3536-4546-5556-6465+Prefer not to answer

Please indicate your race/ethnicity:*

American Indian / Alaska Native (AI/AN)AsianBlack / African AmericanCaucasian (White / European)Hispanic / LatineMixed Race / Two or More RacesNative Hawaiian / Pacific IslanderPrefer not to answerOther

Please indicate your gender:*

ManTrans ManWomanTrans WomanNon-BinaryPrefer not to answerI identify differently

Please indicate your annual individual income range (income levels represent a percentage of the 2024 Federal Poverty Level for individuals):*

$0 - $15,060 / year$15,060 - $20,783 / year$20,783 - $30,120 / year$30,120 - $45,180 / year$45,180 - $60,240/ year$60,240 - $75,300/ yearMore than $75,300/ yearPrefer not to answer

Demographic Questions