Table 1 Detailed Content of The Questionnaire on Medical Expense
Category | Questions | Choices and appendix questions |
|---|---|---|
Medical Treatment | Q1.Treatment regimens/option | A:Western medicine B:Chinese medicine C: combination of A and B |
Q2. Western medicine usage: name of medicine, price, frequency of administration. | ||
Q3. Chinese medicine usage: name of medicine, price, frequency of administration. | ||
Q4. Frequency of medical care | Once a week? Twice a month? Once a month? Once a quarter? Other: please specify | |
Q5. Auxiliary therapy or not | If yes, A:moisture chamber glasses B: lacrimal plug implantation C: combination of A and B | |
Expense on Medical Treatments | Q6. Total expense on medical treatment per month | |
Q7.Expense on western medical treatment per month | ||
Q8. Expense on Traditional Chinese medical treatment per month | ||
Q9. Indirect costsfor activities associated with medical treatment, such as transportation, nutrition, shelter,and household appliance | ||
Q10. The amount of expense paid by yourself (uncovered by insurance) | ||
Q11. Your personal income per year | ||
Q12. Self-perception of the economic burden | A: barely affected B: affected to some extent but can be accepted C:affected to a large extent |