Questionnaire Home Icu
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QUESTIONNIARE – HOME ICU Details of Respondent: Name: ………………………………………………………………………………… Gender: ………………….. Address: ………………………………………………………… .................... Age: ………………. Income: Contact No: Questionnaire 1. Have you got any health problems? If yes …………………………………………. 2. Whom you are staying with? a) Children b. Grand children c. Relatives d. Others ………………………. 3. Who is care taker of you? a. Children b. Grand children c. Relatives d. Others ………………………. 4. What is your daily routine …………………………………………………………………………………? 6. How often do you visit hospital? a) once a week b)once in 2 weeks c)once a month d)Quarter 10. which hospital you are most familiar with? If yes, then specify……………………………………………………………………………………… 14. How much distance are you traveling to reach the hospital? a) < 1km b) 1 - 5 km c) 5 - 10 km d) > 10 km
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Transcript of Questionnaire Home Icu
QUESTIONNIARE – HOME ICU
Details of Respondent:
Name: …………………………………………………………………………………
Gender: …………………..
Address: ………………………………………………………….................... Age: ………………. Income: Contact No:
Questionnaire
1. Have you got any health problems?
If yes ………………………………………….
2. Whom you are staying with?a) Children b. Grand children c. Relatives d. Others ……………………….
3. Who is care taker of you?a. Children b. Grand children c. Relatives d. Others ……………………….
4. What is your daily routine …………………………………………………………………………………? 6. How often do you visit hospital? a) once a week b)once in 2 weeks c)once a month d)Quarter
10. which hospital you are most familiar with?
If yes, then specify………………………………………………………………………………………
14. How much distance are you traveling to reach the hospital? a) < 1km b) 1 - 5 km c) 5 - 10 km d) > 10 km
7. Who accompanies you during your visit to the hospital?a. Children b. Grand children c. Relatives d. Others ……………………….
8. Are you satisfied with your present medical care? a. Yes b. No
How much do you spend monthly on hospital……………………………………………………..?
9. Do u prefer home service or hospital? And why ……………………………………………………………………….?
12. Are you willing to take the medical care services at your home if provided?
a) Yes b) No 11. Do you prefer home ICU?( Explain the respondent the concept of Home ICU)
Reason for willingness a) you can stay with your family b) Reduces the stress of travelling
12. Do you know any of the following home ICU providers?
13. What percentage of medical expenditure , you are expecting to reduce on Home ICU? a) More than 20% b) More than 50% c) More than 80% d) More than 100%
17. Opinion about Home ICU ……………………………………………………………………………………………………...
Observations:
Home ICU is a well established market in western countries. It is a developing market in India at the moment. Big investors are showing their interest in home ICU market using technology. Employment growth is possible in medical field through home ICU. In India People who know about home ICU are showing interests in home ICU services.
