EmblemHealth: Diversity Survey

Thank you for taking the time to fill out this survey. EmblemHealth is interested in finding out about your experience with us, your health plan, and your doctors. Your feedback will help us improve the quality and types of services you receive. Let's begin.

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1. When talking with your doctor, do you prefer to use a language other than English?
2. Thinking about your most recent office visit, did your doctor speak to you in the language you prefer?
3. The following are questions about your race and ethnicity. This information helps us to better meet your needs and the needs of the communities we serve. Your answers will be kept private and will not affect your health care coverage.
Please tell us your ethnicity (select one):






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4. Are you Hispanic or Latino?
5. Using a scale of 1 to 10, where 1 is not well at all and 10 is very well, how well do you understand English? (select one)
6. Using a scale of 1 to 10, where 1 is not at all satisfied and 10 is very satisfied, how satisfied are you with the way you and your doctor communicate?
7. Using that same 1 to 10 scale, where 1 is not at all satisfied and 10 is very satisfied, how satisfied are you that your primary care doctor understands your cultural, gender, racial, ethnic and language needs?
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8. Using that same 1 to 10 scale, where 1 is not at all satisfied and 10 is very satisfied, how satisfied are you that any specialists you see understand your cultural, gender, racial, ethnic and language needs?
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9. Do you feel your health plan offers enough primary care and specialist doctors from whom to choose who meet your cultural, gender, racial, ethnic and language needs?
10. Do you prefer to see only doctors or specialists from your culture and/or ethnicity?
11. Do you prefer to see doctors or specialists who are familiar with your culture and/or ethnicity?
12. Please tell us what kind of doctors and/or specialists you’d like to see EmblemHealth offer. Please include information regarding their language, race, culture, ethnicity and location.
If you haven’t looked for, or received services from, a mental or behavioral health professional like a psychiatrist, counselor, therapist or social worker, skip to question 18.

13. Do you feel your plan offers enough mental health professionals who meet your cultural, gender, racial, ethnic and language needs?
14. Do you prefer to see only mental health professionals from your culture and/or ethnicity?
15. Do you prefer to see only mental health professionals who are familiar with your culture and/or ethnicity?
16. Using that same 1 to 10 scale, where 1 is not at all satisfied and 10 is very satisfied, how satisfied are you that your mental health professional understands your cultural, gender, racial, ethnic and language needs?
17. Please tell us what kind of mental or behavioral health professionals you’d like EmblemHealth to have in the network. Please include information on their language, race, culture, ethnicity and location.
18. Using a scale of 1 to 10, where 1 is very dissatisfied and 10 is very satisfied, how satisfied are you with the overall number of primary care doctors, specialists and behavioral or mental health providers in your plan who speak your language and meet your cultural, gender, racial and ethnic needs?
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19. Thinking about the last visit with your primary care doctor, how satisfied were you with the services you received? Use the same 1 to 10 scale where 1 is very dissatisfied and 10 is very satisfied.
20. If you saw a specialist, how satisfied were you with the services you received during your last visit? Use the same 1 to 10 scale where 1 is very dissatisfied and 10 is very satisfied. If you haven’t seen a specialist, just skip this question.
21. If you saw a mental or behavioral health doctor, how satisfied were you with the services you received? Use the same 1 to 10 scale where 1 is very dissatisfied and 10 is very satisfied. If you haven’t seen a mental or behavioral health doctor, just skip this question.
22. Now it’s your turn. Please tell us what you like most about your health plan, or what you think we could do better. If you don’t have any feedback, just skip this question.
23. Would you like EmblemHealth to contact you regarding your responses to this survey?
 
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