Please answer all eight questions below ("N/A" means "No answer") 1. Do you have private health insurance? N/A Yes No 2. How many dependents do you have (including your partner/spouse)? N/A 5+ 4 3 2 1 0 3. How good is your understanding of your District Health Board surgical booking system? N/A Not so good Good Quite good 4. What is your household income (pre-tax)? N/A Above $ 90,000 70,001-90,000 50,001-70,000 30,001-50,000 Below $ 30,000 5. How old are you? N/A Over 65 51-65 36-50 21-35 Below 20 6. Please rank your top three concerns about public hospital surgery (1st, 2nd, 3rd), or select "Not Concerned" if you have little or no concern about public surgical services: 0 3 2 1 Having to wait too long to be assessed and prioritised by a specialist; 0 3 2 1 Being rejected for surgery, even though I am suffering; 0 3 2 1 Being accepted for surgery, but then having to wait (at all); 0 3 2 1 Being accepted for surgery, but then having to wait (a long time); 0 3 2 1 Getting poor quality care; 0 3 2 1 Other: N/A Not Concerned Not concerned -- I am not very concerned about public hospital surgical services; 7. Suppose that, given the public health system 'as-is,' someone could guarantee you that if a specialist assesses you as needing elective surgery, you will get that surgery within six months (and usually much sooner). Please select what you think would be a fair 'price' for you to pay to get this guarantee for one year (for one person): N/A $ 300 or more $ 250 $ 200 $ 150 $ 100 $ 50 $ 10 $ 0 8. Why did you choose that value? Please click the button below to submit your form with total anonymity. Thank you for participating in my study!