Dear Sir/Madam,
                                This is an academic survey conducted
as
  part of a term paper assignment.
                                 
                                  Your responses to this survey will
be kept
  strictly anonymous and confidential. Your responses will be
  used only for academic purposes.

                                   Thanking you in anticipation for
your
  valuable responses.

                                                                 
                                                           Suneet
Bhutta.
                                                        Graduate
Assistant,
                                                       St. John's
University,
                                                              New
York.

Assume a new drug treatment for asthma becomes available that you can
take instead of you current asthma medication.

This new treatment will reduce the probability of the risk of adverse
drug reactions associated with your current asthma medication from 10
in 100,000 to 2 in 100,000 ( A 80 % reduction )

Due to reduction in the risk of adverse drug reactions due to the new
treatment, you will be able to save up on the cost of drugs used to
treat such adverse drug reactions.

The effectiveness of this new treatment would be the same as that of
your current asthma medication. The number of ‘episode free days'
associated with your current asthma medication would be the same with
this new treatment.

Assume that this new treatment is not covered by your health
insurance. If you want this new treatment, you have to pay for it on
your own.

What is the most u would pay for this new treatment per month?

                              $ 50
                              $ 60
                              $ 70
                              $ 80
                              $ 90
                              $ 100
                              $ 120
                              $ 140
                              $ 160
                              $ 180
                              $ 200
                              $ 250
                              $ 300
                              $ 350
                              $ 400
                              $ 450
                              $ 500

Please, type the amount(s) from the choices given above, that you are
sure you WOULD PAY for this treatment

Please type the amount(s) from the choices given above, that you are
sure you WOULD NOT PAY for this treatment

Please type in the MAXIMUM AMOUNT that you would pay for this
treatment.

If amount is more that $ 500, type here -

       
                                                             

                                               

                              Section 2

Assume that this new treatment is covered by your health insurance for
a monthly premium. This new treatment will be available to you at no
extra cost other than the monthly premium.

What is the monthly premium you would pay for this treatment?

                                 $ 0
                                 $ 5
                                 $ 10
                                 $ 15
                                 $ 20
                                 $ 25
                                 $ 30
                                 $ 35
                                 $ 40
                                 $ 45
                                 $ 50
                                 $ 55
                                 $ 60
                                 $ 65
                                 $ 70
                                 $ 75
                                 $ 80

Please, type the amount(s) from the choices given above, that you are
sure you WOULD PAY for this treatment.

Please type the amount(s) from the choices given above, that you are
sure you WOULD NOT PAY for this treatment

Please type in the MAXIMUM AMOUNT that you are sureyou would pay for
this treatment

If amount is more than $ 80, type here -

                               
                               Section 3


                                             

1) How would you rate your current health status due to asthma on a
scale of
   1 – 10 ?  1 = Poor and 10 = excellent

Answer -

2) Which of the following best describes your annual household income?

a) $ 10000 - $ 20000

b) $ 20000 - $ 35000

c) $ 35000 - $ 50000

d) $ 50000 - $ 70000

e) $ 70000 and above.

Answer - _________

3) Sex:         a) Male                        b)  Female

Answer - _______