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SUSENAS
SSN90-S1
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
1990 NATIONAL SOCIO-ECONOMIC SURVEY
HEALTH AND DEMOGRAPHY LISTING
Confidential
I. LOCATION IDENTIFICATION
1
II. HOUSEHOLD LISTING
Province
2
District/ Municipality *)
3
Sub-district
4
Area
5
Susenas Sample Code Number
6
Household Sample Serial Number
1
Name of household head
2
Number of household members
3
Total amount of monthly household
expenses
(Filled by CBS)
4.
Total amount monthly household
income/revenue.
(Filled by CBS)
*) Cross out inapplicable category
2
3
III. HEALTH AND DEMOGRAPHY LISTING
Serial
number
Name of
household
member
(1)
(2)
Relation to
the head of
household
(code)
Gender:
M
-1
F
-2
(3)
(4)
Code for Relation to the head of household
Column 3:
Head of h.h.
Husband/wife
Children
Son/daughter
in-law
-1
-2
-3
-4
Parent/in-laws
Other relative
Servant
Other
-6
-7
-8
-9
Age
(year)
(5)
Marital
Status
(code)
(6)
Codes for marital status
Column 6:
Single
Married
Widowed
Divorced
-1
-2
-3
-4
Highest
education
completed
(code)
Were you in
an accident
during the
past month
Yes
-1
No
-2
(7)
(8)
If "yes"
type of
accident?
(code)
(9)
Codes for highest education completed
Column 7:
No schooling
Not yet completed
Primary school
Primary School
Junior high school
Vocational junior
School
-0
-1
Were you ill
in the past
month
Yes
-1
No
-2
(10)
If col.(8)/
column (10)
coded 1 (was in
an accident/was
ill) place where
you were
treated
(code)
Only for those
who received
outpatient
treatment *)
(11)
(12)
Total cost/
expenses
(Rp)
Codes for type of accident
Column 9:
High School
-5
Accident in the house
Vocational
-6
Accident at the work place
high school
Traffic accident
-2 Diploma I/II
-7
Accident causes by
-3 Academy/
-8
criminal acts
-4 Diploma III
Other
University/
-9
Diploma IV
*) If a household member had an accident/fell ill during the past month, and because of the graveness of the condition was hospitalized, write the total cost for treatment and
medication directly in column (15).
-1
-2
-3
-4
-5
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III. HEALTH AND DEMOGRAPHY LISTING (CONTINUED)
Were you
ever treated
during the
past year?
Yes
-1
No
-2
Place of treatment
Govt. Hosp. -1
Priv. Hosp.
-2
Puskesmas
-3
At health
-4
worker's
house
Total cost /
expenses
(in thousand)
Women aged
15 – 49 years
old and who
is married/
ever married
Yes
-1
No
-2
(13)
(14)
(15)
(16)
Codes for place of treatment
Column (11)
Government hospital
Private hospital
Clinic/BP
Puskesmas
Supporting puskesmas
"Posyandu"/ cader
Doctor’s practice
-01
-02
-03
-04
-05
-06
-07
Midwife’s practice -08
Health assistant/nurse’s
practice
-09
Traditional healer
-10
Self-treated/OTC
-11
Treated in more than
one place
-12
No treatment
-13
To be asking if column (16) coded 1
Pregnancy
in the past
month
(code)
If column
(17) not
coded 00 and
13, cost for
pregnancy
examination
for the past
month**)
(Rp)
(17)
(18)
Births
in the
past
year
(code)
(19)
Codes for Pregnancy
Column (17)
No pregnancy
- Pregnant;
Examined at govt.
Hospital
Private Hospital/
Maternity Hospital
Private maternity
house/maternity clinic
Puskesmas
Supporting Puskesmas
-00
-01
-02
-03
-04
-05
Posyandu/cader
Doctor’s practice
Midwife’s practice
Nurse’s practice
Traditional Birth
Attendants
Never been checked
Total cost
for childbirth
(in thousand)
(20)
IV. METHOD OF PAYMENT
If not paid by
Are there
yourself/family,
delivery/
what is the
pregnancy
percentage of
examination/
total medical
health
costs that is
treatment
paid by the
costs paid by
insurance
other party?
company/comp
No
-1
Yes, by -2 any
Insurance
Yes, by -3
company
(21)
(22)
Codes for delivery, Column (19):
-06
-07
-08
-09
-10
-13
No childbirth
- Childbirth;
At Private Hospital/Maternity Hospital
At Private Maternity House/Maternity Clinic
At Puskesmas
At Midwife's house
At own house with help by doctor
At own house with help by midwife
At own house with help by traditional birth
attendants
-0
-3
-4
-5
-6
-7
-8
-9
**) If childbirth occurred in the past month, then the respondent not recorded as a pregnant, Column (17) is coded 00, and all the total cost (includes pre-natal
examination costs) filled in Column (20)
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