Emergency Department Use Rises; Knowledge of New Health Plans, Models of Care is Limited
Contact: Richard Gulla
Waltham -- August 5 -- Seven years into health care reform, and despite longer wait times for appointments with physicians, Massachusetts residents remain as satisfied with the health care they receive as they were before reform began and are finding access to the care they need without difficulty, according to a public opinion poll released today by the Massachusetts Medical Society, the statewide association of physicians.
The poll, seeking the opinions and perceptions of Massachusetts adults on a range of health care issues, also revealed that residents think the cost of care is the most important health care issue facing the Commonwealth, that residents have limited knowledge and unfavorable opinions of the new types of health plans and care models, and that more adults are using the emergency room for care.
“This year’s survey has good news for patients and physicians as well as some warning signs,” said Ronald Dunlap, M.D., president of the Massachusetts Medical Society, who noted that the latest results compare favorably with data from previous public opinion polls.
“Reform has not caused major disruption in the delivery of care as perceived by the patients,” he said. “Residents are telling us that they are satisfied with the quality of their care and that getting access to care is not difficult, despite longer-than-desired wait times for both new and existing patients to see physicians. The survey results also speak well of the state’s healthcare work force, as the number one reason for this satisfaction is quality of care.”
Among the warning signs cited by Dr. Dunlap were the rise in emergency department usage and patients’ limited knowledge of new health insurance plans and models of care. “As emergency department use has a considerable impact on costs, and as new insurance plans and models of care become more prevalent,” Dr. Dunlap said, “these areas call for more attention and more patient education.”
The Society’s Public Opinion Survey of Health Care in the Commonwealth has been conducted periodically since 2003 as part of the Society’s continuing effort to gauge patient opinions of health care in the state. The 2013 survey was conducted by telephone May 14-16 and included 417 randomly selected interviews with adults 21 and over. Major findings:
Top Concerns: Cost and Affordability
When asked to choose among cost of care, access to care, and quality of care, 78% of respondents say that the cost of care is the most important health care issue facing Massachusetts today. When asked a separate, similar, open-ended question, 45% indicated that affordability is the most important issue.
65% of residents believe their health care costs are more expensive than last year, including 28% who think they are “much more expensive” and 37% who believe costs have increased “somewhat.”
Satisfaction with Care
84% of residents expressed satisfaction with the care they received over the last year, including 56% who indicated they are “very satisfied” and 28% who are “somewhat satisfied.” While the 84% is a slight dip from 2012, when 87% said they were satisfied, satisfaction with care has remained highly stable since the Medical Society first asked this question in 2004, when 88% of adults indicated they were satisfied. The biggest reasons for this high level of satisfaction are “quality of care,” cited by 51%, and “good access,” named by 27%.
As in prior polls, residents with higher income and educational levels are more likely to be satisfied with their care and report less difficulty in obtaining care than those with lower levels.
Access to Care
73% of residents reported that gaining access to health care they need is “not difficult” (down 5% from 2012). Despite the declines from last year, ease of access is markedly higher than in 2008, when just 57% said access was not difficult. However, the percentage of residents reporting a wait of a month or more to see their primary care physicians is at its highest level in the history of this study, increasing from 21% in 2012 to 28% in 2013.
For serious medical problems, 86% said the amount of time they needed to wait was not a problem, with the majority of residents (62%) reporting that they waited less than two weeks to get an appointment for a serious problem.
Utilization of Health Services
Primary Care Visits:
The percentage of adults visiting a primary care physician has remained high and steady since 2005, with 88% reporting seeing a primary care physician in 2012. And despite the fact that the percentage of adults who reported waiting a month or more to see their physician is at its highest level in the history of this study (28% in 2013, up 7% from 2012), the overwhelming majority of those who did see a physician last year – 89% - said that the amount of time they waited was not a problem.
Emergency Department Use:
31% of residents reported using the emergency room last year, an increase of 6% from 2012. Emergency room use was higher among younger residents – 40% of adults 40 years of age and younger, compared to 22% of adults over 60.
The most frequently cited reasons for using the ER were: it was a serious but not life-threatening medical problem that needed immediate attention; it was a life-threatening problem that needed immediate attention; ER is the easiest place to get care; difficulty in getting an appointment with my primary care physician; and not having a primary care physician.
Fewer residents (43%, a decline of 5% from 2012) reported seeing a nurse, nurse practitioner, or physician’s assistant, and of those who saw a clinician other than a physician, only 46% did so by choice – the lowest percentage in the history of this study. And while a new state law allows nurse practitioners and physician assistants to act as primary care providers, 67% of respondents said they would prefer to receive care from a physician. In a separate question about retail health clinics, 24% of respondents said they had considered using such a facility.
Sources of Information About Care:
The primary care physician remains the most preferred choice of residents as a source of information when deciding where to go for medical care: 74% of adults said they have asked their physician for suggestions, a number comparable to the 2012 result (77%).
Residents use online information less frequently: only 38% use the internet to find information about physicians, and only 31% go online to find information on quality and cost of care. One reason for the low use of the internet to find cost and quality data is that few residents are aware that such information exists: only 39% said they are aware that this information is available online.
Health Insurance Options
Tiered and Limited Network Plans:
As discovered in last year’s poll, residents’ knowledge of the new health insurance options of tiered health plans and limited network plans remains low. Among those who do offer opinions, adults have generally negative views of these offerings: 43% unfavorable versus 20 favorable for tiered plans; 36% unfavorable to 18% favorable for limited network plans. Providing more information about such plans increases unfavorable views.
Accountable Care Organizations:
Residents’ understanding of ACOs, a new model of care, is also limited: 62% said they don’t know enough to offer an opinion. However, when provided with more information, respondents indicated strong favorability for the coordinated care aspects of ACOs (60% favorable versus 23% unfavorable), but were not in favor of the global payments aspects (45% unfavorable versus 32% favorable).
The complete 2013 Massachusetts Medical Society Public Opinion Survey is available at www.massmed.org/poll2013. It is part of the Society’s continuing efforts to gauge the healthcare landscape in the state and follows the Society’s release last month of its MMS 2013 Patient Access to Care Study, a survey of physician offices regarding wait times for new patients. The 2013 MMS Physician Workforce Study, a comprehensive examination of the physician labor force in the state, is scheduled for release after Labor Day.
The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and NEJM Journal Watch alerts and publications covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.