Mass. Survey: Happy With Health Care, Concerned About Costs, ER Use Up

Last month, the Massachusetts Medical Society released its findings on how hard it is to get in to see a primary care doctor in the state. Reminder: Often pretty hard.

Today, the society dropped the second shoe of its state-wide data on the health care system: So how are we feeling about it?

Today's bottom lines: We're still generally very satisfied with the care we get, but man, those medical bills are high and ever higher. And emergency room use is up 6 percent — not something that is supposed to happen under health care reform. From the press release:

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.

The nuts and bolts:

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%.

And more:

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.

On emergency care:

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.

And what's up with non-doctor visits going down?

Non-Physician Visits: 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.

As for deciding where to get care, not many are using the Internet:

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.

And we either don't know about those new health plan and care delivery models or we don't like 'em much...

Health Insurance OptionsTiered 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 full Massachusetts Medical Society survey is here. Readers, any surprises?