PATIENTS PERSPECTIVES ON HEALTH CARE IN THE UNITED STATES: NEW JERSEY

PATIENTS PERSPECTIVES ON HEALTH CARE IN THE UNITED STATES: NEW JERSEY February 2016

INTRODUCTION The landscape and experience of health care in the United States has changed dramatically in the last two years. January 2014 saw insurance purchased on state exchanges and the federal marketplace go into effect, the start of the Affordable Care Act s individual mandate and its accompanying subsidies and tax credits for qualifying Americans, discrimination protections, including pre-existing conditions, for those seeking to buy health insurance, and the implementation of essential health benefits for all plans sold through the insurance marketplace. The Patients Perspectives on Health Care survey series seeks to illuminate the self-reported experiences today of health care consumers across the country and in seven states: Florida, Kansas, New Jersey, Ohio, Oregon, Texas and Wisconsin. This report, in particular, highlights the experiences of recent patients in New Jersey and aims to answer seven main questions: 1. What is the overall picture in New Jersey what has changed in the past two years, and how do adults in New Jersey rate their health care and costs at the state and personal levels? 2. How do adults in New Jersey rate the quality of their health care? 3. How do adults in New Jersey perceive the cost of their health care? 4. Do adults in New Jersey face barriers to accessing health care? 5. How do adults in New Jersey experience health care at different sites, including doctor s offices, hospitals, emergency rooms, urgent care centers and retail or drug store mini-clinics? 6. What do adults in New Jersey think of national health reform? 7. How do the health care experiences of adults in New Jersey differ from the experiences of adults nationwide? All participants both those sampled in the seven states and across the nation were asked to share their personal experiences and opinions. Thus, comparisons between New Jersey and the nation contrast the views of a representative sample of New Jersey residents to a representative sample of residents across the country asked about their perceptions of their own state. Only those adults who report having received care during a given type of health care visit were asked to rate the quality of their health care during their most recent visit. This prevents residents who have never used urgent care centers, for example, from weighing in on the quality or cost of those facilities. 1

EXECUTIVE SUMMARY A new poll of adults across the U.S. and in seven states by National Public Radio, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health shows that despite major shifts in the American health care system over the past two years, most New Jersey residents report that the health care they personally receive has remained about the same. In terms of health care costs, most adults in New Jersey view these as reasonable, but getting less affordable over time. Survey results also indicate that adults in New Jersey are more positive about the health care they personally receive than about the functioning of the state s overall health care system. Where most rate their own health care positively, far more adults in New Jersey rate the state s overall health care system as fair or poor than rate it as excellent. What is the overall picture in New Jersey? Adults in New Jersey reflect more positively on the health care they personally receive than they do on the state s health care system, overall. Far more adults rate the care they personally receive as excellent than rate the health care system in their state similarly. Most also believe their personal costs are reasonable, if getting costlier over time. However, most adults in New Jersey say health care costs are a major problem in their state and more than a quarter say that the health of people in the state is getting worse. More than a third of adults in New Jersey also believe their health insurance co-pay, deductible and premium costs have increased in the past two years, while only one in five say the same of their benefits. How do adults in New Jersey rate the quality of their health care? Adults in New Jersey report mixed feelings when it comes to the quality of their health care. Only one type of health care facility urgent care centers prompted more than forty percent of patients to say the quality of health care they received during their most recent visit was excellent. In contrast, recent patients put emergency rooms at the bottom of the list, as the proportion of patients who rated their care as excellent nearly equaled the proportion that rated their care as fair or poor. Overall, most adults in New Jersey do not consider the health care they receive to be excellent, even though a minority of adults says their care is fair or poor. How do adults in New Jersey perceive the cost of their health care? Most adults in New Jersey believe their health care costs are reasonable, although this varies substantially by facility. Patient cost ratings indicate emergency room visits are perceived to be most unreasonable, followed by overnight hospitalization. Mini-clinic patients are much more likely to say their health care costs are reasonable, though overall use is low. Health care costs cause serious financial problems for more than a quarter of New Jersey adults, many of whom report being contacted by bill collectors. Notably, one in five Garden State residents say they struggle to afford prescription drugs and one third of adults in New Jersey with problematic health care costs say they have spent all or most of their personal savings in the past two years. 2

Do adults in New Jersey face barriers to accessing health care? The vast majority of adults in New Jersey report having a regular doctor or health care professional that provides most of their care when they are sick or have a health concern. In the past two years, more than one in five adults say there has been at least one time when they couldn t see their regular doctor, but a strong majority of these patients were able to see a different provider often at urgent care centers. About one in seven adults in New Jersey report having been unable to get the care they needed at some point in the past two years. Also, when asked whether they would be able to receive the best treatment available in their state if they became seriously ill, about two-thirds of New Jersey adults believe they would. How do adults in New Jersey experience health care at different sites? None of the six measures used to assess visits to a doctor or other health professional in this survey, including overall experience and quality of care, received excellent ratings from at least half of recent patients. Among those who have recently seen a doctor, adults in New Jersey rate their provider s concern with maintaining their long-term health the highest, and their ability to get in touch with their doctor by phone or email outside of appointments the lowest. Overnight hospitalization received even worse ratings for quality and cost from recent patients. However, nearly four out of five recent patients say their views and preferences were taken into account by staff and providers during their most recent stay. When it comes to alternative care sites, emergency rooms are used by more than half of patients to treat major wounds or illnesses, while urgent care centers are most often used for minor health problems, and mini-clinics are frequented for vaccines. Emergency rooms rank last among all surveyed health care facilities when it comes to cost, and approximately the same proportion of recent emergency room patients rate the quality of care they received as fair or poor. Urgent care centers, by contrast, are perceived to be of much higher quality, and mini-clinics, much more affordable. Reported use of all three sites is trending sharply up, as more than a quarter of recent patients say they use alternate facilities more now than they did two years ago. When asked why they prefer these sites over doctor s offices or community health centers, many patients cite convenience and availability as major factors. What do adults in New Jersey think of national health reform? Feelings on the individual-level effects of the Affordable Care Act are mixed among adults in New Jersey. More people believe national health reform has either hurt them personally or not had a direct impact on them at all than believe it has helped them. At the state level, however, many more adults believe the law has directly helped adults in New Jersey than believe it has hurt state residents. Do health care experiences in New Jersey differ from those nationwide? Adults in New Jersey are less likely to face barriers to health care access than adults nationwide, as more patients in the Garden State report having a regular doctor and having been continuously insured over the past two years. When it comes to health care facilities, adults in New Jersey are more likely than their peers across the country to rate urgent care centers highly and say their use of these sites has gone up in recent years. Notably, adults in New Jersey are much more likely to say health care costs are a problem at the state and personal levels. This may be attributable to greater use of medical specialists for care and reported health insurance premium increases. 3

OVERALL PICTURE This section answers the question What is the overall picture in New Jersey? What has or has not changed in the past two years, and how do adults in New Jersey rate their health care and costs at the state and personal levels?" Adults in New Jersey reflect more positively on the health care they personally receive than they do on the state s health care system, overall. Far more adults rate the care they personally receive as excellent than rate the health care system in their state similarly. Most also believe their personal costs are reasonable, if getting costlier over time. However, most adults in New Jersey say health care costs are a major problem in their state and more than a quarter say that the health of people in the state is getting worse. More than a third of adults in New Jersey also believe their health insurance co-pay, deductible and premium costs have increased in the past two years, while only one in five say the same of their benefits. Assessment of Care Personally Received Many adults in New Jersey are happy with the care they personally receive as patients; however, most do not rate their care as excellent (Figure 1) and a strong majority believes their care has stayed about the same in recent years (Figure 2). Just over half of New Jersey adults say the cost they personally pay for their care is reasonable (Figure 3), although many believe these costs for health care services and prescription drugs have become less affordable in recent years (Figure 4). Few adults in New Jersey believe the health care they receive is excellent; however, more New Jerseyans say their care is excellent than say it is fair or poor. FIGURE 1. Percent of adults in New Jersey who rate the health care they personally receive as excellent, good, fair, or poor (Q9). Excellent Good Fair Poor 27% 50% 16% 4% The vast majority of adults in New Jersey believe the health care they have received has stayed about the same over the past two years. Just over one quarter believe it has gotten better or worse. FIGURE 2. Percent of adults in New Jersey who say the health care they personally receive has gotten better, worse, or stayed about the same over the past two years (Q10). Better Stayed about the Same Worse 13% 72% 12% 4

Most adults in New Jersey say the cost they personally pay for their health care is reasonable. In contrast, nearly two in five (39%) disagree and say the amount they pay is unreasonable. FIGURE 3. Percent of adults in New Jersey who say the cost they personally pay for health care, including premiums, deductibles, copayments, and prescription drugs, is reasonable or unreasonable (Q15). Reasonable Unreasonable 52% 39% Many adults in New Jersey believe costs are getting worse over time. More than a quarter believe prescription drugs have become harder to afford in the past two years, and nearly two in five believe their health care services are harder to afford now than they used to be. FIGURE 4. Percent of adults in New Jersey who say the cost of their health care services and prescription drugs has gotten more affordable, less affordable, or stayed about the same over the past two years (Q16 a-b). More Affordable Stayed about the Same Less Affordable 11% 47% 39% Cost of health care services 11% 54% 26% Cost of prescription drugs The State of the State Adults in New Jersey are much less positive about their state s health care system than they are about the care they personally receive as patients. More than four in ten New Jersey adults say the state s health care system is just fair or poor (Figure 5), and more than one in four believes the health of people in their state has gotten worse in the past two years (Figure 6). As depicted in Figure 7, nearly three-quarters of adults in New Jersey say health care costs are a problem in the state, and most also say state costs have risen in recent years (Figure 8). Nearly half (45%) of adults in New Jersey say their state s health care system is fair or poor. This is substantially larger than the 12 percent of Garden State residents who say it is excellent. 5

FIGURE 5. Percent of adults in New Jersey who rate the health care system in their state as excellent, good, fair, or poor (Q2). Excellent Good Fair Poor 12% 38% 30% 15% Almost half (46%) of adults in New Jersey believe the health of people in their state has stayed about the same over the past two years. Others note changes, however, with more believing the health of people in New Jersey has worsened (26%) over the past two years than believing it has improved (13%). FIGURE 6. Percent of adults in New Jersey who say the health of people in their state has gotten better, worse, or stayed about the same over the past two years (Q1). Better Stayed about the Same Worse 13% 46% 26% Nearly three-quarters of adults in New Jersey say health care costs are a problem in their state. Almost three in five (59%) say costs are a major problem, while just over one in seven (14%) say costs are a minor problem. Less than one in five (19%) disagree, saying health care costs are not a problem in the Garden State. FIGURE 7. Percent of adults in New Jersey who say health care costs are or are not a problem in their state (Q66). Not a Problem Minor Problem Major Problem 19% 14% 59% An overwhelming majority of adults in New Jersey believe the cost of health care in their state has increased in the past two years a much greater proportion than those who believe health care costs have decreased. FIGURE 8. Percent of adults in New Jersey who say the cost of health care in their state has increased, decreased, or stayed about the same over the past two years (Q4). Decreased Stayed about the Same Increased 3% 22% 63% 6

Health Insurance Just under one in ten (9%) adults age 18 or older in New Jersey say they are currently uninsured and just under a quarter (23%) of adults ages 18-64 say there has been at least once in the past two years when they have not had health insurance (Q57/62a). Among those adults in New Jersey who report being currently insured, most reflect positively on the quality of their coverage (Figure 9), but only just over a third (36%) say their coverage is excellent (Q61). In contrast, more than a quarter (27%) of insured adults in New Jersey say the quality of their health insurance is just fair or poor. FIGURE 9. Percent of adults in New Jersey who rate their health insurance as excellent, good, fair, or poor (Q61). Excellent Good Fair Poor 36% 36% 19% 8% More insured adults in New Jersey say the cost of their coverage has gone up in recent years than those who say their benefits have increased. Whereas nearly half (49%) of all insured New Jersey adults say their premiums have gone up in the past two years and more than one in three (35%) say their co-pays or deductibles have risen, only one in five (20%) say their benefits have increased (Figure 10). FIGURE 10. Percent of adults in New Jersey who say the cost of their health insurance benefits, co-pays and deductibles, and premiums have increased, decreased, or stayed about the same over the past two years (Q63 a-b, 64). Decreased Stayed about the Same Increased 10% 66% 20% Benefits 3% 55% 35% Co-pays and deductibles 3% 41% 49% Premium 7

HEALTH CARE QUALITY This section answers the question How do adults in New Jersey rate the quality of their health care? by examining how adults in the state rate the care they have received during visits to five different health care facilities over the past two years. Adults in New Jersey report mixed feelings when it comes to the quality of their health care. Only one type of health care facility urgent care centers prompted more than forty percent of patients to say the quality of health care they received during their most recent visit was excellent (Figure 11). In contrast, recent patients put emergency rooms at the bottom of the list, as the proportion of patients who rated their care as excellent nearly equaled the proportion that rated their care as fair or poor. Overall, most adults in New Jersey do not consider the health care they receive to be excellent, even though a minority of adults says their care is fair or poor. FIGURE 11. Percent of adults in New Jersey who rate the quality of health care they received during visits to five different health care facilities in the past two years as excellent, good, fair, or poor (Q12b, 33, 38, 45, 51). Excellent Good Fair Poor 39% 45% 12% 4% Visit to a doctor 35% 34% 21% 10% Overnight hospitalization 34% 32% 19% 14% Visit to emergency room 42% 44% 12% 2% Visit to urgent care center 37% 45% 18% 0% Visit to retail or drug store mini-clinic 8

HEALTH CARE COSTS This section answers the question How do adults in New Jersey perceive the cost of their health care? by examining how adults in the state characterize the cost of the care they have received during visits to five different health care facilities over the past two years. Most adults in New Jersey believe their health care costs are reasonable, although this varies substantially by facility. Patient cost ratings indicate emergency room visits are perceived to be most unreasonable, followed by overnight hospitalization. Mini-clinic patients are much more likely to say their health care costs are reasonable, though overall use is low. Health care costs cause serious financial problems for more than a quarter of New Jersey adults, many of whom report being contacted by bill collectors. Notably, one in five Garden State residents say they struggle to afford prescription drugs and one third of adults in New Jersey with problematic health care costs say they have spent all or most of their personal savings in the past two years. Cost of Care across Facilities Most adults in New Jersey say the cost of health care they received during their most recent visit to five types of health care facilities in the past two years is reasonable (Figure 12); however, a substantial portion of recent patients, in some cases, disagree. The only exemplary cost performer in this group is retail or drug store mini-clinics; however, only one in eight (13%) adults in New Jersey visits these sites of care. Four in ten recent ER patients say the cost of their most recent visit is unreasonable, making it the worst cost performer in the group. FIGURE 12. Percent of adults in New Jersey who characterize the cost of health care they received during visits to five different types of health care facilities in the past two years as reasonable or unreasonable (Q14, 34, 39, 46, 52). Reasonable Unreasonable 71% 22% Visit to a doctor 58% 33% Overnight hospitalization 50% 43% Visit to emergency room 77% 15% Visit to urgent care center 85% 13% Visit to retail or drug store mini-clinic 9

Health Care Value When asked to think about the cost and quality of health care they receive, more than two-thirds (67%) of New Jersey adults say they get good value for what they pay toward the cost of their health care (Q65). Just under three in ten (28%) disagree, saying they do not believe they get good value for what they pay. Serious Financial Problems More than a quarter of adults in New Jersey say health care costs have caused a serious financial problem for them as individuals or for their family (Table 1). Being contacted by bill collectors was the most common consequence of these serious financial problems, experienced by just under half of patients who struggle with health care costs. The second and third most common consequences are having to set up a payment plan with a hospital or provider and spending all or most of one s personal savings. TABLE 1. Percent of adults in New Jersey who say their health care costs over the past two years caused a very or somewhat serious problem for their personal or their family s overall financial situation and for whom the following happened because of large medical bills (Q20, 21 a-g). Health care costs caused a serious financial problem 27% Contacted by bill collectors 47% Set up a payment plan with a hospital or health care professional 44% Spent all or most of their personal savings 32% Taken on credit card debt that may be difficult to pay off 28% Unable to pay for basic necessities like food, heat or housing 27% Taken out a loan that may be hard to pay back 8% Declared bankruptcy 3% Prescription Drugs The cost of prescription drugs has caused one in five residents to not fill a prescription, and more than one in seven to cut pills in half or skip doses of medicine (Table 2). TABLE 2. Percent of adults in New Jersey who say they did the following at least once in the past two years because of the cost of prescription drugs (Q22 a-b). Did not fill a prescription 20% Cut pills in half or skipped doses of medicine 15% 10

HEALTH CARE ACCESS This section answers the question Do adults in New Jersey face barriers to accessing health care? by examining whether or not adults in the state report having a regular doctor, being able to see their regular doctor, and being able to get the health care they needed in the past two years. The vast majority of adults in New Jersey report having a regular doctor or health care professional that provides most of their care when they are sick or have a health concern. In the past two years, more than one in five adults say there has been at least one time when they couldn t see their regular doctor, but a strong majority of these patients were able to see a different provider often at urgent care centers. About one in seven adults in New Jersey report having been unable to get the care they needed at some point in the past two years. Also, when asked whether they would be able to receive the best treatment available in their state if they became seriously ill, about two-thirds of New Jersey adults believe they would. Experiences with a Regular Doctor About one in five (19%) adults in New Jersey say they do not have a regular doctor or health care professional who provides most of their health care when they are sick or have a health concern, while 81 percent say they do (Q27). Among those with a regular doctor, more than one in five (22%) say there has been at least one time in the last two years when they needed health care, but could not see their provider. Among those who could not see their regular doctor when they needed care, most say it was because either their doctor did not have any available appointment times or they needed care at night or on the weekend when their doctor s office was not open (Table 3). Seven in ten (71%) of these patients were able to receive health care from another provider, most often at an urgent care center; however, 28 percent say they were unable to receive health care from a different provider. Overall, one in six (16%) adults in New Jersey say it has gotten harder to see a doctor in the past two years, while just under three-quarters (74%) of adults in New Jersey say their ability to see a doctor has stayed about the same. Only eight percent of Garden State residents say it has gotten easier to see a provider in recent years (Q26). 11

TABLE 3. Factors cited by adults in New Jersey that contributed to being unable to see their regular doctor sometime in the past two years and where they were ultimately able to receive care, among those who were able to see a different doctor (Q28, 29 a-g, 30, 31 a-e). Could not see their regular doctor or health care professional at some point in the past two years when they needed health care 22% Doctor did not have any available appointment times 58% Needed care at night or on the weekend when doctor s office was not open 45% Doctor was away from the office 38% Could not afford the visit 24% Lost insurance coverage 18% Doctor was too far away or difficult to get to 17% Doctor stopped taking patient s insurance 17% Able to get health care from a different doctor 71% At an urgent care center 62% At regular doctor s office, but with a different doctor 57% In the emergency room 53% At a different doctor s office or clinic 46% At a retail or drug store mini-clinic 20% Unable to get health care from a different doctor 28% Problems Getting Needed Health Care Just over one in seven (14%) adults in New Jersey say there has been a time in the past two years when they needed health care, but couldn t get it (Table 4). Being unable to afford it was the leading reason for not receiving needed health care. Notably, more than one in five (22%) adults who say they could not get the health care they needed at some point in the past two years also say they were turned away at least once by a doctor or hospital for financial or insurance reasons while trying to seek care. TABLE 4. Factors cited by adults in New Jersey that contributed to being unable to receive the health care they needed sometime in the past two years (Q17, 18 a-d, 19). Needed health care, but could not get it at least once in the past two years 14% Could not afford the health care 62% Could not get an appointment during the hours they needed 35% Could not find a doctor who would take their health insurance 32% Felt the health care center was too far or difficult to get to 25% Tried to get medical care and were turned away for financial or insurance reasons 22% 12

Perceived Ability to Access Excellent Care Survey participants were asked, If you became seriously ill, do you think you would or would not be able to get the best treatment available in your state? One-quarter (25%) of adults in New Jersey say they do not think they would be able to access the state s best available treatment if they were seriously ill, while two-thirds (66%) say they think they would be able to get the best treatment available (Q3). 13

EXPERIENCES AT DIFFERENT SITES OF CARE This section answers the question How do adults in New Jersey experience health care at five different facilities, including doctor s offices, hospitals, emergency rooms, urgent care centers and retail or drug store mini-clinics? None of the six measures used to assess visits to a doctor or other health professional in this survey, including overall experience and quality of care, received excellent ratings from at least half of recent patients. Among those who have recently seen a doctor, adults in New Jersey rate their provider s concern with maintaining their long-term health the highest, and their ability to get in touch with their doctor by phone or email outside of appointments the lowest. Overnight hospitalization received even worse ratings for quality and cost from recent patients. However, nearly four out of five recent patients say their views and preferences were taken into account by staff and providers during their most recent stay. When it comes to alternative care sites, emergency rooms are used by more than half of patients to treat major wounds or illnesses, while urgent care centers are most often used for minor health problems, and mini-clinics are frequented for vaccines. Emergency rooms rank last among all surveyed health care facilities when it comes to cost and approximately the same proportion of recent emergency room patients rate the quality of care they received as fair or poor. Urgent care centers, by contrast, are perceived to be of much higher quality, and mini-clinics, much more affordable. Reported use of all three sites is increasing sharply, as more than a quarter of recent patients say they use alternate facilities more now than they did two years ago. When asked why they prefer these sites over doctor s offices or community health centers, many patients cite convenience and availability as major factors. DOCTOR S OFFICES The vast majority of adults in New Jersey say they have visited a doctor or other health professional in the past two years (Table 5). Of those, just over three in five say they were seen by a general practitioner such as a family physician or nurse practitioner during their most recent visit, while more than a third say they saw a medical specialist like a cardiologist or surgeon. TABLE 5. Types of medical practitioners seen by adults in New Jersey during their most recent visit to a doctor or other health professional (Q11, 13). Visited a doctor or health care professional in the past two years 85% General practitioner 62% Medical specialist 36% Most Recent Doctor s Visit Adults who report having visited a doctor or other health care professional in the past two years were asked to rate their most recent visit on six different measures. More than two in five recent patients in New Jersey say their doctor s concern with maintaining their long-term health and other factors in their 14

life that could affect their health and well-being was excellent, and about the same proportion also gave an excellent rating to the quality of the health care they received (Figure 13). In contrast, just over a quarter of recent patients say their ability to get in touch with their doctor outside of an appointment, by phone or email, was excellent a smaller proportion than those who rate this same measure as fair or poor. FIGURE 13. Percent of adults in New Jersey who rate six aspects of their most recent visit to a doctor or other health professional as excellent, good, fair or poor, among those have visited a doctor or other health professional in the past two years (Q12 a-f). Excellent Good Fair Poor 37% 49% 11% 3% Overall experience 39% 45% 12% 4% Quality of health care 39% 43% 10% 1% Doctor s sensitivity to patient s cultural background 41% 40% 13% 5% Doctor s concern with maintaining long-term health and other factors that could affect well-being 32% 46% 15% 6% Amount of time spent with the doctor 27% 36% 18% 13% Ability to get in touch with the doctor outside of an appointment, by phone or email When asked about cost, recent patients in New Jersey were very positive. Just over seven in ten (71%) say the cost of the health care they received during their last doctor s visit was reasonable, while less than a quarter (22%) say it was unreasonable (Q14). Sick Visits Two-thirds (66%) of adults in New Jersey say they have scheduled a visit with a doctor or other health professional in the past two years because they were sick or had a health concern (Table 6). Most (56%) patients report three days or fewer elapsed between when they made the appointment and when they actually saw the doctor. About one in eight (13%), however, say they had to wait more than three weeks to be seen by a doctor when they were sick or had a health concern. 15

TABLE 6. Amount of time that passed between scheduling an appointment and actually seeing the doctor, among those adults in New Jersey who say they scheduled a doctor s appointment in the last two years because they were sick or had a health concern (Q23, 24). Scheduled a sick visit in the past two years 66% Less than 24 hours 26% About one to three days 30% About four to seven days 16% More than one week 9% More than two weeks 5% More than three weeks 4% More than one month 9% Among those who report having scheduled a sick visit in the past two years, three-quarters (75%) say the length of time they had to wait between scheduling the appointment and seeing a doctor was reasonable (Q25). More than one in five (23%), however, say the amount of time they had to wait for an appointment was unreasonable. Overall, one in six (16%) adults in New Jersey say it has gotten harder to see a doctor in the past two years, while just under three-quarters (74%) of adults in New Jersey say their ability to see a doctor has stayed about the same. Only eight percent of Garden State residents say it has gotten easier to see a provider in recent years (Q26). HOSPITALS About one in five (21%) New Jersey adults say they have been hospitalized overnight in the past two years (Q32). Quality & Cost More than a third (35%) of recently hospitalized patients in New Jersey say the quality of health care they received during their last hospitalization was excellent and nearly the same proportion (34%) say their last overnight hospital stay was good (Q33). In contrast, about one in five (21%) say their care was just fair, and one in ten (10%) say it was poor. In terms of cost, less than three in five (58%) recently hospitalized patients in New Jersey say the cost of the health care they received during their most recent hospitalization was reasonable, while one third (33%) says it was unreasonable (Q34). Treatment by Doctors & Staff The vast majority (79%) of recently hospitalized patients in New Jersey say that during their most recent hospital stay, their views and preferences were taken into account by the doctors and other health professionals who treated them, while one in five (20%) say their views and preferences were not taken into account (Q35). 16

Just over a third (34%) of recently hospitalized patients in New Jersey say that during their most recent stay, staff did an excellent job of preparing them for the care they would need after leaving the hospital (Q36). Two in five (40%) rate their preparation as good, while about one in six (16%) say it was fair and just under one in ten (9%) say staff prepared them poorly. EMERGENCY ROOMS More than a third (35%) of adults in New Jersey say they have received health care in the emergency room (ER) of a hospital in the past two years (Q37). Of those, more than one in five (23%) say their use of the emergency room has gone up in the last two years, whereas about one in ten (11%) recent patients say they use the ER less now than they used to (Q42). Purpose of & Reason for Visit Most (52%) recent patients in New Jersey say they went to the emergency room to get treatment for a major health problem like a broken bone, a cut, or a high fever (Table 7). When asked why they went to the ER instead of an urgent care center, doctor s office or community health center, more than two in five (43%) recent patients say it was because they thought they might need to be hospitalized, because they were brought by ambulance, or because they felt other facilities did not have the necessary staff or equipment to treat them. By comparison, 37 percent of patients say they went to the emergency room because other facilities were not open or they could not get an appointment, they thought the ER was the only place that would treat them, or because other facilities were too far away. TABLE 7. Main purpose for seeking treatment in the emergency room and main reasons for seeking care there, among recent ER patients in New Jersey (Q37, 40, 41). Received health care in the emergency room of a hospital in the past two years 35% Main purpose of most recent visit Treatment for major health problem 52% Some other purpose 27% Treatment for minor health problem 20% Main reason for visiting the emergency room instead of other facilities Some other reason 20% Other facilities were not open or could not get an appointment 18% Brought by ambulance 18% Might need to be admitted to the hospital overnight 14% Felt the ER was the only place that would treat them 12% Other facilities did not have the necessary staff or equipment 11% Other facilities were far away too 7% Quality & Cost Just over a third (34%) of recent ER patients in New Jersey say the quality of health care they received during their most recent visit was excellent, while nearly the same proportion (32%) say it was good. In 17

contrast, about one in five (19%) say the care they received in the ER was only fair, while one in seven (14%) characterize their care as poor (Q38). In terms of cost, only one in two (50%) recent patients in New Jersey say the cost of health care they received during their most recent visit to the ER was reasonable, while more than two in five (43%) say it was unreasonable, making emergency rooms the lowest cost-performer of any surveyed health care facility in New Jersey (Q39). Treatment by Doctors & Staff More than three in ten (31%) recent ER patients in New Jersey say that during their most recent hospitalization, staff did an excellent job of preparing them for the care they would need after leaving the hospital, while less than two in five (37%) say staff did a good job (Q43). On the other hand, one in five (20%) patients say ER staff prepared them only fairly and one in ten (10%) say staff prepared them poorly. URGENT CARE CENTERS Urgent care centers are a category of free-standing, walk-in healthcare facilities typically located in highly visible, easily accessible locations. They generally do not require appointments and have extended evening and weekend hours of service. 1 Centers are typically staffed by physicians, sometimes nurse practitioners or physician assistants, 2 and offer short-term medical care for a range of acute, non-life threatening illnesses and injuries, as well as a limited array of diagnostic services such as lab testing and imaging. 3 Urgent care centers began to appear in the early 1980s and as of 2015 there were nearly 7,000 locations nationwide. 4 New Jersey alone has more than 130. 5 Just under three in ten (28%) adults in New Jersey say they have received health care at an urgent care center in the past two years (Q44). Of those, the same proportion (28%) say their use of urgent care centers has gone up in the last two years, whereas just two percent of recent patients say they use urgent care centers less now than they used to (Q49). Quality & Cost More than two in five (42%) of recent urgent care center patients in New Jersey say the quality of health care they received during their most recent visit was excellent, while a slightly larger proportion (44%) say it was good, making urgent care centers the top-rated health care facility in the state. In contrast, more than one in ten (12%) say their care was just fair and two percent say it was poor (Q45). In terms of cost, more than three-fourths (77%) of recent patients in New Jersey say the cost of health care they received 1 Urgent Care Association of America, Industry FAQs, http://www.ucaoa.org/general/custom.asp?page=industryfaqs 2 American College of Emergency Physicians, Urgent Care Fact Sheet, http://newsroom.acep.org/index.php?s=20301&item=30033 3 AMN Healthcare, Will Healthcare Staffing Shortages Challenge Urgent Care Growth?, https://www.amnhealthcare.com/will_healthcare_staffing_shortages_challenge_urgent_care_growth/ 4 Urgent Care Association of America, The Case for Urgent Care, 2011, http://c.ymcdn.com/sites/www.ucaoa.org/resource/resmgr/files/whitepaperthecaseforurgentca.pdf 5 Urgent Care Locations, New Jersey Urgent Care and Walk-in Clinics, https://www.urgentcarelocations.com/nj/new-jerseyurgent-care 18

during their most recent visit to an urgent care center was reasonable, while just over one in seven (15%) say the cost was unreasonable (Q46). Purpose of & Reason for Visit When asked about the purpose of their last visit to an urgent care center, most (52%) recent patients in New Jersey say it was to get treatment for a minor wound or illness like a sprain or sore throat (Table 8). Just under a quarter (23%) of recent patients say they went to an urgent care center because they thought it would take less time to be seen and treated, and more than one in five (22%) say they went because the hours were more convenient, compared to other facilities like hospitals, doctor s offices and community health centers. TABLE 8. Main purpose for seeking treatment at an urgent care center and main reasons for seeking care there, among recent urgent care center patients in New Jersey (Q44, 47, 48). Received health care at an urgent care center in the past two years 28% Main purpose of most recent visit Treatment for minor wound or illness 52% Some other purpose 19% Treatment for major wound or illness 15% Routine screening, test, exam or vaccination 7% Prescription or treatment for a long-term health condition 5% Main reason for visiting urgent care instead of going to other facilities Thought it would take less time to be seen and treated 23% Hours were more convenient 22% Location was more convenient 21% Some other reason 20% Considered the cost to be more affordable 8% Considered quality of health care to be better 4% Felt more comfortable with the staff 2% RETAIL OR DRUG STORE MINI-CLINICS Retail and drug store mini-clinics, also referred to as convenient care clinics, are a category of walk-in healthcare facilities located in high traffic retail settings such as supermarkets and drug stores. Generally, these facilities do not require appointments and have extended evening and weekend hours of service. Mini-clinics are typically staffed by advanced practice nurses, such as nurse practitioners, or by physician assistants. 6 They offer routine care for a narrow range of common, low-severity, illnesses and conditions as well as preventive health care services such as physical exams and vaccinations. 7 Most locations accept 6 Association of State and Territorial Health Officials, Defining the Safety Net: Retail Clinics, 2011, http://www.astho.org/programs/access/primary-care/safety-net-fact-sheets/materials/retail-clinics-fact-sheet/ 7 Rheumatology Network, The Impact of Mini-Clinics, 2011, http://www.rheumatologynetwork.com/pearls/impact-miniclinics 19

private health insurance plans, though insurance is not necessary to receive treatment. 8 Nationally, these clinics first appeared in 2000, 9 and as of December 2015, New Jersey had several varieties, including 37 CVS Minute Clinic locations 10 and seven Walgreens Healthcare Clinics. 11 Less than one in seven (13%) adults in New Jersey say they have received health care at a retail or drug store mini-clinic in the past two years (Q50). Of those, one quarter (25%) say their use of mini-clinics has gone up in the last two years, whereas less than one in twenty (3%) recent patients say they use miniclinics less now than they used to (Q55). Quality & Cost Just under four in ten (37%) recent mini-clinic patients in New Jersey say the quality of health care they received during their most recent visit was excellent, while more than four in ten (45%) say it was good. In contrast, less than two in ten (18%) say their care was only fair (Q51). In terms of cost, the vast majority (85%) of recent patients in New Jersey say the cost of health care they received during their most recent visit to a mini-clinic was reasonable, while about one in eight (13%) say the cost was unreasonable (Q52). Purpose of & Reason for Visit When asked about the purpose of their last visit to a mini-clinic, the top reason cited by recent patients was to get a vaccine (Table 9). More than a third (34%) of recent patients say they went to a mini-clinic instead of an urgent care center, doctor s office or hospital because the location was more convenient, making this the top reason for care at mini-clinics in New Jersey. In second place, convenient hours were cited by 20 percent of recent mini-clinic patients in New Jersey. 8 Association of State and Territorial Health Officials, Defining the Safety Net: Retail Clinics, 2011, http://www.astho.org/programs/access/primary-care/safety-net-fact-sheets/materials/retail-clinics-fact-sheet/ 9 Convenient Care Association, History of the Industry, http://ccaclinics.org/about-us/history-of-the-industry 10 CVS Minute Clinic, Clinic Locator: New Jersey, http://www.cvs.com/minuteclinic/clinics/new-jersey 11 Walgreens Healthcare Clinic, Healthcare Clinic Locator, http://www.walgreens.com/storelocator/ 20

TABLE 9. Main purpose for seeking treatment at a retail or drug store mini-clinic and main reasons for seeking care there, among recent mini-clinic patients in New Jersey (Q50, 53, 54). Received health care at a retail or drug store mini-clinic in the past two years 13% Main purpose of most recent visit Vaccine 46% Treatment for minor illness 23% Prescription or treatment for long-term health condition 12% Physical exam 9% Treatment for minor wound or skin condition 3% Some other purpose 3% Health screening or test 2% Main reason for visiting a mini-clinic Location was more convenient 34% Hours were more convenient 20% Some other reason 18% Thought it would take less time to be seen and treated 15% Considered cost to be more affordable 8% More comfortable with staff 2% Considered quality of health care to be better 2% 21

OPINIONS ON NATIONAL HEALTH REFORM This section answers the question What do adults in New Jersey think of national health reform? Feelings on the individual-level effects of the Affordable Care Act are mixed among adults in New Jersey. More people believe national health reform has either hurt them personally or not had a direct impact on them at all than believe it has helped them. At the state level, however, many more adults believe the law has directly helped adults in New Jersey than believe it has hurt state residents. National Health Reform.Views on the Affordable Care Act (ACA), also called Obamacare, are mixed among adults in New Jersey. About four in ten (38%) adults believe national health reform has benefitted state residents, while less than one in five (18%) feel the law has helped them personally (Figure 14). In contrast, the proportion of people who believe the ACA has directly hurt them, as individuals, (25%) is almost equal to the proportion of people who believe it has directly hurt the people of New Jersey (27%). FIGURE 14. Perceptions of the Affordable Care Act s impact on survey participants or on people in the state where they live, among adults in New Jersey (Q5, 6). Directly Helped No Direct Impact Directly Hurt 18% 53% 25% Individual 38% 17% 27% The people of New Jersey 22

NEW JERSEY v. THE NATION On most measures in this survey, the views of adults in New Jersey do not diverge substantially from the views of adults across the United States about their own state. In a few key areas, however, the opinions and experiences of Garden State residents differ significantly 12 from their peers nationwide for better and for worse. Adults in New Jersey tend to face fewer barriers to health care access than adults nationwide. Whereas less than three-quarters (74%) of adults around the country say they have a doctor or health care professional who provides most of their health care when they are sick or have a health concern, more than four in five (81%) New Jersey residents say they have a regular doctor. This is also reflected in the higher proportion of Garden State adults (66%) who say they have scheduled a sick visit with their provider in the past two years, compared to 58 percent nationwide. Adults ages 18-64 in New Jersey (76%) are also more likely to report having had continuous insurance coverage over the past two years, compared to adults nationwide (71%), and New Jerseyans (9%) are less likely to report being currently uninsured, compared to 14 percent nationally. Despite being more likely to have a regular doctor and more likely to have scheduled a recent sick visit, adults in New Jersey (25%) are also more likely than adults nationwide (19%) to believe they would not be able to get the best treatment available in their state if they became seriously ill. When it comes to their views on different types of health care facilities, adults in New Jersey are more likely to like urgent care centers and more likely to reflect negatively on the cost of emergency room care. More than two in five (42%) patients in New Jersey rate the quality of health care they received during their most recent visit to an urgent care center as excellent. This stands in sharp contrast to the less than three in ten (29%) adults nationally who rate their last visit to an urgent care center similarly. This may account for why patients in New Jersey (28%) are much more likely than their peers nationwide (17%) to say their use of urgent care centers has gone up in the last two years. By comparison, patients in New Jersey are much more likely to be unhappy with emergency rooms, especially when it comes to cost. Nearly one-third (32%) of ER patients in New Jersey say the cost of their last visit to an emergency room was very unreasonable, compared to just one in five (20%) adults nationwide. Notably, adults in New Jersey (52%) report using the ER to treat major health problems like broken bones, cuts or high fevers at much higher rates than U.S. adults (40%). Costs are a common concern among adults in New Jersey. At a macro-level, residents are more likely to say the cost of health care in their state has increased (63% v 53%) and that health care costs are a major problem in the Garden State (59% v 52%), compared to adults nationwide. This is reflected by the more than one in four (28%) adults who say they do not get good value for what they pay toward the cost of their health care much higher than the 22 percent of adults nationwide who say the same. When it comes to costs on a more personal level, adults in New Jersey are not any happier. They are more likely than adults across the U.S. to say the cost they personally pay for health care, including premiums, deductibles, copayments, and prescription drugs is unreasonable (39% v 29%), and more likely to report that health care costs have caused a very serious problem for their personal or their family s financial situation (13% v 9%). 12 This section only reports results that are statistically significant at the p < 0.05 level. 23