2013 massachusetts medical society public opinion poll

8/22/2019 2013 Massachusetts Medical Society Public Opinion Poll

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2013 Health Care

Public OpinionSurvey

A Survey of Massachusetts Adults

Health Care in the Commonwealth

August 2013


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2013 MMS Health Care Public Opinion Survey Page 2 of47

2013 Massachusetts Medical Society. All rights reserved. www.massmed.org/poll2013

Table of Contents

Introduction ...........................................................................................................3

Executive Summary ............................................................................................... 4

Summary of Key Findings ....................................................................................... 7

Health care landscape ...................................................................................................................... 7Overall satisfaction with health care over the last 12 months ....................................................... 8Access to health care .......................................................................................................................11Identifying barriers to health care access ..................................................................................... 14Perceived price of health care ........................................................................................................ 14Primary care appointments ........................................................................................................... 16

Appointments for serious medical care ........................................................................................ 19Non-doctor medical visits .............................................................................................................. 21Deciding where to go for care ........................................................................................................ 25Emergency department utilization............................................................................................... 28New health insurance options ....................................................................................................... 31Legislation restricting pain medication prescription ................................................................... 34

Appendix: Topline Results .................................................................................... 36

This study was conducted by Anderson Robbins Research for the Massachusetts Medical

Society.
http://www.massmed.org/poll2013http://www.massmed.org/poll2013http://www.massmed.org/poll2013


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Introduction

This document reports the findings of a telephone survey of Massachusetts adults commissioned

by the Massachusetts Medical Society (MMS). The survey, which has been conducted

periodically over the past decade, examines a range of factors related to Massachusetts

residents satisfaction with and access to health care services. Many of the graphs included inthis report present historical trend data. It is important to note, when examining this trend data,

that the survey was not conducted in 2009, 2010, and 2011. Additionally, not all questions were

asked each year.

This report includes an Executive Summary, followed by a detailed Summary of Findings.

Complete survey findings are included as an Appendix.

M et h o d o l o g y

A total of 417 telephone interviews were conducted by trained professionals working from a

central, monitored location from May 14 to 16, 2013. The margin of error on questions involvingthe whole sample is +/- 4.8 percentage points.

Respondents were selected for the survey using a random digit dial (RDD) selection process,

which gives every household in the state an equal chance of receiving a call. Respondents were

interviewed on their landlines and cellphones. Respondents were screened to ensure they were

in fact residents of Massachusetts and at least 21 years of age.

Region and gender quotas were established to produce a representative sample of residents

statewide. Slight age weights were applied to the final data to bring the overall results in

accordance with the overall adult population.


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Executive Summary

Most Massachusetts adults believe that affordability is the single most important health care

issue facing the state. Residents are more likely to cite affordability and cost-related issues than

mention issues related to health care access by a three-to-one margin. When asked to choose

among cost of care, access to care, and quality of care as the most pressing issue, nearly eight-in-ten residents select cost.

Per cep t i o n s o f H ea l t h Ca r e Cost s

When asked directly, most Massachusetts residents believe that the cost of the health care

services they utilized in the last year was more expensive than the year before (65%) including

28% who believe that their health care has gotten much more expensive. Another 28% believe

that the price of their health care has stayed the same, while just 3% believe their care has

become less expensive.

Access t o H ea l t h Car e i n M assachuset t s

Consistent with the finding that access to care is not the most pressing issue for Massachusetts

adults, a variety of measures indicate that residents have relatively little difficulty in accessing

the services they need. Three-quarters (73%) report that accessing the care they need is not

difficult, which is a slight decrease from 2012 (78%).

Resi d en t s Sa t i sf a c t i o n w i t h H ea l t h Car e Ser v i c es

As has been the case since 2004, most Massachusetts residents are generally satisfied with the

health care they receive. Nearly six-in-ten residents (56%) are very satisfied with the health care

they received last year, and another 28% are somewhat satisfied. These numbers have remainedhighly stable for the past eight years.

While the survey findings are largely positive in terms of residents feelings about health care

quality and access, there are clear divisions with regard to socioeconomic status. Those with

higher income levels and more education are more likely to be satisfied with their health care

and report less difficulty in obtaining care than those with lower income and less education.

90% of those with household income over $100,000 are at least somewhat satisfied with

their health care, compared to 76% of those with income under $50,000

Satisfaction is 10 percentage points lower among those with just a high school education

or less (76%) than among those with at least some college education (86%) 82% of those with household income over $100,000 report that obtaining the health care

they need was not difficult, compared to 64% of those with income under $50,000


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U t i l i z a t i o n o f Qua l i t y a n d Co st o f Ca r e Da t a

Most residents remain unaware that data on quality and cost of care is available online, and less

than a third have actually used this data to decide where to go for care. Instead of using this

information, residents continue to rely on their primary care physician for opinions about where

to go for care.

Older adults particularly men over 50 as well as those with a high school education or less

are especially unlikely to use online quality and cost of care data to inform their choice of doctor.

V i s i t s t o Pr im a r y Ca r e Ph y s i ci a n s an d O t h er M ed i c a l Pr o f essi o n a l s

Nearly nine-in-ten Massachusetts residents have seen their primary care physician in the past

year. Residents report waiting longer for appointments with primary care doctors than in past

years 42% of respondents who saw a PCP last year reported waiting more than two weeks, up

from 32% who said the same last year. However, for nearly 90% of residents, this wait was not

problematic.

Four-in-ten residents also report seeing medical professionals other than medical doctors (i.e.

nurses, nurse practitioners, or physicians assistants) for care in the last year.

When residents learned that a new law allows nurse practitioners and physicians assistants to

serve as primary care providers for the purpose of increasing the number of medical

professionals available to patients, two-thirds of Massachusetts adults indicated that they would

rather see a medical doctor than a nurse practitioner or physicians assistant. However, two-

thirds of Massachusetts residents indicated that they are either very likely or somewhat likely to

make an appointment with a nurse practitioner or physicians assistant in the future, especially

if they are likely to have a shorter wait time.

Em er g en c y Depa r tm en t U t i l i za t i o n

Approximately three-in-ten Massachusetts residents report visiting an emergency department at

a hospital in the past year a slight increase from 2012, when one-quarter of residents did so.

Younger residents and those on a government-backed insurance plan (e.g. Medicare and

MassHealth) were more likely than others to utilize the emergency department.

Most of those who visited an emergency department did so because they had a serious but not

life-threatening medical problem that required immediate attention. One-third of those who

went to an emergency room indicate that the fact that the emergency room is the easiest place

to get care was a major factor behind their utilization of the ER.

Op i n i o n s o f New H ea l t h I n su r a n c e M odel s

Similarly to last year, reactions to limited and tiered health plans are generally unfavorable. By a

roughly two-to-one margin, residents are more likely to react unfavorably than favorably to brief

descriptions of each type of plan.


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Overall awareness of Accountable Care Organizations (ACOs) is low, with more than six-in-ten

residents unable to offer an opinion on ACOs after hearing a brief, generic description. When

provided with more information on the coordination of care offered by ACOs, Massachusetts

adults have favorable overall impressions of ACOs. However, residents are more likely to react

unfavorably to the global payments structure of ACOs.


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Summary of Key Findings

This section of the report provides a detailed discussion of the survey results, organized by topic.

H ea l t h c a r e l a n d s ca p e

Issues of cost and affordability continue to dominate residents concerns related to health care

in Massachusetts. When asked an open-ended question (Table 1) about the single most

important health care issue facing the state, the most common responses by a wide margin

focus on cost and affordability.

Over four-in-ten residents (45%) believe that affordability, cost, or expenses are the most

important health care issues facing the state.

Access-related issues are a distant second, mentioned by slightly more than one-in-ten residents

(13%). Seven percent of residents reported access to care as the single most important health

care issue, while 6% mentioned access to health insurance.

Table 1

(Q1: What do you think is the single most important health care issue facing Massachusetts today?)

Similarly, when asked to choose among cost of care, access to care and quality of care as the

most important health care issue facing the state, four times as many residents indicate that cost

concerns are the most pressing issue as those selecting health care access or quality, as can be

seen in Figure 1. As Table 2 indicates, cost concerns are lower among residents of Western

Massachusetts (67%, compared to 82% among those not living in the western part of the state).


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Figure 1 Table 2

(Q2: Which one of the following do you think is the most

important health care issue facing Massachusetts today?)

Table 2 (Q2: Which one of the following do you think is the

most important health care issue facing Massachusetts today?)

Over a l l s a t i sf a c t i o n w i t h h e a l t h c a r e o v er t h e l a st 12 m on t h s

The vast majority (84%) of Massachusetts residents are satisfied with the health care they have

received over the past year. This percentage includes 56% of residents who are very satisfied and

28% who are somewhat satisfied with the health care they have received. As Figure 2 shows,overall levels of satisfaction dipped slightly compared to 2012, when 87% of Massachusetts

residents were satisfied. This three percentage point change is not statistically significant.

Satisfaction with health care by this measure has remained highly stable since the

Massachusetts Medical Society first reported this data in 2004, when 88% of Massachusetts

adults were satisfied with the care they had received.


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Figure 2

(Q3: All things considered, have you been satisfied or dissatisfied with the health care you have received during the

last 12 months?)

Massachusetts residents without any college education (76% satisfied) are significantly less

likely to be satisfied with the health care they have received than those who have attended

college (86% satisfied). Similarly, households making under $50,000 per year are less likely to

be satisfied than households earning more (Figure 2, inset).

Table 3

(Q4: Specifically, why are you (satisfied / dissatisfied) with your care?)


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As indicated in Table 3, above, amongst the small number of residents who are somewhat or

very dissatisfied with their health care over the last year, too expensive (50%) is the most

common explanation, followed by complaints about poor medical care (27%), poor insurance

coverage (23%), limited access (18%), and long wait times (12%).

As Table 4 shows, when those who say they are either very or somewhat satisfied are asked toexplain why, they are most likely to explain their satisfaction in terms of the quality of care they

have received. More than four-in-ten (45%) report that their satisfaction is based on quality of

care / good doctors, while another 6% report that they like their doctor / have a good

relationship with their doctor. After quality of care-related explanations, residents explain their

satisfaction in terms related to the ease of access to health care (27%) as well as positive

experiences with health insurance (20%). Finally, 11% mention affordability as the main reason

for their satisfaction (Table 4).

Table 4

(Q4: Specifically, why are you (satisfied / dissatisfied) with your care?)


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Access to h ea l t h ca r e

Overall, most Massachusetts residents (73%) report that gaining access to the health care they

need is not difficult. However, the number of residents reporting that accessing health care was

not difficult decreased slightly, down from 78% in 2012 (Figure 3). This year, 54% of adults

indicate that obtaining the care they needed was not difficult at all, down from 62% in 2012.Despite these declines, ease of access to care remains dramatically higher than 2008, when just

57% of residents indicated that accessing the care they needed was not difficult.

Much like satisfaction with care, there is variation among Massachusetts residents based on

household income (Figure 3, inset). Households that earn less than $50,000 annually (64% not

difficult) are less likely to report that accessing necessary care was not difficult than those

earning over $100,000 (82% not difficult).

Figure 3

(Q5: In general, how would you rate the difficulty in obtaining the health care you need for you and your family

whether it be for a routine problem or a serious problem over the last few years? On a scale of 1 to 5, where 1

means not difficult at all, and 5 means extremely difficult, please rate the level of difficulty youve experienced in

obtaining this care.)

Residents who report difficulty accessing needed health care offer a range of explanations, butcost issues are the most frequently-cited individual reason, as shown in Table 5. Nearly four-in-

ten (38%) of those who found obtaining care difficult mention expense. Many other

explanations center on insurance: 17% mention red tape / paperwork, 15% report poor

coverage, 13% indicate limits on where I can go, and another 10% mention difficulty in

accessing health insurance. Just over one-in-ten residents (13%) cite poor care or bad

doctors for their difficulty obtaining health care.


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Table 5

(Q6: Specifically, why do you feel that way? Multiple responses accepted)

As shown in Figure 4, this study finds that most Massachusetts residents get the care they

believe they need when they need it. Approximately one-fifth (21%) of residents say that at some

point during the last 12 months they waited to get medical care they thought they needed, which

is similar to last year, when 19% reported waiting to get needed care.

Older residents are much less likely than others to put off needed care only 11% of those over60 report waiting to get care, compared to 25% of adults 60 and younger (Figure 4, inset).


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Figure 4

(Q8: Was there any time during the past 12 months when you waited to get medical care you thought you needed?)

When asked, the most common reason provided by those who waited to get care is that the

desired physician was booked (42%). Issues with insurance coverage and approval are cited by

one-quarter of adults, while less than two-fifths (17%) mention issues of affordability(Table 6).

Table 6

(Q9: (IF YES TO Q8) What was the primary reason you waited to get that medical care?)


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I d e n t i f y i n g b a r r i er s t o h ea l t h c a r e a cc ess

All residents including those who indicated no difficulty obtaining the care they needed were

asked to select one of eight factors that might contribute to difficulties in accessing health care.

As Figure 5 shows, the most common response, selected by 27% of residents, places the blame

on insurance companies. Another 15% of adults believe the government is most responsible fordifficulties in access, while 11% select the economy or personal economic circumstances. Nearly

one-quarter (24%) volunteer that they had no problems accessing care.

These numbers are all relatively consistent with data from 2012, although residents were

somewhat less likely to volunteer that they had no access problems (24% this year compared to

30% last year).

Figure 5

(Q7: Which ONE of the following do you believe is most responsible for any problems you might have had gaining

access to health care over the last few years?)

Per cei v ed p r i c e o f hea l t h ca re

More than six-in-ten (65%) Massachusetts residents believe that the health care services they

use were more expensive last year than the year before. This includes 28% who believe that theirhealth care is much more expensive, and 37% who think costs have increased somewhat. Only

3% believe that the care they use has gotten less expensive (Figure 6).


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Figure 6

(Q10: In general, do you think the price of the health care services you and your family used over the past 12 months

was much more expensive now than the same services would have been two years ago, somewhat more expensive,

about the same, somewhat less, or much less expensive than the same services would have been two years ago?)

As Table 7 shows, Massachusetts adults with a high school degree or less education areparticularly likely to believe the health care services they use have gotten much more expensive

(42%, compared to 27% of college graduates and just 18% of those with graduate degrees).

Residents on a government-backed health insurance program (e.g. Medicare or MassHealth)

are less likely to think that health care has gotten much more expensive (23%), compared to

those using private insurance or managed care (30%).


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Table 7

(Q10: In general, do you think the price of the health care services you and your family used over the past 12 monthswas much more expensive now than the same services would have been two years ago, somewhat more expensive,

about the same, somewhat less, or much less expensive than the same services would have been two years ago?)

Pr i m a r y ca r e a p po i n t m e n ts

Approximately nine out of ten residents (88%) report seeing a primary care physician (PCP)

sometime over the last year. As Figure 7 shows, the percentage of Massachusetts adults visiting a

PCP has remained high and fairly steady since 2005.

Figure 7

(Q16: Have you had an appointment with a primary care physician in the last year?)


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A slight majority (52%) of residents who saw a PCP last year waited less than two weeks between

making an appointment and seeing the doctor. This continues an eight-year downward trend, as

shown in Figure 8. Moreover, the percentage of residents reporting a wait of a month or more is

at its highest level in the history of this study, increasing from 21% in 2012 to 28% this year.

Figure 8

((IF HAD APPOINTMENT IN THE LAST YEAR, n = 369) Q17: Please think back to your last routine visit to a primary

care physician. How long did you have to wait between the time you made the appointment and the day you actually

saw the doctor?)

Despite the increases in wait times before PCP appointments, Figure 9 shows that most (89%) of

those who saw a PCP last year report that the amount of time they waited was not a problem for

them. Massachusetts residents without college degrees were more likely to report problematic

wait times (15%, compared to 6% for college graduates)(Figure 9, inset).


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Figure 9

((IF HAD APPOINTMENT IN THE LAST YEAR, n = 369) Q19: Was the length of time you had to wait for an

appointment a problem for you, or not?)

Among those who waited more than a few days to see a PCP, 46% indicate that the wait was due

to the doctors availability, while 30% cite their own personal schedule as the reason for the

delay.

Figure 10

((IF MORE THAN A FEW DAYS, n = 232) Q18: Was the delay in seeing the doctor primarily due to:)


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Appo i n t m en t s f o r s er i o u s med i ca l c a r e

When thinking about the last time they visited a primary care physician or a specialist for a

serious medical problem (as opposed to a routine matter), Massachusetts residents report a

slightly different picture with regard to wait times. This year, 62% indicate that they waited less

than two weeks an increase over 2012, when 57% reported waits of less than two weeks(Figure 11). This year, waits for serious medical problems compare favorably to waits for PCP

appointments, for which 52% report waiting less than two weeks (Figure 8, page 17).

Figure 11

(Q23: Please think back to your last appointment with either a specialist or your primary care physician for a serious

but not life threatening medical problem. How long did you have to wait between the time you made an appointment

and the day you actually saw the doctor?)

Similarly to wait times for PCP appointments, most (86%) of respondents indicate that the

amount of time they needed to wait for an appointment was not a problem for them. This is

unchanged compared to 2012 (Figure 12).


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Figure 12

(IF HAD AN APPOINTMENT IN Q23, n = 366)

Q25: Was the length of time you had to wait for an appointment a problem for you, or not?)

While three-in-ten respondents blame their own schedules for delays in seeing their PCP (Figure

10, page 18), only 19% do so for delays in seeing a doctor about a serious medical problem.

Instead, 70% of residents indicate that the doctors availability was the cause of the delay. As

shown in Figure 13, this is up from 58% in 2012.


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Figure 13

((IF MORE THAN A FEW DAYS IN Q23, n = 179)

Q24: Was the delay in seeing the doctor primarily due to:)

Non - d o ct o r m ed i c a l v i si t s

Fewer residents report seeing a nurse, nurse practitioner or physicians assistant for a medical

appointment than last year (43% now, compared to 48% last year), and the percentage reporting

seeing a clinician other than a medical doctor is at comparable levels to 2007 (Figure 14).


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Figure 14

(Q20: During the past year, have you had a medical appointment in which you saw a nurse, a nurse practitioner or a

physicians assistant, but did not see a doctor?)

Of those who saw a clinician other than a medical doctor, less than half (46%) did so by choice

as Figure 15 indicates, this is the lowest such percentage in the history of this study. Four-in-ten

(40%) saw a nurse, nurse practitioner, or physicians assistant because they could not get an

appointment with a medical doctor, and another 10% were unaware before the appointment that

they would not be seeing a physician. Older residents (55%) are more likely than residents aged

60 or younger (41%) to see a non-physician by choice (Figure 15, inset).


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Figure 15

((IF SAW A NURSE, NURSE PRACTITIONER, OR PHYSICIANS ASSISTANT, n = 178)

Q21: Did you make this appointment by choice, or because you couldnt get an appointment with a medical doctor?)

Among those who saw a nurse, nurse practitioner, or physicians assistant, two-thirds (66%) feel

the care they received was about the same as the care they typically receive from a medical

doctor, while 13% feel the care from a medical doctor is generally superior. Two-in-ten (19%)

believe the care from the non-clinician they saw was better than typical care from a medical

doctor (Figure 16).


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Figure 16

((IF SAW A NURSE, NURSE PRACTITIONER, OR PHYSICIANS ASSISTANT, n = 178)

Q22: How would you rate the care you received from the nurse practitioner or physicians assistant compared to the

care you typically receive from a medical doctor?)

When told of a new law in Massachusetts that allows nurse practitioners and physicians

assistants to serve as primary care physicians in an effort to increase the number of practitioners

available to patients, two-thirds (66%) of residents indicated that they would be very (29%) or

somewhat (37%) likely to schedule an appointment with a nurse practitioner or physiciansassistant (Figure 17).

However, as Figure 18 shows, two-thirds (67%) of residents would prefer to receive care from a

medical doctor, and just 15% would rather receive care from either a nurse practitioner (12%) or

physicians assistant (3%).


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Figure 17 Figure 18

(Q34: As you may know, a new law in Massachusetts allows

nurse practitioners and physicians assistants to serve as

primary care providers. The goal of this change was to

increase the number of medical professionals available to

patients. Knowing this, how likely would you be to schedule an

appointment with a nurse practitioner or physicians assistant

rather than scheduling an appointment with a medical doctor?)

(Q35: Would you prefer to receive care from a medical doctor,

physicians assistant, or nurse practitioner?)

Deci d i n g w her e t o g o f o r c a r e

When deciding where to go for medical care, Massachusetts residents are far more likely to ask

their primary care physician for advice than to rely on other sources (Figure 19). Three-quarters

(74%) report that they have asked their doctor for a suggestion, which is comparable to findings

in 2012, when 77% indicated that they would ask their doctor for an opinion.

Fewer than half (45%) of residents have asked their friends where to go for care. Residents

utilize online options whether looking online to see what others have said about a doctor

(38%) or using the internet to find quality and cost of care data (31%) less frequently.

Unsurprisingly, there are differences between age groups when it comes to using the internet to

find a health care provider (Figure 19, inset). Half (50%) of adults 50 years old or younger

indicate that they have used the internet to read what others have said about a doctor, while only

a quarter (27%) of residents over 50 have done so. Men over 50 are particularly unlikely to use

the internet in this manner. Residents without any college education are also much less likely to

use the internet to find out what others have said about a doctor or hospital (15%, compared to

44% of those with at least some collegiate experience).


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The above age- and education-based differences in internet utilization also hold true for

individuals using the internet to look up data about the quality and cost of care delivered by

specific doctors and hospitals, though the differences between groups are less pronounced.

For the first time, respondents were also asked this year whether they had considered going to a

limited service clinic (e.g. CVS Minute Clinic) for care. A quarter (24%) of residents hadconsidered doing so (Figure 19).

Figure 19

(Q11-15: Now I am going to mention different things some people do to help them decide where to go for medical

care. For each one, please tell me if it is something you do or have done prior to making an appointment with a new

doctor or hospital. Have you)

One explanation for the relatively low number (31%, Figure 19) of Massachusetts adults using

the internet to look up data on cost and quality is that few residents are aware that this data is

publicly available. This year, 39% of residents report being aware that this information is online

(Figure 20). This suggests but does not prove that most of those who know the data is

available utilize it.

Overall, awareness of the availability of cost and quality data declined three percentage points

relative to 2012, but increased compared to 2007 and 2008, when a third of all residents were

aware of the information.


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Figure 20

(Q32: A variety of sources, including the state and insurers, recently began posting information regarding the quality

and cost of care provided by medical groups and in some cases individual physicians on the Internet and in health

plan directories. Were you aware that this information is available?)

Once residents are made aware that data on cost and quality is available online, many say that

they would be likely to use it to help inform their decision the next time they have to choose a

doctor. This year, 57% say they are very or somewhat likely to use the data (Figure 21). Younger

adults (age 40 and younger) are particularly likely to indicate that they would use the data (76%

very / somewhat likely, compared to 41% of adults over 60). Similarly, those with collegedegrees are more likely to say they will use the data than those with only a high school education

or less (Figure 21, inset).


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Figure 21

(Q33: Now that you know that you can get this type of information about medical groups and physicians, how likely

are you to use it the next time you have to choose a doctor? Are you)

Em er g en c y d ep a r tm en t u t i l i z a t i o n

Just over three-in-ten (31%) Massachusetts residents report utilizing the emergency department

in the last year, a slight increase over 2012, when a quarter (25%) reported doing so (Figure 22).

Self-reported emergency room utilization was higher among younger residents 40% among

adults 40 and younger, compared to 22% among those over 60 (Table 8). Similarly, those on agovernment-backed insurance plan (Medicare or MassHealth) are more likely to indicate

visiting the emergency department than those on private insurance. There were no significant

differences in emergency department utilization based on household income.


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Figure 22 Table 8

(Q26: Have you visited an emergency department at a

hospital in the past year?)(Q26: Have you visited an emergency department at a

hospital in the past year?)

For those who used an emergency department last year, the biggest factor in the decision to go to

the ER was that they faced a serious but not life-threatening medical problem that neededimmediate attention. As Figure 23 shows, fully six-in-ten (60%) adults who had been to an

emergency department in the last year indicate that the availability of immediate attention for

serious problems was a significant factor in their decision.

A third (34%) of those who used an emergency department in the last year indicate that the fact

that the ER is the easiest place to get care was a significant factor in their decision. Issues

related to primary care physicians were important factors for a smaller percentage of residents,

with 18% citing difficulty getting an appointment with my primary care physician and 16%

indicating not having a primary care physician as major factors involved in their decision to

seek care at the emergency department (Figure 23).

The rationales provided by those who utilized an emergency department in the last year have not

changed significantly compared to 2012.


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Figure 23

(Q27-31: I am going to mention some different reasons why some people use emergency departments. Please rate

how big of a reason each one was for you when you last visited an emergency department using a scale from 1,

meaning not a factor at all, to 10, meaning it was a major factor.)

When all residents not just those who have utilized an emergency department in the last year

are asked about the factors behind the decision to go to the ER the last time they went, the

relative importance of the ratings is similar, but the percentages of those indicating that each

explanation was a major factor is lower across the board (Figure 24).

Figure 24


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(Q27-31: I am going to mention some different reasons why some people use emergency departments. Please rate

how big of a reason each one was for you when you last visited an emergency department using a scale from 1,

meaning not a factor at all, to 10, meaning it was a major factor.)

New h ea l t h i n su r a n c e o p t i o n s

For the second consecutive year, survey respondents were asked for their opinions of tiered healthplans, limited network plans, and Accountable Care Organizations (ACOs). Respondents were

first asked if they had favorable or unfavorable opinions of each new option based on a one-

sentence description, then provided more information and asked for their opinion again.

After a brief description of each new health insurance option, many respondents are unable to

offer a concrete opinion: 37% are not able to offer an opinion about tiered plans, and 62% dont

know enough to opine about ACOs (Figure 25a).

Among those who do offer opinions, residents have generally negative views of limited network

and tiered insurance plans. As Figure 25a, Figure 25b, and Figure 25c indicate, twice as many

residents have unfavorable views of these plans as have favorable views (43% unfavorable versus20% favorable for tiered plans; 36% unfavorable to 18% favorable for limited network plans).

Views of ACOs are more balanced.

Figure 25a

(Q36: Now I am going to mention a few different types of health care options offered by some Massachusetts insurers.

Please tell me if you have a generally favorable or unfavorable opinion of each. If you have never heard of one, or

dont know enough about it to have an opinion, please just say so.)

20%16%

62%

20%

13%

67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Favorable Unfavorable Never heard of/Don't know

enough

a) Accountable Care Organizations, which seek to integrate physicians and

hospitals and provide different payment structures

May, 2013

February, 2012


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Figure 26b




Figure 27c




18%

36%

45%

19%

37%

43%

0%

10%

20%

30%

40%

50%


enough

b) Limited network plans where care is covered among some doctors and

hospitals

May, 2013

February, 2012

20%

43%

37%

23%

42%

35%

0%

10%

20%

30%

40%

50%


enough

c) Tiered plans that have higher co-pays and deductibles for seeing some doctors

and hospitals than for others

May, 2013

February, 2012


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When provided with more detailed information about tiered plans, residents opinions do not

shift much. After hearing about the payment structure of tiered plans, 53% of residents have

unfavorable views of the plans, compared to 32% with favorable views (Figure 26). This 21-point

gap is similar to the gap in favorability before the plan was explained (Figure 25c).

Providing more information about limited network plans nearly doubles unfavorable views from 36% unfavorable based on a brief description (Figure 25b) to 69% unfavorable after the

detailed description (Figure 26).

Figure 26

(Q39-42: Now Id like to give you a little more information about each of these three types of health care coverage

options and then ask your opinion again.)

Upon hearing more about ACOs, respondents are much more likely to offer an opinion, with those

volunteering dont know enough / not sure dropping from 62% (Figure 25a) based on a brief

description to between 18% and 23% (Figure 27).

As Figure 27 shows, Massachusetts adults react very differently to different aspects of ACOs.

Residents strongly favor the coordinated care aspect of ACOs, with favorable opinions

outnumbering unfavorable ones by a 37 percentage point margin (60% favorable versus 23%

unfavorable). However, unfavorable views outnumber favorable ones by a 13 percentage pointmargin when residents consider the global budgets reimbursement structure of ACOs.


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Figure 28

Q39-42: Now Id like to give you a little more information about each of these three types of health care coverage

options and then ask your opinion again.

L e g i sl a t i o n r est r i c t i n g p a i n m ed i c a t i o n p r escr i p t i o n

The Massachusetts state legislature recently passed a law that restricts physicians from

prescribing certain pain medications. As a result, for the first time this year, this study included aquestion asking residents whether or not they were concerned that this legislative action might

limit their access to pain medications they might need.

Overall, most residents are not concerned that the law might limit their access to pain medication,

55% report being unconcerned. Slightly more than one-third (37%) are concerned, however

(Figure 28). As Table 9 indicates, residents with graduate degrees are particularly unlikely to be

concerned.


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Figure 29

(Q43: As you may know, the legislature recently passed a lawthat restricts physicians from prescribing certain pain

medications, such as narcotics. Are you concerned this will

limit your access to these medications when necessary?)

Table 9

(Q43: As you may know, the legislature recently passed a law

that restricts physicians from prescribing certain pain

medications, such as narcotics. Are you concerned this will

limit your access to these medications when necessary?)


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Appendix: Topline Results

Interviewing dates: May 14 16, 2013Sample: 417 Massachusett s adults age 21+

FINAL TOPLINE RESULTS

0A. First of all, are you 21 years of age or older?Yes 100%

No -

1. What do you think is the single most important health care issue facing Massachusetts today? (RECORDVERBATIM)1.

May 2013 Feb 2012

Affordability / cost 43% 47%

Access to care / access to doctors 7 9Access to health insurance 6 7Mention specific condition / disease 6 6Health care for the elderly 5 1ObamaCare 5 1Poor health insurance 4 -Mandated health insurance 3 4Paying for others / illegal immigrants 2 2Quality of care 1 3Drug expense 1 3Controlling cost 1 1Government interference - 2Need single payer - 2Other 3 4Nothing 1 3

Dont know/Refused 12 6

2. Which ONE of the following do you think is the most important health care issue facing Massachusettstoday? (RANDOMIZE)

Cost of health care 78%

Quality of health care 9

Access to health care 10

(Dont know) 2

All things considered, have you been satisfied or dissatisfied with the health care you have received during the last 12months? (IF SATISFIED OR DISSATISFIED) Is that very (satisfied / dissatisfied), or just somewhat?

Very satisfied

Somewhat

satisfied

Somewhat

dissatisfied Very dissatisfied (Dont know)May 2013 56% 28 7 8 2

Feb 2012 61% 26 4 7 2

April 2008 62% 26 6 6 1

April 2007 65% 26 6 3 1

April 2006 60% 32 4 3 3

April 2005 62% 26 5 4 4

March 2004 56% 32 5 4 3


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3. Specifically, why are you (satisfied / dissatisfied) with your care? (RECORD VERBATIM) (NOTE:MULITPLE RESPONSES WERE ACCEPTED)

SatisfiedMay 2013(n=349) Feb 2012 (n=348)

Quality of care / Good doctors 45% 38%

Easy access / can go anywhere 16 7

Needs have been met 15 17

Good health insurance / plan 12 18

Affordable 11 12

Able to get an appointment when needed 11 9

Good coverage 8 9

Like my doctor / relationship with doctor 6 11

Too expensive 4 2

Poor care / poor doctor 2 -

Long wait for appointment 1 -

Poor coverage / care not covered 1 -

Dont get sick / Havent needed 9 11

Other 2 2

Nothing - 1

Dont know / Refused 1 2

Dissatisfied May 2013 (n=60) Feb 2012 (n=47)

Too expensive 50% 56%

Poor care/poor doctor 27 23

Poor coverage/care not covered 23 18

Lack of access/limits on where I can go 18 13

Long wait for appointment 12 6

Needs havent been met 5 11

Poor health insurance plan 3 14Quality of care/good doctors 3 -

Other 13 13

(RESUME ALL)

4. In general, how would you rate the difficulty in obtaining the health care you need for you and your family whether it be for a routine problem or a serious problem over the last few years? On a scale of 1 to 5,where 1 means not difficult at all, and 5 means extremely difficult, please rate the level of difficultyyouve experienced in obtaining this care.

Mean1 (Not difficult atall) 2 3 4

5 (Extremelydifficult)

(Dontknow)

May 2013 1.90 54% 19 15 5 6 -

Feb 2012 1.73 62% 16 11 4 5 2

April 2008 2.37 42% 15 17 11 13 2

April 2007 2.06 49% 19 14 7 9 2

April 2006 2.21 48% 15 15 9 12 1

April 2005 2.29 45% 15 17 7 15 2

March 2004 2.18 46% 17 18 9 9 1

anuary 2003 2.06 49% 16 16 10 7 2


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5. Specifically, why do you feel that way? (RECORD VERBATIM)(NOTE: MULITPLE RESPONSES WERE ACCEPTED)

Not difficult (Q5 =1 or 2)May 2013(n=306) Feb 2012 (n=315)

No problems 23% 21%

Quality of care / good doctors 21 17

Good coverage / good insurance 17 15

Not wait for appointment / fast access 13 16

Ease of getting an appointment 9 8

Have access to doctors 8 12

Large network / can go anywhere 8 8

Have access to health insurance 8 4

Covered by employer 7 8

Affordable 7 2

Long wait for appointment 5 4

Too much red tape / paperwork 3 1

Too expensive 2 3

Limits on where I can go 2 1

Hard to get appointment 2 -

Poor coverage 1 1

Cant get needed care 1 1

Poor care / bad doctors - 1

No health insurance - -

Dont get sick / havent needed 3 6

Other 4 3

Nothing - 1

Dont know / Refused 1 3

Difficult (Q5 =4 or 5) May 2013 (n=48) Feb 2012 (n=39)

Too expensive 38% 26%

Too much red tape / paperwork 17 10

Poor coverage 15 5

Poor care/bad doctors 13 20

Limits on where I can go 13 19

Long wait for appointment 8 -

Cant get needed care 6 22

No health insurance 6 18

Hard to get appointment 4 -

Insurance not provided by employer 2 4

Access to doctors 2 -

Access to health insurance 2 -

No problems / satisfied 2 -

Quality of care / good doctors 2 -

Dont get sick / havent needed - 2

Other 10 3


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6. Which ONE of the following do you believe is most responsible for any problems you might have had gainingaccess to health care over the last few years? [READ AND ROTATE 1-8]

May 2013 Feb 2012Insurance companies 27% 29%Government 15 13

The economy or your economic circumstances 11 8Physicians 5 4

Your own fault 4 3Drug companies 3 5Hospitals 3 3New, expensive technologies 2 2(All of them) 3 2(No problems) 24 30(Not sure / Refused) 3 3

7. Was there any time during the past 12 months when you waited to get medical care you thought youneeded?

Yes, waitedto get care

No, did notwait to get care

(Not sure /Refused)

May 2013 21% 79 -

February 2012 19% 80 1

April 2008 25% 74 1

April 2007 21% 79 1

April 2006 18% 81 1

April 2005 17% 82 1

March 2004 22% 78 -

anuary 2003 29% 70 1

(IF YES TO Q8)

8. What was the primary reason you waited to get that medical care? (RECORD VERBATIM)

May 2013 (n=86) Feb 2012 (n=75)

Physician booked 42% 22%

Couldnt afford treatment 13 19

Not approved by insurance / waiting for approval 13 18

Too busy / No time - 12

No insurance 9 8

Poor coverage / not covered 7 4

Had to find provider who accepted insurance 5 -

High deductible / co-pay 3 7

Routine/not urgent 3 -

Paperwork 2 -

Disagreed with treatment 2 -

Insurance too expensive 1 4

Pre-existing condition - 3

Other 8 4

Dont know/Refused 1 -


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9. In general, do you think the price of the health care services you and your family used over the past 12months was much more expensive now than the same services would have been two years ago, somewhatmore expensive, about the same, somewhat less, or much less expensive than the same services wouldhave been two years ago?

Much more expensive 28%Somewhat more expensive 37About the same 28Somewhat less expensive 3Much less expensive -(Not sure / Refused) 5

Now I am going to mention different things some people do to help them decide where to go for medical care. Foreach one, please tell me if it is something you do or have done prior to making an appointment with a new doctor orhospital. Have you(RANDOMIZE)

Yes No (Not sure) (Refused)10. Asked your primary care physician for his or

her opinion?

May 2013 74% 25 1 -

February 2012 77% 23 - -

11. Used the internet to look up data about thequality and cost of care provided by specificdoctors or hospitals?

May 2013 31% 67 1 -

February 2012 34% 64 1 -

12. Used the internet to see what other peoplehave to say about a doctor or hospital?

May 2013 38% 61 1 -

February 2012 36% 64 - -

13. Asked friends about where to go for care?

May 2013 45% 55 1 -

February 2012 49% 50 1 -

14. Considered going to a limited service clinic,like a CVS Minute Clinic, for medical careinstead of a doctors office?

May 2013 24% 75 1 -

15. Have you had an appointment with a primary care physician in the last year?

Yes No (Not sure)

May 2013 88% 12 -February 2012 90% 9 -

April 2008 86% 14 -

April 2007 89% 11 -

April 2006 83% 18 -

April 2005 85% 16 -

March 2004* 77% 22 1

anuary 2003* 83% 16 1*Have you had a routine doctors appointment in the last year?


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(IF YES TO Q16)

16. Please think back to your last routine visit to a primary care physician. How long did you have to waitbetween the time you made the appointment and the day you actually saw the doctor? [DO NOT READ]

May

2013 Feb 2012 Apr 2008 Apr 2007 Apr 2006 Apr 2005 Mar 2004* an 2003*(A few days) 30% 36% 37% 34% 44% 45% 18% 26

(More than a few days,


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19. During the past year, have you had a medical appointment in which you saw a nurse, a nurse practitioner ora physicians assistant, but did not see a doctor? [IF YES, PROBE: Do you remember if that was with anurse, nurse practitioner, or a physicians assistant?]

Yes, nurse Yes, NP Yes, PAYes, not a doctor but dontknow who it was No (Not sure)

May 2013 3% 29 9 2 56 1

February 2012 4% 34 9 2 51 1

April 2008 7% 26 5 1 60 1

April 2007 5% 26 8 2 58 2

(IF YES TO Q20)

20. Did you make this appointment by choice, or because you couldnt get an appointment with a medicaldoctor?

By choiceCouldnt get an appointmentwith a medical doctor

(Didnt know I wasnt going to seea medical doctoruntil the appointment) (Not sure)

May 2013 46% 40 10 4

February 2012 53% 36 6 5April 2008 51% 36 8 4

April 2007 53% 35 6 6

(IF YES TO Q20)

21. How would you rate the care you received from the nurse practitioner or physicians assistant compared tothe care you typically receive from a medical doctor? Would you say[ROTATE 1-2]

The care from the nurse practitioner or physiciansassistant was better 19%

The care from the medical doctor is typically better 13Or, the care was about the same 66(Not sure / Refused)

2

(RESUME ALL)

22. Please think back to your last appointment with either a specialist or your primary care physician for aserious but not life threatening medical problem. How long did you have to wait between the time you madean appointment and the day you actually saw the doctor? [DO NOT READ]

May 2013 Feb 2012

(A few days) 40% 40%

(More than a few days,


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23. Was the delay in seeing the doctor primarily due to:

The inability of the doctorto see you sooner

Your own schedulemaking it hard to see thedoctor sooner

Because financial orinsurance issues made ithard to schedule (Not sure)

May 2013 70% 19 3 8

February 2012 58% 22 4 15

(SKIP IF HAVENT MADE AN APPOINTMENT IN Q23)

24. Was the length of time you had to wait for an appointment a problem for you or not?

Yes No (Not sure)

May 2013 14% 86 -

February 2012 8% 86 6

(RESUME ALL)

25. Have you visited an emergency department at a hospital in the past year?

Yes No (Not sure)

May 2013 31% 69 -February 2012 25% 75 -

I am going to mention some different reasons why some people use emergency departments. Please rate how big ofa reason each one was for you when you last visited an emergency department using a scale from 1, meaning not afactor at all, to 10, meaning it was a major factor.(RANDOMIZE)

Mean 1-3 4-6 7-10 (Not sure)26. Difficulty getting an appointment with your

primary care physician

May 2013 2.37 75% 6 12 7

February 2012 2.20 78% 5 10 7

27. Not having a primary care physician

May 2013 2.43 75% 4 14 7

February 2012 2.36 76% 3 12 9

28. It was a serious but not life threateningmedical problem that needed immediateattention

May 2013 5.86 31% 16 44 10

February 2012 5.34 40% 11 41 8

29. It was a life threatening problem that neededemergency attention

May 2013 4.77 45% 11 34 10

February 2012 4.57 46% 10 32 12

30. The emergency department is the easiestplace to get care

May 2013 4.02 54% 10 27 8

February 2012 3.76 58% 6 25 11


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31. A variety of sources, including the state and insurers, recently began posting information regarding thequality and cost of care provided by medical groups and in some cases individual physicians on the Internetand in health plan directories. Were you aware that this information is available?

Yes, aware No, not aware (Not sure)

May 2013 39% 60 1

February 2012 42% 55 3April 2008 33% 65 2

April 2007 32% 67 2

32. Now that you know that you can get this type of information about medical groups and physicians, how likelyare you to use it the next time you have to choose a doctor? Are you

Very likely Somewhat likely Not very likely Not at all likely (Not sure)

May 2013 27% 30 14 28 1

February 2012 29% 25 15 29 2

April 2008 33% 32 8 24 4

April 2007 24% 30 20 23 3

33. As you may know, a new law in Massachusetts allows nurse practitioners and physicians assistants toserve as primary care providers. The goal of this change was to increase the number of medicalprofessionals available to patients. Knowing this, how likely would you be to schedule an appointment with anurse practitioner or physicians assistant rather than scheduling an appointment with a medical doctor?

Very likely Somewhat likely Not very likely Not at all likely (Not sure)

May 2013 29% 37 15 18 2

34. Would you prefer to receive care from a medical doctor, physicians assistant, or nurse practitioner? [DONOT READ]

(Medical doctor) 67%(Physicians assistant) 3

(Nurse practitioner) 12(MD and PA but not NP) 1(MD and NP but not PA) 1(PA and NP but not MD) -(All of the above) 12(Not sure / Refused) 4

Now I am going to mention a few different types of health care options offered by some Massachusetts insurers.Please tell me if you have a generally favorable or unfavorable opinion of each. If you have never heard of one, ordont know enough about it to have an opinion, please just say so. (RANDOMIZE)

Favorable UnfavorableNever heardof

Dont knowenough (Refused)

35. Tiered plans that have higher co-pays and

deductibles for seeing some doctors andhospitals than for others

May 2013 20% 43 15 22 1

February 2012 23% 42 14 21 -

36. Limited network plans where care is coveredamong some doctors and hospitals

May 2013 18% 36 21 24 1

February 2012 19% 37 18 25 -


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37. Accountable Care Organizations, which seekto integrate physicians and hospitals andprovide different payment structures

May 2013 20% 16 29 33 1

February 2012 20% 13 33 34 -

Now Id like to give you a little more information about each of these three types of health care coverage options andthen ask your opinion again.

(RANDOMIZE ORDER OF NEXT FOUR QUESTIONS)

38. An Accountable Care Organization is a group of health care providers and/or hospitals that work as a teamto manage the coordination of care for the range of services that patients are expected to need. Hearingthis, do you have a favorable or unfavorable opinion of Accountable Care Organizations? (IF FAVORABLEOR UNFAVORABLE) Is that very or just somewhat (favorable / unfavorable)?

Very favorableSomewhatfavorable

Somewhatunfavorable Very unfavorable (Not sure)

May 2013 22% 38 12 11 18

February 2012 18% 36 14 9 23

39. In these new Accountable Care Organizations, physicians may be reimbursed differently physicians mayreceive global budgets for the year per patient, rather than a payment per visit or procedure. Hearing this, doyou have a favorable or unfavorable opinion of global budgets? (IF FAVORABLE OR UNFAVORABLE) Isthat very or just somewhat (favorable / unfavorable)?



May 2013 8% 24 20 25 23

February 2012 12% 16 18 26 27

40. Tiered health insurance plans often offer lower annual premiums than other similar plans, but co-pays anddeductibles are higher for some doctors and hospitals than others. Insurance companies usually useinternal quality and cost ratings to develop their tiers of doctors and hospitals. Members pay low or no co-pays to visit providers who are deemed to provide the best value, and higher co-pays for providers thatinsurance companies believe are too expensive for the level of care they provide. Hearing this, do you havea favorable or unfavorable opinion of Tiered health insurance plans? (IF FAVORABLE ORUNFAVORABLE) Is that very or just somewhat (favorable / unfavorable)?



May 2013 7% 25 27 26 16

February 2012 11% 20 24 29 16

41. Limited network plans offer lower premiums than other comparable plans, but limit the doctors and hospitalscovered to a list approved by the insurance company. If you choose to see doctors outside the network, thecost is higher. Hearing this, do you have a favorable or unfavorable opinion of Limited Network Plans? (IF

FAVORABLE OR UNFAVORABLE) Is that very or just somewhat (favorable / unfavorable)?



May 2013 6% 17 32 37 9

February 2012 8% 17 27 36 11


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42. As you may know, the legislature recently passed a law that restricts physicians from prescribing certainpain medications, such as narcotics. Are you concerned this will limit your access to these medicationswhen necessary?

Yes No (Not sure)

May 2013 37% 55 8

Now, I'd like to ask you some final questions for statistical purposes only.

43. Do you have health insurance through either a government plan or a private health care plan?

Government plan 24%

Private plan 59

No health insurance 3

(Both private and government) 11

(Dont know) 1

(Refused) 2

(SKIP IF NO HEALTH INSURANCE IN Q44)

44. Is your health insurance through a managed care plan such as an HMO like Harvard Pilgrim, Tufts, Fallon,Blue Care, or the Neighborhood Health Plan?

Yes 52%

No 41

(Dont know) 4

(Refused) 2

(SKIP IF NO HEALTH INSURANCE IN Q44)45. How well do feel like you understand your health care plan benefits? Do feel like you understand them

Entirely 16%

Very well, but not entirely 47ust somewhat 26

Not very well 8

Not at all 1

(Not sure / Refused) 2

46. How much would you estimate that you spend on your health care needs per year?

[READ ALL GROUPS EXCEPT RESPONSES 9 AND 10]

$0-100 5%

$100-250 8

$250-500 12

$500-1,000 12

$1,000-2,500 21

$2,500-5,000 17

$5,000-10,000 10

$10,000 or more 6

(Don't know) 6

(Refused) 3


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47. What was the last grade you completed in school?

Less than high school (1-11) 2%

Graduated high school 19

Some college/Tech.Voc. 21

Graduated college 28

Graduate/professional school 27

(Don't know) -

(Refused) 2

48. In which of the following categories is your age?

21-34 12%

35-40 11

41-50 24

51-60 23

61-75 20

Over 75 9


49. How many individuals, including yourself, live in your household?

One 23%

Two 35

Three 17

Four 14

More than four 9


50. Would you please tell me in which of the following categories I read is your total household income that is,of everyone living in your household?

[READ ALL GROUPS EXCEPT RESPONSES 11 AND 12]

$0-11,999 4%

$12-14,999 4

$15-19,999 2

$20-24,999 2

$25-34,999 7

$35-49,999 13

$50-74,999 16

$75-99,999 12

$100-124,999 7

$125,000 or more 16

(Don't know) 2

(Refused) 15

51. Gender: [OBSERVATION]

2013 massachusetts medical society public opinion poll

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