According to New Jersey doctors, the managed care system has had a decidedly negative impact on health care, ranging from decreased quality of services for patients to diminished financial returns for medical practices. These are some of the findings from a 2008 Monmouth University/New Jersey Monthly survey of physicians who have been licensed in the state for at least five years.
Since enactment of the Health Maintenance Organization Act of 1973, managed care has become the country’s predominant health care coverage and delivery system. Few New Jersey doctors have a positive view on how this has affected their practice and the state of care that their patients receive. More than three-quarters (78%) say that managed care has had a negative impact on the way they practice medicine. Only 4% say it has had a positive impact and 15% say the impact has been neutral.
Just 3-in-10 (31%) New Jersey doctors feel they have a great deal of freedom to make clinical decisions that best meet their patients’ needs. About half (51%) say they have some freedom and 15% say they do not have much freedom making these decisions.
Large majorities of doctors feel that both the quality of health care for those who are sick (75%) and the ability of patients to see medical specialists (79%) have worsened in the past five years due to managed care. Only 4% feel managed care has improved these aspects of health care.
“New Jersey doctors are nearly unanimous in their opinion that managed care has generally made it more difficult to treat patients with both acute and chronic health problems,” commented Patrick Murray, director of the Monmouth University Polling Institute. “For many doctors, that also means that fewer patients access preventive care, which was supposed to be one of the main benefits of managed care.”
Only 21% of New Jersey doctors say that managed care has increased the likelihood that patients will get preventive services, such as immunizations and screenings. In comparison, 42% feel that managed care has actually decreased utilization of preventive care in the past five years, and another 26% say it has had no impact. This reflects a decline in access to preventive care reported by patients according to a national Kaiser Foundation survey (http://www.kff.org/spotlight/managedcare/upload/Spotlight_Jan06_ManagedCare.pdf)
More than 8-in-10 doctors (84%) report that managed care has also had a negative effect on the income their practice receives. Just 1% say that managed care has improved their bottom line and 7% say it has had no effect.
Despite the negative financial impact of managed care, most New Jersey physicians say that they charge their uninsured patients the same (47%) or even less (35%) than the reimbursement amount they would receive if those patients were covered by health insurance. Only 8% of doctors say they charge their uninsured patients more than what they would typically receive from health insurance for the same service. In fact, about 16% of doctors report that they waive their fees for more than half of their patients without insurance. About 20% waive all fees for between 1-in-10 and 5-in-10 of their uninsured patients, and 30% of doctors waive their fees for 1-in-10 or fewer uninsured patients. Only 18% of doctors way they never waive their fees for patients who are uninsured.
Interestingly, the survey found fairly similar opinions on these issues for most New Jersey physicians, regardless of their area of medical specialty or the length of time they have been practicing in the state.
This survey was conducted by the Monmouth University Polling Institute in partnership with New Jersey Monthly magazine. The survey was conducted by mail in April 2008 with 2,624 physicians licensed to practice medicine in New Jersey for at least five years. Survey results have a margin of sampling error of ± 1.8%. The survey is featured in the November 2008 issue of New Jersey Monthly magazine.
DATA TABLES
The questions referred to in this release are as follows:
(* Some columns may not add to 100% due to rounding.)
1. Overall, has managed care had a positive, negative, or neutral impact on the way you practice medicine?
|
Years in practice |
Selected Fields of Medicine | |||||||||||||||
|
Total |
5 to 10 | 11 to 20 | Over 20 | Anesthes iology | Family Practice | Internal Medicine | OB/GYN | Ophthal mology | Orthopedic Surgery | Pediatrics | Podiatry | Psychiatry | Radiology | Surgery |
Urology | |
| Positive | 4% |
5 | 3 | 3 | 5 | 6 | 4 | 1 | 2 | 3 | 4 | 2 | 0 | 4 | 4 |
0 |
| Negative | 78% |
74 | 80 | 80 | 71 | 81 | 79 | 88 | 77 | 91 | 69 | 91 | 81 | 50 | 82 |
86 |
| Neutral | 15% |
17 | 14 | 15 | 12 | 12 | 14 | 9 | 14 | 2 | 21 | 7 | 15 | 46 | 10 |
12 |
| No answer | 3% |
4 | 3 | 2 | 12 | 1 | 3 | 2 | 7 | 3 | 5 | 0 | 4 | 1 | 4 |
2 |
| Unweighted n | (2624) | (629) | (1024) | (816) | (90) | (159) | (687) | (156) | (81) | (129) | (244) | (108) | (86) | (125) | (199) | (78) |
2. How much freedom do you have to make clinical decisions to best meet your patients’ needs?
|
Years in practice |
Selected Fields of Medicine | |||||||||||||||
|
Total |
5 to 10 | 11 to 20 | Over 20 | Anesthes iology | Family Practice | Internal Medicine | OB/GYN | Ophthal mology | Orthopedic Surgery | Pediatrics | Podiatry | Psychiatry | Radiology | Surgery |
Urology | |
| Great deal | 31% |
30 | 29 | 32 | 24 | 25 | 31 | 27 | 35 | 32 | 31 | 34 | 38 | 17 | 38 |
24 |
| Some | 51% |
51 | 52 | 50 | 53 | 55 | 48 | 54 | 52 | 50 | 52 | 52 | 49 | 63 | 45 |
58 |
| Not much | 15% |
15 | 16 | 14 | 9 | 20 | 19 | 19 | 6 | 12 | 13 | 13 | 7 | 16 | 13 |
17 |
| No answer | 3% |
4 | 3 | 3 | 14 | 1 | 2 | 1 | 7 | 6 | 5 | 2 | 6 | 3 | 4 |
2 |
| Unweighted n | (2624) | (629) | (1024) | (816) | (90) | (159) | (687) | (156) | (81) | (129) | (244) | (108) | (86) | (125) | (199) | (78) |
3. Do you charge uninsured patients more, less, or about the same amount for care compared to what you are paid by insurers for the same service?
|
Years in practice |
Selected Fields of Medicine | |||||||||||||||
|
Total |
5 to 10 | 11 to 20 | Over 20 | Anesthes iology | Family Practice | Internal Medicine | OB/GYN | Ophthal mology | Orthopedic Surgery | Pediatrics | Podiatry | Psychiatry | Radiology | Surgery |
Urology | |
| More | 8% |
7 | 7 | 10 | 6 | 12 | 8 | 14 | 13 | 7 | 8 | 4 | 7 | 5 | 5 |
15 |
| Less | 35% |
37 | 36 | 34 | 42 | 34 | 42 | 27 | 27 | 42 | 26 | 35 | 21 | 20 | 44 |
41 |
| Same | 47% |
45 | 49 | 49 | 36 | 47 | 41 | 50 | 46 | 42 | 52 | 56 | 58 | 64 | 46 |
37 |
| No answer | 10% |
11 | 9 | 8 | 17 | 7 | 10 | 9 | 15 | 9 | 14 | 5 | 14 | 11 | 5 |
7 |
| Unweighted n | (2624) | (629) | (1024) | (816) | (90) | (159) | (687) | (156) | (81) | (129) | (244) | (108) | (86) | (125) | (199) | (78) |
4. For approximately what percent of your uninsured patients do you waive all fees?
|
Years in practice |
Selected Fields of Medicine | |||||||||||||||
|
Total |
5 to 10 | 11 to 20 | Over 20 | Anesthes iology | Family Practice | Internal Medicine | OB/GYN | Ophthal mology | Orthopedic Surgery | Pediatrics | Podiatry | Psychiatry | Radiology | Surgery |
Urology | |
| None | 18% |
19 | 19 | 18 | 12 | 17 | 16 | 32 | 26 | 20 | 24 | 19 | 16 | 40 | 10 |
8 |
| 1 – 10% | 30% |
29 | 30 | 32 | 32 | 35 | 28 | 29 | 25 | 22 | 26 | 60 | 31 | 22 | 28 |
38 |
| 11 – 25% | 10% |
10 | 10 | 9 | 6 | 12 | 11 | 8 | 15 | 14 | 8 | 4 | 8 | 3 | 8 |
20 |
| 26 – 50% | 10% |
9 | 11 | 9 | 11 | 12 | 10 | 9 | 4 | 7 | 6 | 5 | 5 | 7 | 15 | 10 |
| 51 – 75% | 5% |
3 | 5 | 8 | 4 | 3 | 6 | 6 | 0 | 8 | 5 | 3 | 13 | 3 | 11 |
7 |
| 76 – 100% | 11% |
14 | 10 | 11 | 15 | 6 | 13 | 5 | 9 | 17 | 10 | 0 | 5 | 13 | 17 |
5 |
| No answer | 17% |
17 | 15 | 13 | 19 | 15 | 16 | 12 | 21 | 11 | 22 | 9 | 23 | 12 | 11 | 13 |
|
Unweighted n | (2624) | (629) | (1024) | (816) | (90) | (159) | (687) | (156) | (81) | (129) | (244) | (108) | (86) | (125) | (199) | (78) |
5. During the past five years, do you think managed care has made the following issues better or worse, or has managed care had no significant effect? [READ ITEMS]
The quality of health care for people who are sick
|
Years in practice |
Selected Fields of Medicine | |||||||||||||||
| Total | 5 to 10 | 11 to 20 | Over 20 | Anesthes iology | Family Practice | Internal Medicine | OB/GYN | Ophthal mology | Orthopedic Surgery | Pediatrics | Podiatry | Psychiatry | Radiology | Surgery | Urology | |
| Better | 4% |
4 | 2 | 4 | 2 | 7 | 4 | 3 | 3 | 1 | 7 | 4 | 1 | 0 | 3 |
0 |
| Worse | 75% |
75 | 78 | 77 | 76 | 73 | 77 | 77 | 70 | 79 | 60 | 90 | 88 | 86 | 74 |
82 |
| No effect | 16% |
14 | 15 | 17 | 13 | 17 | 15 | 17 | 18 | 15 | 26 | 4 | 5 | 11 | 16 |
13 |
| No answer | 6% |
7 | 5 | 3 | 9 | 3 | 4 | 4 | 9 | 6 | 8 | 2 | 6 | 4 | 7 |
5 |
| Unweighted n | (2624) | (629) | (1024) | (816) | (90) | (159) | (687) | (156) | (81) | (129) | (244) | (108) | (86) | (125) | (199) | (78) |
The likelihood that patients will get preventive services such as immunizations and screenings
|
Years in practice |
Selected Fields of Medicine | |||||||||||||||
|
Total |
5 to 10 | 11 to 20 | Over 20 | Anesthes iology | Family Practice | Internal Medicine | OB/GYN | Ophthal mology | Orthopedic Surgery | Pediatrics | Podiatry | Psychiatry | Radiology | Surgery |
Urology | |
| Better | 21% |
19 | 24 | 21 | 7 | 31 | 24 | 25 | 24 | 16 | 28 | 11 | 20 | 12 | 17 |
20 |
| Worse | 42% |
44 | 41 | 43 | 53 | 43 | 44 | 44 | 36 | 42 | 33 | 61 | 40 | 29 | 46 |
42 |
| No effect | 26% |
26 | 26 | 26 | 28 | 22 | 26 | 22 | 24 | 25 | 32 | 17 | 24 | 19 | 24 |
29 |
| No answer | 11% |
10 | 9 | 11 | 12 | 4 | 6 | 9 | 15 | 18 | 7 | 13 | 17 | 40 | 13 |
9 |
| Unweighted n | (2624) | (629) | (1024) | (816) | (90) | (159) | (687) | (156) | (81) | (129) | (244) | (108) | (86) | (125) | (199) | (78) |
The ability of patients to see medical specialists
|
Years in practice |
Selected Fields of Medicine | |||||||||||||||
|
Total |
5 to 10 | 11 to 20 | Over 20 | Anesthes iology | Family Practice | Internal Medicine | OB/GYN | Ophthal mology | Orthopedic Surgery | Pediatrics | Podiatry | Psychiatry | Radiology | Surgery |
Urology | |
| Better | 4% |
2 | 2 | 5 | 0 | 5 | 4 | 4 | 2 | 2 | 7 | 3 | 1 | 2 | 2 |
1 |
| Worse | 79% |
84 | 81 | 80 | 79 | 75 | 77 | 80 | 80 | 87 | 71 | 93 | 84 | 83 | 81 |
85 |
| No effect | 11% |
8 | 12 | 11 | 7 | 17 | 15 | 9 | 9 | 5 | 15 | 1 | 5 | 10 | 8 |
9 |
| No answer | 6% |
7 | 5 | 4 | 14 | 3 | 4 | 7 | 9 | 6 | 7 | 3 | 10 | 5 | 9 |
5 |
| Unweighted n | (2624) | (629) | (1024) | (816) | (90) | (159) | (687) | (156) | (81) | (129) | (244) | (108) | (86) | (125) | (199) | (78) |
The income your practice receives
|
Years in practice |
Selected Fields of Medicine | |||||||||||||||
|
Total |
5 to 10 | 11 to 20 | Over 20 | Anesthes iology | Family Practice | Internal Medicine | OB/GYN | Ophthal mology | Orthopedic Surgery | Pediatrics | Podiatry | Psychiatry | Radiology | Surgery |
Urology | |
| Better | 1% |
1 | 1 | 2 | 0 | 4 | 1 | 1 | 2 | 1 | 3 | 2 | 0 | 0 | 1 |
0 |
| Worse | 84% |
86 | 86 | 87 | 84 | 83 | 86 | 90 | 84 | 90 | 81 | 93 | 68 | 85 | 85 |
91 |
| No effect | 7% |
7 | 7 | 7 | 5 | 10 | 7 | 5 | 4 | 4 | 8 | 0 | 19 | 8 | 7 |
5 |
| No answer | 7% |
7 | 6 | 4 | 12 | 3 | 6 | 5 | 10 | 5 | 9 | 5 | 13 | 7 | 7 |
4 |
| Unweighted n | (2624) | (629) | (1024) | (816) | (90) | (159) | (687) | (156) | (81) | (129) | (244) | (108) | (86) | (125) | (199) | (78) |
Results for this poll are based on a mail survey conducted by the Monmouth University Polling Institute in April 2008 with a statewide sample of 2,624 doctors. The sample was drawn from the full list of 20,254 doctors living in New Jersey who have been licensed by the state for at least five years. Survey results have a margin of sampling error of ± 1.8%. The list was provided by the New Jersey Board of Medical Examiners via the Department of Community Affairs. In addition to sampling error, one should bear in mind that question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of opinion polls.
Click on pdf file link below for full methodology and results by key demographic groups.
