New Jerseyans Find It Hard to Find Doctors Who Accept Their Insurance

Quest for physicians who take their health coverage proves much more difficult for NJ residents compared to national average

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New Jersey residents are more than four times as likely as the national average to have difficulty finding a doctor who accepts their health insurance, according to a new Rutgers University report.

Of state residents between the ages of 18 and 64, 14.6 percent reported having trouble finding a doctor who would accept their insurance, while 9 percent of those 65 and older had difficulty.

These numbers are much higher than the national averages of 3.3 percent of those 18 to 64 and 2.1 percent of those 65 and older. The figures are from a Rutgers Center for State Health Policy report, which drew on a state survey of residents.

While the numbers are troubling, center Director Joel Cantor said the reason for the disparity isn’t clear. He said further study of the issue is needed.

“It’s possible that there’s a fair number of physicians in New Jersey who don’t accept Medicare,” as well as private insurance, said Cantor, noting that problem was found across all age groups.

The Rutgers report is the fourth in a series intended to provide more state-level information on the implementation of the Affordable Care Act here.

It aims to provide a baseline to understand what the state’s needs were before the January expansion of health insurance through the federal marketplace and Medicaid eligibility expansion.

“It really grows out of the concern that as the number of people with health insurance increases, that there will be stress on the physician supply,” said Cantor, who is an NJ Spotlight columnist.

The state Behavioral Risk Factor Surveillance System survey that the report was based on was conducted between January 2012 and June 2013.

Cantor said that it’s possible that the relatively high percentage of people who had difficulty finding a doctor who accept their insurance may be because New Jersey residents having higher expectations.

But it’s “more likely that New Jersey physicians are less likely to accept all comers,” Cantor said.

Most state residents didn’t have a problem finding a general doctor, such as a primary-care doctor, who accepted their insurance. The report found that only 5.1 percent reported having difficulty finding a general doctor, including 1.8 percent who never found one.

More residents reported difficulty finding a specialist who took their coverage, with 6.4 percent having difficulty, including 2.5 percent unable to find a specialist.

Not surprisingly, the problems were greatest for people insured through New Jersey FamilyCare or Medicaid, which reimburse doctors at a much lower rate than Medicare or private insurers. Of Medicaid recipients, 9.5 reported having difficulty finding a general doctor and 13.6 reported problems finding a specialist.

“That’s consistent with other studies, not only in New Jersey, but around the country,” Cantor said.

The percentage of people who reported being told by a doctor that their insurance wasn’t accepted was higher than the percentage of those who reported having difficulty finding a doctor.

People with frequent mental-health problems were among those with the greatest difficulty finding access to doctors. Of those who reported having four or more “bad mental health days” in the prior month, 19.6 percent said a general doctor told them that their health insurance wasn’t accepted, while 18.8 percent had that experience with a specialist.

“It raises questions about the network adequacy” of these patients’ insurance plans, Cantor said. Insurers are legally required to provide an adequate network of providers.

The challenge that some New Jerseyans have in finding a doctor wasn’t a surprise to the New Jersey Academy of Family Physicians, according to Raymond J. Saputelli, academy executive director.

“I think as good as it is for the state to see more people covered as a result of the ACA, I think it’s only going to exacerbate the problem,” said Saputelli, referring to various financial pressures on family doctors.

Saputelli noted that New Jersey is a “net exporter” of family doctors, with the number of physicians trained in the state exceeding the number who chose to practice in it.

“They leave school with a tremendous amount of debt and when they look at the potential for paying that debt, the payment is far inferior in New Jersey,” Saputelli said.

Saputelli said the high cost of practicing in the state threatens to make New Jersey a “primary-care desert.” The academy wants the state government to reduce family doctors’ medical school debt, among other steps to encourage them to practice in the state.

“The primary-care environment in the state is toxic to family medicine,” he said. “I think the ACA — as hopeful as it might be in terms of covering people — is going to expose and exacerbate the creation of that desert pretty quickly if we don’t change some things. “

He also noted the poor Medicaid reimbursement rate in the state. Medicaid fees amount to only 45 percent of Medicare reimbursement rates in the state, which is the second-lowest ratio in the country, behind only Rhode Island, according to Kaiser Family Foundation statistics.

The Rutgers Center for State Health Policy plans to continue to study residents’ access to doctors as the number of people with insurance increases. In 2011, Cantor and other Rutgers researchers estimated that 444,000 state residents would gain insurance as a result of the ACA.

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