New Jersey fell 13 places, to 30th, due to worsening scores in Access to Emergency Care and the Quality and Patient Safety Environment. At the same time, the state has failed to significantly improve its poor Medical Liability Environment.
New Jersey's strongest performance was in Public Health and Injury Prevention, in part because of strong state policies that require child safety seat and adult seatbelt use, prohibit texting and cell phone use while driving, prohibit smoking at worksites and in bars and restaurants, and require helmets for all motorcycle riders. These policies have likely played a critical role in the low traffic fatality rate (4.6 per 100,000 people), high rate of seat belt use (94.5%), and low proportion of adult smokers (16.8%) in the state.
While New Jersey's Disaster Preparedness grade has remained the same since 2009, the state's ranking has moved up 13 places due to improvements in a number of areas. The state has incorporated special needs patients, patients dependent on dialysis, and mental health patients into its medical response plans, and bed surge capacity has significantly improved since 2009 (from 201.2 to 655.6 per 1 million people). New Jersey is one of only 11 states that have a state budget line item for Disaster Preparedness funding specific to health care surge.
New Jersey's Access to Emergency Care has hit a tipping point. The state ranks among the lowest for many measures related to hospital capacity, financial barriers, and availability of providers. It has below-average rates of emergency physicians (11.8 per 100,000 people), ranking 33rd in the nation. The state has below-average rates of neurosurgeons; ear, nose, and throat specialists; and registered nurses. Additionally, New Jersey has one of the highest hospital occupancy rates (74.5%) and a below-average number of staffed inpatient beds (287.2 per 100,000). These factors have likely contributed to the long wait times in the emergency department (ED): The median time from ED arrival to ED departure for admitted patients is 355 minutes, or 5.9 hours, putting New Jersey at 47th nationally.
Despite the persistent need to recruit and retain health care providers, New Jersey's Medical Liability Environment has changed little since 2009. The state has some of the highest average medical liability insurance premiums for physicians and specialists and falls well below average in the number of insurers writing policies (3.7 compared with 11.0 insurers per 1,000 physicians nationally). In addition, the number of malpractice award payments has increased more than threefold since the previous Report Card (3.5 versus 1.0 per 100,000 people). New Jersey lacks pretrial screening panels, periodic payments, and medical liability caps on non-economic damages, all of which would contribute to lessening the burden on physicians and increasing access to care.
While New Jersey continues to support the same practices and policies that resulted in a positive showing in 2009, the addition of new indicators in Quality and Patient Safety has revealed that the state is about average for many quality measures, such as the percentage of hospitals with computerized practitioner order entry (81.3%) and with electronic medical records (91%). More than half of New Jersey's hospitals collect data on patient race or ethnicity and primary language (65.3%).
New Jersey must work harder to attract providers of all types to meet the growing health care needs of its population and improve overall Access to Emergency Care. The state needs to act immediately to alleviate those issues that contribute to crowding and boarding in the ED, including high hospital occupancy rates, hospital closures, and lack of specialists. Compounding these problems, New Jersey has failed to increase Medicaid fees to an adequate level, as currently it pays only 40% of the national average, representing a slight increase since 2007. Grossly inadequate Medicaid fees will continue to make it difficult to recruit and retain vital specialists in the state.
To aid in addressing issues of access to quality emergency care, New Jersey needs to implement medical liability reforms aimed at lowering insurance premiums and reducing excessive malpractice award payments. The state should enact special liability protection for providers of emergency care mandated by the Emergency Medical Treatment and Labor Act who assume significant risks in providing immediate, lifesaving care to patients, often with no knowledge of their medical history. New Jersey should also consider apology inadmissibility laws, pretrial screening panels, and required periodic payments of awards.
While New Jersey fared well in Public Health and Injury Prevention overall, racial and ethnic health disparities persist in infant mortality rates, cardiovascular disease, and HIV diagnoses. For instance, the state has the fourth highest infant mortality disparity ratio, despite having the eighth lowest infant mortality rate, with non-Hispanic black infants 4.5 times more likely to die in their first year than Asians and Pacific Islanders (who had the lowest rate). The state should consider taking action to improve health equity and reduce disparities for these and all racial and ethnic groups.