Mount Sinai South Nassau ‘Truth in Medicine’ Poll: More than One-Third Support Legalizing Medical Aid in Dying

Most residents surveyed feel good about their health; Blacks, Men least engaged on health care

More than one-third of metro area residents support legalized medical aid in dying (MAID, also referred to as physician-assisted death), with 37 percent saying they supported legislation that would allow MAID in New York, while 21 percent opposed it, and 43 percent were not sure.

The latest results of the Mount Sinai South Nassau Truth in Medicine public health poll of Long Island and New York City residents sought feedback from the public on a wide range of health-related topics:

• 60 percent of respondents age 65 and older say their overall health is “excellent” or “good” and are generally optimistic about their health, even though the risk for chronic health conditions like dementia, heart disease, type 2 diabetes, and arthritis increases with age.
• 70 percent say their overall health is “excellent” (13 percent) or “good” (57 percent), with just 2 percent defining their health as “poor.”
• One-third of all have received an unexpected medical bill.
• Black respondents access the health care system at lower levels than all other racial groups, while men are often less engaged in health care than women.

“There remains a divide in our health care system when it comes to reaching minority communities, who generally experience poorer health care outcomes for a variety of reasons,” said Adhi Sharma, MD, President of Mount Sinai South Nassau. “We can work to close that gap.”

The Truth in Medicine Poll, sponsored by Bethpage, aims to gather data about public attitudes on key public health topics and spur education and discussion. The latest poll was conducted from March 21 through 26, 2024, via both landlines and cell phones with 600 Long Island and New York City residents. Poll findings are subject to a sampling error of plus or minus 3.9 percent.

Other key findings of the Truth in Medicine poll include:

• 29 percent of all respondents have taken an independent patient satisfaction survey after a hospital stay. Nearly one-half of respondents age 65 and older have taken such a survey. Blacks, men, and those under age 65 are the least likely to have done so.
• A slim majority of respondents 65 and older have a living will (53 percent) or a health care proxy (52 percent). Only 32 percent have long-term care insurance; 27 percent have made long-term care plans with their children or family, and 15 percent have toured an assisted living facility.
• Satisfaction with private health insurance is strong but not overwhelming among the 52 percent of all respondents who have private health insurance policies (that percentage was held down by the 39 percent of respondents age 65 and older who do not hold private insurance, although approximately two-thirds of all age cohorts have private health insurance). Of those poll respondents with private health insurance, 25 percent have a “very positive” perception of their health insurer, 45 percent are “somewhat positive,” 27 percent are neutral, and just 3 percent are “negative.”
  

“Appointing a health care proxy (or agent) is vital to ensuring that you get the care that you want in an emergency or at the end of life when you may not be able to make your own decisions about your medical care,” said Aaron E. Glatt, MD, Chair of the Department of Medicine, Chief of Infectious Diseases, and Hospital Epidemiologist at Mount Sinai South Nassau. “The health care proxy can also assist with decisions that are in accord with your wishes in the event your condition changes and ensures that providers follow your wishes.” (For a free health care proxy form, visit www.health.ny.gov/community/advance_care_planning.)

Surprise Medical Billing
The federal No Surprises Act (NSA) took effect on January 1, 2022, to protect patients from receiving “surprise medical bills” when they are treated at hospitals by physicians who are not listed in their health plan’s network of providers.

One-third of all poll respondents have ever received an unexpected medical bill, including 42 percent of all the respondents from Long Island, 44 percent of all those respondents with health insurance, 43 percent of all respondents with a health care visit in the last year, and 43 percent of all age 65+.
 
According to a survey conducted by American Health Insurance Providers and the Blue Cross Blue Shield Association, NSA has been effective in preventing more than 10 million surprise medical bills from reaching patients.
 
Physician-Assisted Suicide
The finding that many poll respondents were unsure about the issue of medical aid in dying parallels recent debate in Albany, where the issue of physician-assisted suicide regularly comes up, including in the most recent legislative session, but no bill has yet passed both houses of the state legislature. It remains illegal in New York State.

Oregon was the first state to legalize MAID in 1994, followed by nine other states and the District of Columbia. Proponents of MAID say it brings “humanity and dignity to death,” while opponents argue it is contrary to physicians' Hippocratic oath—their responsibility to care for patients and “do no harm.”

In most states with laws for MAID, terminally ill patients with a prognosis of six months or less to live are permitted to request a prescription from a doctor that they can take at home if and when they decide to end their lives.

Doctors can only prescribe the drugs to patients they deem mentally competent. Not all patients who are granted a prescription follow through on it. According to a study published in the Journal of the American Geriatrics Society, as of 2020 approximately 5,330 patients of the 8,451 patients in the United States who received a prescription died with medical assistance.

Religious and civic leaders in New York remain deeply divided on the issue.

Attitudes Toward Primary Care Providers
Seventy-five percent of poll respondents said they have a primary health care provider (PCP), including 62 percent of poll respondents age 18-34 and 89 percent of those age 65 and older.

Of the small number of respondents who had a negative experience with their providers, lack of follow-up and communication were their primary complaints. “Poor communication between patients and physicians is typically associated with reduced patient compliance with the care they are prescribed, reducing the effectiveness of the plan of care for these patients,” said Dr. Sharma. “The poll results indicate that we must continue to do a better job of narrating care when we see patients and communicate in a way that patients can easily understand.”

In fact, a study cited in the article “Physician, Poor Physician-Patient Communication and Medical Error,” published in the June 15, 2021, edition of American Family Physician, found that when patients stated that communication with their physicians was optimal, 70 percent of them followed physicians’ recommendations as compared to just 50 percent of those who said that the quality of communication was poor.

“Studies show that people who regularly see a primary care physician report improved health and health outcomes,” said Dr. Glatt. “People with a primary care doctor are significantly more likely to comply with doctors’ recommendations, fill prescriptions, and get health screenings and early treatment for chronic diseases.”

Meanwhile, younger respondents are more engaged with healthcare, but on less-traditional platforms. The 2022 Annual Report: Trends in Utilization of Urgent Care and Telehealth Service published by the Healthforce Center at the University of California-San Francisco indicated that adults below the age of 40 are increasingly turning to urgent care and telehealth providers for healthcare services.

Most Are Positive About Recent Hospitalization Experience
Respondents who were recently hospitalized reported a favorable experience, with 16 percent saying it was “very positive,” 43 percent “somewhat positive,” and 26 percent neutral.

The 15 percent of subjects who reported a negative experience in the hospital cited a lack of follow-up by health care providers along with a substandard quality of care.

Seventy percent of respondents said they had visited a health care provider in the past 12 months, which is lower than the nationwide percentage of 83.4 percent. Of those respondents, 24 percent rated their experience “very positive” and 46 percent rated it “somewhat positive,” while 23 percent rated it neutral and only 7 percent said they had a “negative experience.”

This is Mount Sinai South Nassau’s 18th “Truth in Medicine” Poll and the first of 2024. The poll seeks to evaluate public knowledge and sentiment toward key public health issues.

The “Truth in Medicine” Poll is a component of Mount Sinai South Nassau’s mission of improving education around critical public health issues. The poll was conducted by a nationally recognized, independent polling firm, LJR Custom Strategies, with offices in Washington, DC, and New Orleans. LJR has conducted more than 2,000 studies for a broad spectrum of health care, business, education, cultural, and political clients in nearly every state in the country and around the world.

Mount Sinai South Nassau began conducting the public health poll in January 2017. Previous polls have focused on mental health services, holiday stress, the human papilloma virus vaccine, legalization of recreational marijuana, supplements, antibiotic use and misuse, and screen time, among others. For more information about the polls, visit www.southnassau.org/sn/truth-in-medicine.
 
About Mount Sinai South Nassau
The Long Island flagship hospital of the Mount Sinai Health System, Mount Sinai South Nassau is designated a Magnet® hospital by the American Nurses Credentialing Center (ANCC) for outstanding nursing care. Mount Sinai South Nassau is one of the region’s largest hospitals, with 455 beds, more than 900 physicians and 3,500 employees. Located in Oceanside, New York, the hospital is an acute-care, not-for-profit teaching hospital that provides state-of-the-art care in cardiac, oncologic, orthopedic, bariatric, pain management, mental health, and emergency services.

In addition to its extensive outpatient specialty centers, Mount Sinai South Nassau provides emergency and elective angioplasty, and offers Novalis Tx™ and Gamma Knife® radiosurgery technologies. Mount Sinai South Nassau operates the only Trauma Center on the South Shore of Nassau County verified by the American College of Surgeons as well as Long Island’s only free-standing, 9-1-1 receiving Emergency Department in Long Beach. Mount Sinai South Nassau also is a designated Stroke Center by the New York State Department of Health and Comprehensive Community Cancer Center by the American College of Surgeons; is an accredited center of the Metabolic and Bariatric Surgery Association and Quality Improvement Program; and an Infectious Diseases Society of America Antimicrobial Stewardship Center of Excellence.

Accredited by The Joint Commission, an independent peer review organization that conducts rigorous and unannounced, on-site surveys of the hospital, Mount Sinai South Nassau holds Joint Commission Gold Seal of Approval™ Certification in eight specialties: Heart Failure, Primary Stroke Center, Joint Replacement Hip, Joint Replacement Knee, Bariatric Surgery, Wound Care, End-Stage Renal Disease and Perinatal Care.
For more information, go to www.mountsinai.org/southnassau.