New Jersey residents spent more than 42 other states on health care in America, with Type 2 diabetes, hip, knee and back injuries and dental care the conditions the most responsible for driving up costs, a first-ever national study on medical bills found.
New Jerseyans spent $75.6 billion on medical care in 2019, the seventh highest in the nation, according to the study from the Institute for Health Metrics and Evaluation at Washington University. That amounted to about $8,000 per person.
Residents from Morris and Ocean counties were tied for spending the most out of all New Jersey’s 21 counties, while Hudson County spent the least, according to the study.
The university analyzed billions of insurance claims from all 50 states and Washington D.C. in 2019 to find out how we spend our health care money and identify which counties may lack access to hospitals, surgery centers, doctors and other health care professionals, said the study’s author, Associate Professor Dr. Joe Dieleman.
The researchers say many factors influence medical costs beyond the price tag. They include patient’s age, the prevalence of chronic disease and whether it is caught early. But the most significant driver of spending is how often patients use their health insurance and the proximity and availability of doctors, hospitals and other treatment providers.
Ocean County ranks among the biggest spenders, likely because many older people live there, they are insured by Medicare and they tend to see a lot of doctors, the study found. Residents in Morris County, ranked as one of New Jersey’s most affluent and healthiest counties, are frequent users of their health insurance, the study said.
Hudson County residents spend the least of any county in New Jersey, which may be due to it having the youngest population in the state. According to 2022 Census data, the median age of a Hudson County resident is 36. But there is also an acute shortage of primary care doctors in Hudson County, with 1 doctor for every 2,110 residents, far fewer than the state average of one doctor for every 1,280 residents, according to the Population Health Institute at the University of Wisconsin-Madison.
The per capita cost for a Hudson County resident is about $6,100 compared to nearly $11,000 in Ocean and Morris counties, according to the data.
When Dieleman sees such wide disparities within a state it may be a sign that there may not be enough medical services available for those need them.
Dieleman said the data may also show that sheer volume suggests one of two things: people are getting more services than they need and some aren’t getting enough services. It’s likely there aren’t enough doctors and other outpatient centers nearby.
“When we boil it down, two factors make sense: age and disease prevalence. You want sicker and older populations to get more services,” he said.
“There is huge disparity in utilization of services that can’t be explained by age and disease prevalence. And that suggests to me that there are populations that are simply not getting the access to care that the rest of the country has now,” he said.
“If people had better insurance coverage, they would be more likely to pursue regular health checkups, potentially reducing the need for emergency care. This change would also lead to better health outcomes and allow emergency providers to focus on patients with urgent medical needs,” Dieleman said.
What Ails Us and Why
The study examines which conditions are responsible for making us sick and shortening our lifespans and compares them to what consumes most of our health care spending.
Many are the same.
The leading causes of poor health and early death in New Jersey in 2019 were ischemic heart disease, which is caused by a lack of oxygen, often by coronary artery disease.
The top causes of poor health include low back pain; joint disorders and osteoporosis; chronic obstructive pulmonary disease; Alzheimer’s disease and other dementias; stroke; lung cancer, chronic kidney disease, headache disorders; and anxiety disorders, according to the study.
Meanwhile, New Jerseyans spend the most money — about $4.5 billion — treating Type 2 diabetes, a disease caused by the body’s failure to use and control sugar in the blood. Diabetes may cause or contribute to the development of three of the most prevalent and harmful conditions: heart disease, kidney disease, stroke and Alzheimer’s disease, according to the Mayo Clinic.
Another $3.5 billion was spent treating musculoskeletal disorders and osteoporosis — representing the second and third-most common medical conditions among New Jersey residents: low back pain and and joint disorders, the study said.
The study concluded that if people had better insurance coverage, they would be more likely to pursue regular health checkups, potentially reducing the need for emergency care, which was the fastest growing category of spending.
With so much spent on treatment, are people living better, healthier lives?
Professor Stephen Crystal, director for the Center for Health Services Research at Rutgers University said the study reveals the weaknesses in the health care system.
If there were more primary care physicians, they could be helping patients prevent these chronic illnesses and injuries or manage them before it turns dire, Crystal said.
A study by the American Board of Family Medicine and the New Jersey Health Care Quality Institute last year found New Jersey had about 5,300 primary care doctors, and about half worked part-time.
New Jersey is tied with Connecticut as having the lowest concentration of family physicians in the nation, at about 17 per 100,000 of population. Low reimbursement leading to much lower pay than for specialists is the prime reason why the shortage of primary care doctors persists. Crystal said improving reimbursement rates for primary care doctors is needed to attract top medical students to the specialty.
Patients at risk for developing Type 2 diabetes could avoid it by following a proper diet, exercise and guidance from their primary care physician, Crystal said.
Crystal also lamented the astronomical cost of many prescription drugs, which limits who can obtain medication living healthier, longer lives.
“One of the really sad things is when you look at this, you see how much of these things could be prevented,” Crystal said. “If we get a handle on obesity, we would be spending less on knee replacements,” he said, adding, “although eventually, if you live long enough, there is a high likelihood that person needs a knee replacement.”
Crystal said it is also unfortunate that medications used to treat type 2 diabetes and obesity by regulating blood sugar levels and appetite, such as Ozempic, Wegovy and Mounjaro, are not widely covered by insurance unless the patient has diabetes.
Monthly treatments can run as high as $1,000, although some manufacturers have begun offering lower starting rates. Some of these drugs are also on the federal government’s list to negotiate a better deal on behalf of Medicare recipients, Crystal noted.
“In particular, Ozempic is scheduled for negotiation this year. Hopefully, the government will negotiate a much lower price that is closer to prices paid in other developed countries, which would enable much broader use to treat obesity and prevent diabetes before it develops,” Crystal said.
Reducing the price of key medications for people with obesity and at risk for diabetes would be a game-changer, he said. So would creating a team around primary care doctors staffed by other medical professionals who could spend time managing diabetes, he said.
“Everyone will tell you can’t get a primary care appointment,” Crystal said. “That’s because these doctors often are blocking out 15-minute appointments, he said. “There should be a team involved.”
Can’t see the map? Click here.
Spending on autism, addiction treatment on the rise
New Jersey, like the rest of the nation, is spending much more on treatments and therapy for autism and addiction, the study found.
New Jersey has the third-highest rate of autism in America, with one in 35 children diagnosed with autism spectrum disorder. One in four of these children are severely disabled and require intensive therapies that are often covered by insurance.
Spending on autism care rose by nearly 12% in New Jersey from 2010 to 2019. Substance abuse disorders treatment climbed nearly 10% during that time, the study said.
Nationally, $5 billion was spent on autism treatments, a 13% increase from 2010, making it the health condition with the fastest average per capita growth rate. Opioid use disorders had the second fastest rate at 9%, followed by alcohol addiction at 7% and other substance use disorders at 6%.
Can’t see the chart? Click here.
The nation’s top 10 spenders per capita in 2019 were Washington D.C.; Alaska; New York; Massachusetts; Delaware; Connecticut; New Jersey; Pennsylvania; West Virginia and Louisiana, according to the study. Utah and Idaho spent the least, ranked 50th and 51st, respectively.
The Institute for Health Metrics and Evaluation based its analysis on 40 billion insurance claims and one billion hospital admissions records processed in 2019 from Medicare, Medicaid, private insurance and out-of-pocket payments. This data, capturing 77% of all US health care spending, was broken down by each of the nation’s 3,110 counties.
Nationally, type 2 diabetes was the most expensive health condition at $144 billion, followed by musculoskeletal disorders at $109 billion, oral disorders like cavities and orthodontic procedures at $93 billion, coronary heart disease at $81 billion, and urinary diseases at $72 billion.
Thank you for relying on us to provide the journalism you can trust. Please consider supporting NJ.com with a subscription.
Katie Kausch may be reached at kkausch@njadvancemedia.com. Follow her on X @KatieKausch.
Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on X @SusanKLivio and Bluesky at @susanklivio.bsky.social.