New URI Survey Initiative Offers Insights Into Local Healthcare

EPISODE DESCRIPTION - Ready to publishRhode Islanders are sending a blunt message: the healthcare system is not just expensive, it's forcing people to delay care, skip tests, and rethink whether treatment is even worth it. University of Rhode Island sociologist Julie Keller unpacks the new survey data exposing how deep the affordability crisis really goes - and why the numbers are more alarming than the anecdotes.The findings go beyond general frustration. 29% of respondents say they delayed medical care in the last year because of cost, and among those postponing recommended care, cost is the biggest reason. Keller explains why the wording of these questions matters, how the survey captures the difference between general concern and real-world barriers, and why that gap is so consequential for health outcomes and medical debt.We also break down the broader public sentiment shaping Rhode Island right now:

• 72% worry about healthcare costs

• 72% also worry about housing costs

• 93% trust their own doctor

• Trust drops sharply for institutions like the CDC, FDA, Rhode Island state officials, RFK Jr., and Trump

• 49% say they use AI for health information, raising new questions about how people search for care and advice

Keller also shares what Rhode Islanders say they would support to fix the system, including a URI medical school, loan forgiveness for doctors who stay in the state, and higher Medicaid reimbursements. If you're trying to understand why healthcare keeps rising to the top of Rhode Island's political agenda, or what kinds of solutions actually have public support, this episode gives you the clearest picture yet.Essential listening if you care about healthcare costs, access to care, policy reform, or the real state of public opinion in Rhode Island right now.

Transcript

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Bill Bartholomew 0:00

I'm going to give a couple of top-line numbers right now. Only 11% of those surveyed recently in this URI survey we're going to talk about would give our healthcare system here in Rhode Island a grade of A. That's actually not shocking at all. In fact, in some ways you might think that's a little bit high. Perhaps that's because once people find access to care, they're comfortable with it. It's just getting there can be an extremely difficult road. That's a portion of the findings that we're going to talk about today from the University of Rhode Island survey initiative. And we're going to speak with Julie Keller, who is an associate professor of sociology at the University. Dr. Keller, thanks for joining us here on Bartholomewtown.

SPEAKER_00 0:38

Thanks so much for having me.

Bill Bartholomew 0:39

Backstory on the survey itself.

SPEAKER_00 0:44

Sure. So the survey initiative at URI began back in 2022 when the Associate Dean of Research of the College of Arts and Sciences, Brian Kruger, came together with the then head of the Harrington School of Media and Communication, Mina Kotardi. And she and Brian came together to basically launch this survey initiative which would bring researchers into conversation with everyday Rhode Islanders through an annual survey of topical issues that were relevant to the state.

Bill Bartholomew 1:22

Right. And no more topical, there is no issue that's more topical than affordability and specifically healthcare acutely here in Rhode Island. There's a lot of reasons for that, many of which are outlined in this initiative. Just your overall takeaway, Dr. Keller, when you look at this, what's the first thing that you glean on a broad level?

SPEAKER_00 1:41

Well, you know, just a little bit of background on our selection of our topic here for healthcare for this year. Every year, our topic for the survey does change. And we we try to make it um, you know, relevant, um, something that is affecting Rhode Islanders at that moment. It's always hard, though, to forecast that. So thankfully, we use our previous year's survey findings to make that decision. So we were finding that healthcare was coming up as a top priority for Rhode Islanders in terms of what the General Assembly and the governor should focus on. So we use that to guide our uh our ultimate thematic focus for 2026 of healthcare. Um, something that pops out, I would say, is when Rhode Islanders are asked, as you referred to, to grade the healthcare system in the state. Um, the majority of respondents give it a grade of C, which is satisfactory. But then when you drill down a bit more to ask specifics about now, could you give a grade to the cost of healthcare? That's where we see those results split off a bit so that the majority of respondents are not satisfied with the cost of healthcare in the state. Most of the respondents are placing um the cost in that in that square of um a D.

Bill Bartholomew 3:05

Right. And what's really interesting about this study is that it highlights that which has been anecdotally available for a while now. I mean, a lot of people can use the field test to understand that look, healthcare is expensive, period. And in Rhode Island, where there's a supply and demand issue, it's all that more much more expensive. Beyond the supply and demand, and even beyond the impact of the big, beautiful bell and the cuts there, um, and the temporary, or I should say, the um, you know, the procedural ways in which the governor here in Rhode Island has tried to stave off some of those that basically a system collapse when it comes to people who are receiving government health care. Beyond those two major bullet points, what else did you find that sort of illuminated just how significant and deep this crisis is here in Rhode Island?

SPEAKER_00 3:53

Well, I think it's all about the kinds of questions you ask, right? And so knowing that healthcare was a top concern for folks in previous surveys, we wanted to drill down more into this affordability question. So then we started to ask questions about, you know, was there a time in the last year where you delayed care due to cost? Um, and that question delaying access to care, you know, in my um in my research in my past, you know, way back in grad school, is when I started asking questions about access to health care. I was working with a marginalized population at that point. And so this question of, you know, at what point are you delaying treatment because of a cost concern? Um, so I think the wording of these questions is really important because then what surfaces is is just how desperate some folks are in the sense of uh cost is a huge concern, affordability. And so what they're willing to do is is really unfortunate and really reveals a lot about the shortcomings of our healthcare system. So, you know, when asked that question, for example, you know, with that precise wording, is when folks are questioned about uh, you know, that delay, at what point are they um delaying access to care? Uh, we see that um 29% of uh of Rhode Islanders had delayed seeking medical care in the last year because of cost.

Bill Bartholomew 5:18

Yeah. And there's a lot, there's sort of subsections to that. First of all, I just want to commend you and the university for providing this data because when we study the healthcare crisis, it is those macro things, the healthcare crisis in Rhode Island. It's those macro things that I mentioned, obviously reimbursement rates that lead to supply and demand shortages, and and that's the driver of supply and demand, most likely, and then what we're seeing in from a federal policy standpoint and what we can make sense of. But it's a lot deeper than that. So this highlights something that is so important that it's not just affordability with, well, that's kind of expensive. It's affordability as in people's lives are on the line potentially as a result of the situation. Is that a fair statement?

SPEAKER_00 6:00

I think it is. I think it is, is that you see that level of desperation. Um, and we know that when you delay accessing medical care, you know, that's linked to poor out health outcomes overall. And it's also um connected to our uh our debt crisis when it comes to medical debt, right? And uh just how severe that problem is for everyday Americans.

Bill Bartholomew 6:23

Yeah. And I'll also point out that the the the delay or the the overall affordability numbers, right, in terms of concern. Here's a f here's something I thought was very interesting. 72% of respondents said that they were worried about health care health care costs, right? Well, 72% of respondents also are worried about housing costs and affordability. And these are so the m it shows that the survey is reaching the right uh consistent responses and this aligns with sentiment on the ground and it puts stark numbers in front of us. So it feels to me like you've really pinpointed down when we talk about the affordability crisis and who's we, I guess the media, academia, et cetera, or even the political class, which use it so broadly and in such an expansive ideological way. But you're talking about no, people literally are not going to the doctor because they can't afford to. And by the way, within those that aren't going, the breakout uh that are delaying an appointment, 47% of those people aren't going because they literally can't afford it. Then another 23 are saying, I don't think it's worth it. So this isn't just, you know, fear of needles. This is I cannot afford health care in the state of Rhode Island, in the heart of the most prosperous industrial corridor in human history. We have 47% of those who said that they're delaying care, it's because they don't have the money in our state.

SPEAKER_00 7:46

Right, exactly. And I'm glad that you pinpointed that because in that in that separate question we ask is, you know, in the last 12 months, you know, was your uh had a doctor recommended a particular test, a particular medical evaluation that you did not pursue? And first asking that question and saying yes or no, and then among those who selected yes, as you refer to, what was the reason behind that? Because like you said, it could be a variety of different reasons. Well, I didn't think I needed it. You know, it seemed like uh too much, right? Too excessive. And uh, you know, or I or it wasn't convenient for me, right? So any number of reasons. That's why it's it is important to do that follow-up question to ask, was it cost related? And that in fact was the most common response.

Bill Bartholomew 8:31

There's something very, very important here, which is the buy-in to the system on the whole. We're trying the or I should where I'm in this conversation, we're identifying that there are shortcomings in the system and that it probably needs to be repaired. There are some people who don't trust the system. Um, however, this survey did find that 93% of people trust their own doctor, at least a fair amount, if not a great deal. When you get to the CDC, 66%, FDA 61%, Rhode Island state officials, 56%, RFK Jr., 42%, uh Trump, 35%, but Rhode Island state officials, 56%. What do you is this COVID fatigue, or is this something much broader?

SPEAKER_00 9:11

That's an interesting question. I don't know exactly what to make of it, but that's something to pin. Um, you know, if we were to ask some follow-up questions in another survey, is where where is that uh faltering trust coming from exactly? So that's again, and that's an opportunity to drill down deeper to understand that. I did I did note that that it ranked lower maybe than I would have expected.

Bill Bartholomew 9:32

Yeah, especially because the attitudes on other, I don't know how to put to phrase this without just saying it, and I will, I'm not putting these words into your mouth, but more typically right-wing uh anti-institution during COVID positions would probably align more so with RFK or Trump trust, which again are are well below 45% each. And um, you know, the the the the Rhode Island State officials are closer to Trump and RFK than one's own doctor. And I think that that's a that's a very interesting metric right there. And we'll and we'll see where that goes. Another thing here, uh 49% say they're using AI for health info. That could be a lot of things. Mostly most of the respondents said it's for extra research before they see a doctor. It's not like they're not seeing a doctor, but they're probably, we can probably safely assume that some of those who are not seeing a doctor are using AI in its stead, in their stead. Um, what do you make of that? That's a that's a big deal.

SPEAKER_00 10:28

Yes, I'm so glad you drew you drawing attention to this. It was a question that I personally wanted to ask um with the uh just the quick pace that we've seen, uh, the rollout of AI, various AI tools uh in the health context. And now, you know, it's interesting as well. There's thinking about the wording of this question and imagining of uh somebody responding to this. Now, you know, your your typical Google search is spitting back, you know, AI uh results. And so I'm wondering too, is how is is how accurate those uh results might be in terms of folks not really being aware that they are using AI to get answers to their health questions, right? But I just want to give also a quick shout out to a colleague, uh Melanie Brasher in um my department, another sociologist at URI, because she had tweaked that question for me to say, hey, we need to actually include a response for people who do not use AI. So that's a real, uh, a real good reminder that your responses need to be exhaustive for any questions that you ask. And so really putting yourself in the shoes of the respondent who does not use AI, you know, has not used AI within a specified period of time. So quick shout out there to her.

Bill Bartholomew 11:41

No, that's great. It's really good stuff. Look, there's a lot of when it comes to, again, that's supply and demand, that's such a basic way of putting it. But the supply and demand issue of primary care physician shortages. Um, look, there's a lot of bipartisan support for a a medical school at URI. 82% of respondents said that that was something that they would support. Um, also 76% support for loan forgiveness for doctors who stay in Rhode Island and practice in Rhode Island, and then 67% support increasing Medicaid reimbursements. That's probably the major driver of a lot of this at the end of the day. So it seems like there's a bipartisan sentiment here that people say, we know we need to fix this. It may require bonding, it may require loan forgiveness, it may require even restructuring taxation, if you will. Um, but there is a sentiment to fix this no matter what. Is that fair to say?

SPEAKER_00 12:32

I hope so. Um, you know, I think that um just given the concerns that um that folks are raising in this survey, um, you know, I'm I'm hoping that this gives just an additional um push to develop solutions to these problems. Um so, you know, that's what we're that's what we're all about is is hopefully providing a public service. You know, we're a land grant institution at the University of Rhode Island or our biggest public institution, higher education in the state. And so we want to um give back to the community, right? We want to be producing scholarship research that's that's useful for stakeholders, for lawmakers, um, to hopefully, hopefully put into place solutions to address some of these concerns.

Bill Bartholomew 13:13

A couple of political tie-ins here as it is political season in in uh as we're recording this, and as a lot of people will be hearing this, uh housing and healthcare lead the pack in terms of the top state priorities, 64 and 62 percent each respectively. McKee approval, 36% approval, 38% disapproval. That's up from a year ago when he was at 2937. Folks run stronger than McKee in hypothetical matchups, but she's looking at low 40s and McKee around 37%. Now, this is not polling. This is not akin to the University of New Hampshire poll or or in terms of um the the sample size or or the the I guess the intention here. This is not a poll on an election or anything like that. But that's very interesting. What is that come from in terms of adding it into the mix?

SPEAKER_00 14:05

So so I would say that in for this particular question, it's actually fairly apples to apples because um we used UNH's survey, you know, as um as a model for this question. The hypothetical matchups was, I think, attractive, so that um registered voters, and this is a sub-sample, a subset of our sample, right? So our sample is Rhode Islanders generally who are 18 and above, and it is um weighted to be uh representative of the state, but we're not exclusively looking at registered voters for these matchups. We are so we are looking at that um, you know, roughly 89% of our sample who are registered voters, we're just looking at that group and then presenting these hypothetical matchups. Um, and so I, you know, pretty closely mirrored the UNH approach there. And then when looking at their most recent poll with these hypothetical matchups out of UNH from August 27th, um, we do see some, you know, remarkable similarities, you know, which is encouraging, I think, from our point of view, because because URI's um, you know, Rhode Island Survey Initiative tends not to be, you know, one of the big uh the big political polls that we see out of the state. However, we do include regularly some of these questions, our approval ratings, um, you know, some um voter uh voting preferences, depending on what election is coming up. So in 2024, um Emily Lynch was our lead survey writer out of the political science department at URI. And the topical um, you know, the theme for that whole survey was elections. So, you know, I encourage folks to go back to that report because she asked a host of different questions about um trust and democracy, um, political violence, um, corruption, things like that that could be of interest to folks. Last year's report, um, another shout out uh to the Department of Political Science. Uh, this was led by Ashley Rundlett, that was our lead survey writer, and that theme was housing. So for folks interested in digging into the numbers there on specific housing policy proposals, you know, support for different approaches to coming up with solutions for our housing crisis in Rhode Island, that's a wonderful source of information. But yes, generally the report, our intentions are different from those of, you know, the Salve Regina folks, um, Katie Saunder, for example, um, because their their questions are really solely focused on, okay, what's going to happen in the primary, what's going to happen in this general election. Um, and as a result, their survey is much, much shorter. So our surveys tend to run at least 50 questions. So it's a it's a big, bulky survey because we're covering all these different areas that are uh relevant to Rhode Islanders.

Bill Bartholomew 16:58

Yeah. And you've got 500 people with a margin of error a little greater than five. Um, last uh quickly here, just on uh the the so much we could talk about. I really appreciate you being on here, Doctor. Um media habits, 54% of respondents say they get their news from television, 50% from news, websites. This is political news, I should say. Radio, 23% of respondents say always or often, and this and 21% of respondents say always or often for podcasts. So we could kind of cluster those together. There'd be some overlap. It's fair to say that about half of Rhode Islanders are still uh engaged with traditional media, and when it comes to Facebook and YouTube, about half of Rhode Islanders use that. It's not an either-or necessarily, but this is kind of interesting because we are again, it's one of those field things having working in media here. I know for sure that people still listen to WPRO and uh en masse, because if they didn't, there's zero chance that Cumulus Media who owns it would send me a check to be there for three hours a day. There's zero chance, it just that it doesn't make any sense. I know that there's an audience. That's an outlier. And I wonder if these numbers in other markets would be the same. Um, just your takeaway on this doesn't necessarily indicate astuteness or anything like that. It just is is about paying attention. Is that fair to say where people paying attention?

SPEAKER_00 18:15

Yeah, I mean, it it yeah, it it all depends on how you know how people are answering this question is when they're thinking about where they get their um political news or their election news from, you know, what's what's top of mind there. Um, but I think TV is still very much relevant, you know, and I think that that for uh folks working on different campaigns currently, right, is um that decision whether or not to to put a um a television ad out there. I mean, of course it's very expensive. Um, so that seems to be a huge consideration, but it's important for a lot of folks in Rhode Island. Um they're getting their political news from television, many of them. So so and the other thing I do do want to note is that slight uptick in podcasts. So we're seeing more folks compared to last year getting their political news from podcasts.

Bill Bartholomew 19:00

Interesting. Well, I hope I hope that's the case here in Rhode Island. And NSC, 25% get their news on the radio and 25% or whatever from podcasts. Uh we're on both mediums here on Bartholomew Town, so hopefully we're meeting people where they are. That's uh that's one goal for sure. And I think candidates are making we're I don't do political advertising, I don't stand to make a dime from it on Bartholomewtown, but I do think it's interesting that candidates aren't advertising on radio um very much. The only one I really heard is that Victor Meller from you know the the Congress, the Republican congressional candidate. It's just interesting the numbers are there that they're out there in Rhode Island and uh probably worth exploring. All right, uh last uh 30 seconds here, as your your big we already did this at the beginning, but after going through the numbers and going through everything, is Rhode Island's healthcare system at crisis mode right now from your standpoint, or is it at a point where we just have to go, we're about to hit that and we've got to stabilize it now?

SPEAKER_00 19:52

You know, it seems to be on par with uh when we compare this question, again, apples to apples comparisons are what we what we're looking for in terms of question wording and our uh you know methods and all of that, being able to compare this question to other questions asked um uh to different populations. So at the national level, Gallup asks this same question about grading the healthcare system. And it's on par with most folks uh rating uh you know their healthcare system in their area uh with a grade of C. Um so I think that you know we're we're just hope hopeful that this information is gonna be useful for folks um who have um who have the uh power to come up with solutions for Rhode Islanders because clearly uh they're very concerned about healthcare costs.

Bill Bartholomew 20:35

Dr. Julie Keller, University of Rhode Island. Thanks so much for your time today.

SPEAKER_00 20:39

Thank you.