|
E-mail this page to a friend!
Senior Citizen Health & Medicine
State Health Scorecard Says Thousands of Lives Could
be Saved with Top States as Models
Hawaii, Iowa, New Hampshire, Vermont, Maine Lead
in Rankings
 June 28, 2007 The first report to access how the
health system in each state is performing in five key areas was released
earlier this month with disturbing findings of large gaps in the areas
measured. They reveal, for example, that death rates for those under age
75 from conditions that might have been prevented are 50 percent higher
in the lowest rated states.
These large gaps in quality of care, access to
care, avoidable hospitalizations and costs, equity and healthy lives
among states are part of a new state scorecard available online
presented by The Commonwealth Fund Commission on a High Performance
Health System.
The striking variability across states adds up to
substantial human and economic costs for the nation, according to the
report.
The report estimates that if all states could do as
well as the top states, 90,000 lives could be saved annually, 22 million
additional adults and children would have health insurance and millions
of older adults, diabetics and young children would receive essential
preventive care.
In addition, Medicare could save $22 billion a year
if high cost states moved down to spending levels of the average states.
The report ranks states on 32 indicators grouped in
categories that include access, quality, avoidable hospital use and
costs, equity and healthy lives.
| |
The complete report and an interactive map to the
scores by state can be found online
Click Here |
|
While no single state performed at the top across
all categories, some states far surpassed others. States in the
Northeast and Upper Midwest often rank high in multiple areas. In
contrast, states with the lowest rankings tend to be concentrated in the
South.
The differences we found between the top and
bottom states were shocking, often a two to three-fold variation or
greater, said co-author and Commonwealth Fund Senior Vice President
Cathy Schoen. Where you live clearly matters: for access to care when
you need it, the quality of care you receive, and opportunities to live
healthier lives.
The report, Aiming Higher: Results from a State
Scorecard on Health System Performance, compares each state to
benchmarks that have already been achieved in states across the country.
Although some states ranked highly on multiple indictors, the report
finds that that no one or group of states scored top marks in every
area.
As policy-makers and private sector leaders look
at how their states did on this scorecard, it should be clear that there
is room for improvement in all states, said lead author and Director of
the Center for State Health Policy at Rutgers University Joel Cantor.
In key areas, even the top states arent doing as
well as they could be.
Access to Health Care and Quality Are Closely
Linked
Across the country, the scorecard found that states
that do well on access to care particularly health insurance
coveragewere also more likely to do better on quality of care. Four of
the five states with the best access to care rankings (Massachusetts,
Iowa, Rhode Island, and Maine) are also among the highest on quality of
care. States with low quality rankings tend to have high rates of
uninsured residents.
Notably, the five top ranked states overall
(Hawaii, Iowa, New Hampshire, Vermont and Maine) all have high rates of
insurance coverage, with nearly 90 percent of working-age adults
insured.
In contrast, in the five lowest ranked states
(Nevada, Arkansas, Texas, Mississippi and Oklahoma) the share of adults
insured ranges between 70 and 78 percent.
These findings point to improving access to care
and health insurance coverage as important first steps toward ensuring
that all patients get recommended care that is patient-centered,
well-coordinated and efficient. In states with low rates of uninsured,
adults and children are more likely to receive essential preventive and
chronic care and to have an ongoing connection to care.
High Cost Doesnt Equal High Quality Care
Researchers found no systematic connection between
high spending and high quality health care. Some states achieve high
quality at relatively low costs. The states with the highest levels of
spending tended to have higher rates of preventable hospital use
including readmissions and admissions for diabetes, asthma, and other
chronic illnesses that should be effectively treated outside the
hospital.
The scorecard documents stark variability across
states in potentially preventable use of hospitals. For example, the
rate of children admitted to the hospital for asthma ranges from 55 per
100,000 in Vermont to 300 per 100,000 in South Carolina.
Opportunities to Improve
The scorecard points to the substantial gains for
the nation if all states could reach levels achieved by the top
performing states on key indicators.
● Nearly 90,000 fewer deaths before the age of
75 would occur annually from conditions amenable to health care if all
states achieved the level of the lowest rate state.
● The uninsured population would be cut in half if insurance rates
nationwide reached insurance rates in the top states.
● Nearly 4 million more diabetics across the nation would receive
basic recommended care, helping to avoid renal failure and lost limbs,
and 9 million adults age 50 or older would receive essential preventive
care.
● If all states reached the lowest levels of potentially preventable
admissions and readmissions, these hospitalizations could be reduced by
30 percent to 47 percent and save Medicare $2 billion to $5 billion each
year.
Wide Variations -- Additional Report Findings:
Access
The percent of adults under age 65 who were
uninsured in 20042005 ranges from a low of 11 percent in Minnesota to a
high of 30 percent in Texas. The percent of uninsured children varies
from 5 percent in Vermont to 20 percent in Texas.
Quality
Even in the best states, performance falls far
short of optimal standards. The percent of adults age 50 or older
receiving all recommended preventive care ranges from a high of 50
percent in Minnesota to 33 percent in Idaho. The percent of diabetics
receiving basic preventive care services varies from 65 percent in
Hawaii to 29 percent in Mississippi. Childhood immunization rates range
from 94 percent in Massachusetts to less than 75 percent in the bottom
five states.
Potentially Avoidable Use of Hospitals and Costs
of Care
Rates of potentially preventable hospital
admissions among Medicare beneficiaries range from more than 10,000 per
100,000 beneficiaries in the five states with the highest rates to less
than 5,000 per 100,000 in the five with the lowest rates (Hawaii, Utah,
Washington, Alaska and Oregon).
Equity
On average, 78 percent of uninsured and 71
percent of low-income adults age 50 and older did not receive
recommended preventive services.
Healthy Lives
Death rates before age 75 from conditions that
might have been prevented with timely and appropriate health care are 50
percent lower in the lowest-rate states (Minnesota, Utah, Vermont,
Wyoming and Alaska) than the District of Columbia and states with the
highest rates (Tennessee, Arkansas, Louisiana and Mississippi). Average
death rates were 74.1 per 100,000 persons in the top five states
compared with 141.7 per 100,000 persons in the bottom five states.
Moving Forward
The report points to the need for action in four
key areas: expanding health insurance to all; having better information
to assess performance to guide and drive change; analyses to determine
the key factors that contribute to state variations; and national
leadership and collaboration across public and private sectors.
In addition, the report underscores opportunities
for states to look to each other as well as models of excellence within
their own borders to inform efforts to improve. For example, in 1974,
Hawaii became the first state to enact legislation requiring employers
to provide health insurance to full-time workers; it now ranks first in
terms of access to care.
For the past decade, Rhode Island has provided
incentive payments to Medicaid managed care plans that reach quality
targets; it now ranks first on measures of the quality of care.
The scorecard tells us where we are. Now we need
to decide where were going, said Commonwealth Fund President Karen
Davis.
States need healthy and productive citizens. Doing
better is possible but it will take commitment and action on all levels
to achieve real change. The state scorecard documents that we have much
to gain as a nation with coherent national and state policies that
respond to the urgent need for action.
Methodology:
The state scorecard includes 32 indicators
grouped into five dimensions of performanceaccess, quality, avoidable
hospital use and costs, equity and healthy lives. The analysis ranks
states on each indicator and then averages the indicator ranks to
determine the dimension rank. Dimension scores determine the overall
rank.
The Commonwealth Fund Commission on a High
Performance Health System, formed in April 2005, seeks opportunities to
change the delivery and financing of health care to improve system
performance, and will identify public and private policies and practices
that would lead to those improvements.
The Commission members are: James J. Mongan, M.D.
(Chair), Partners HealthCare System, Inc.; Maureen Bisognano, Institute
for Healthcare Improvement; Christine K. Cassel, M.D., American Board of
Internal Medicine and ABIM Foundation; Michael Chernew, Ph.D.,
Department of Health Care Policy, Harvard Medical School; Patricia Gabow,
M.D., Denver Health; Robert Galvin, M.D., General Electric Company;
Fernando A. Guerra, M.D., M.P.H., San Antonio Metropolitan Health
District; George C. Halvorson, Kaiser Foundation Health Plan Inc.;
Robert M. Hayes, J.D., Medicare Rights Center; Glenn M. Hackbarth, J.D.,
Consultant; Cleve L. Killingsworth, Blue Cross Blue Shield of
Massachusetts; Sheila T. Leatherman, School of Public Health, University
of North Carolina; Gregory P. Poulsen, M.B.A., Intermountain Health
Care; Dallas L. Salisbury, Employee Benefit Research Institute; Sandra
Shewry, State of California Department of Health Services; Glenn D.
Steele, Jr., M.D., Ph.D., Geisinger Health System; Mary K. Wakefield,
Ph.D., R.N., Center for Rural Health, University of North Dakota; Alan
R. Weil, J.D., M.P.P., National Academy for State Health Policy; and
Steve Wetzell, HR Policy Association.
The Commonwealth Fund is a private foundation
working toward a high performance health system.
The complete report and an interactive map to the
scores by state can be found online
Click Here
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
