A continued wide disparity in access to and quality of care across the United States argues strongly for a national health reform plan, according to executives at the Commonwealth Fund, who released a state-by-state survey of 38 health indicators.
According to the survey, there is a fivefold difference in performance on the indicators between the highest-ranked states and the lowest. “The differences we see among the states translate to real lives and real dollars,” Karen Davis, president of the Commonwealth Fund, said at a press conference. “In the richest country in the world, there is no justification for any state to be far below the best state for quality and access to health care.”
Health reform legislation under consideration in Congress would go a long way toward improving access and coverage, and that would increase quality overall, Ms. Davis said.
Since 2007, the number of uninsured adults has risen—and this survey was done on the eve of the recession, so the “worst is yet to come,” according to Cathy Schoen, senior vice president of the Commonwealth Fund.
The top quartile comprises Connecticut, Hawaii, Iowa, Maine, Massachusetts, Minnesota, Nebraska, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont, and Wisconsin.
Ten of the 13 states in the lowest quartile—Alabama, Arkansas, Florida, Kentucky, Louisiana, Mississippi, Nevada, Oklahoma, Tennessee, and Texas—also ranked at the bottom on the previous 2007 report. Illinois, New Mexico, and North Carolina dropped into the lowest quartile since the last survey, while California, Georgia, and West Virginia moved up out of the last quartile in this most recent report. The lower-performing states had rates of uninsured adults and children that were double those in the top quartile.
The report also reflected some bright spots: The quality of hospital care for heart attack, heart failure, pneumonia, and the prevention of surgical complications improved dramatically for all states, as did the quality of nursing home care.
Conversely, data on ambulatory care quality are sorely lacking, Ms. Schoen said. From what can be gleaned, states' performance on preventive care stayed the same or declined.
According to Ms. Davis and her colleagues, if the lower-performing states were helped to reach the levels of the higher-performing states, 29 million more people would be insured; 78,000 fewer adults and children would die prematurely each year from preventable conditions; 9 million more adults aged 50 years and older would receive recommended preventive care; and almost 800,000 more children would receive key vaccinations.
The organization also said that the nation could realize $5 billion in savings a year by avoiding preventable admissions and readmissions.