States Could Do More To Boost Access to Care, Report Finds

All states could do more to improve access to low-cost health care, insurance coverage and high-quality medical care for residents, according to a report released on Wednesday by the Commonwealth Fund, USA Today reports.

The report uses data from various government agencies -- including CMS, the Census Bureau and CDC -- to rank all 50 states and Washington, D.C., on 32 measures of cost, insurance coverage and quality of care.

Researchers used measures such as insurance coverage rates, the number of Medicare beneficiaries readmitted to a hospital within 30 days of discharge, infant mortality rates, percentage of children who received recommended vaccinations and cost of purchasing health insurance statewide (Appleby, USA Today, 6/13).

Hawaii was ranked No. 1 overall, while Mississippi and Oklahoma tied as the lowest-ranking states (Dorschner, Miami Herald, 6/13).

The report found that top-ranked states often have programs in place to improve residents' access to comprehensive health care. In addition, states with greater numbers of insured residents scored higher on the quality-of-care measures, according to the report (USA Today, 6/13).

This might be because insured residents bring money into the health care system while "a lack of coverage and a high number of uninsured leads to financial distress, less money for information technology," as one example, Joel Cantor, a co-author of the study and director of the Rutgers Center for State Health Policy, said (Miami Herald, 6/13).

The report supports the results of other studies that indicate no connection exists between states that spend more on health care and quality, as well as those that suggest states with higher spending levels have higher rates of preventable hospitalizations, such as readmissions and admissions for chronic illnesses.

The report estimates that Medicare could save $22 billion annually if high-cost states performed as well as the national average (Boulton, Milwaukee Journal Sentinel, 6/12).

Researchers found that residents of the five states that were ranked the lowest in measures of "healthy lives" -- South Carolina, Tennessee, Arkansas, Louisiana and Mississippi -- had twice the premature death rate than those in the five states that ranked at the top of that measure -- Minnesota, Utah, Vermont, Wyoming and Alaska.

Premature death was defined as dying before age 75 because of conditions that could have been prevented or delayed with proper medical attention (USA Today, 6/13).

If the lowest-ranked states performed as well as the highest-ranked states in preventing or delaying premature death, nearly 90,000 premature deaths could be prevented, according to the report (Miami Herald, 6/13).

The report found racial disparities in preventable deaths nationwide, with an average of 194.1 potentially preventable deaths per 100,000 for blacks and 93.6 per 100,000 for whites. In addition, the report found that half of adults ages 50 and older received recommended preventive care, even in the highest-ranked states (Milwaukee Journal Sentinel, 6/12).

The report "comes amid a growing focus on efforts to rate and report on medical quality, from hospital death and infection rates tracked by Medicare to efforts by insurers to measure the performance of doctors and hospitals," according to USA Today.

Cathy Schoen, co-author and a senior vice president at the fund, said that one purpose of the report "is to stimulate discussion and action" (USA Today, 6/12). She added that it should be used as a framework for looking at the health care system as a whole (Milwaukee Journal Sentinel, 6/12).

Schoen said, "Where you live matters for getting care when you need it, getting the right care and the opportunity to live a long and healthy life," adding, "The country needs to take a big step forward on health insurance: start insuring the entire population."

Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured, said that it has been clearly demonstrated that having health insurance is better than not having insurance, but insurance is only one variable in the overall health of people.

According to Rowland, "We also know that quality of people's health is dependent on the environment, whether they live in an area with clean or dirty air, for example" (USA Today, 6/13).

Karen Davis, president of the fund, said, "Moving to extend affordable health insurance to all is critical," and "federal action is essential" in meeting this goal because lower-income states do not have the money to adequately help the uninsured (Miami Herald, 6/13). The report is available online. Note: You must have Adobe Acrobat Reader to view the report.