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Volume 12 Number 114 News: Quality Striking variability among states in quality of care, access to care, costs, and avoidable hospitalizations adds up to substantial human and economic costs for the nation, according to a report released June 13 by the Commonwealth Fund. The report, Aiming Higher: Results from a State Scorecard on Health System Performance, estimates that if all states could do as well as the top-ranked states, 22 million additional adults and children would have health insurance, and millions of older adults, diabetics, and young children would receive essential preventive care. Approximately 90,000 lives could be saved annually, the report said. Medicaid also could save $22 billion a year if high cost states moved down to spending levels of the average states, according to the report. "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." Coverage Nearly 90 percent of working-age adults had insurance coverage in Hawaii, Iowa, New Hampshire, Vermont, and Maine, the five top ranked states overall. Conversely, in the five lowest ranked states, Nevada, Arkansas, Texas, Mississippi, and Oklahoma, 70 percent to 78 percent of adults were insured. The percent of adults under age 65 who were uninsured in 2004 to 2005 ranged from a low of 11 percent in Minnesota to a high of 30 percent in Texas. The percent of uninsured children varied from 5 percent in Vermont to 20 percent in Texas. Quality of Care Four of the five states with the best access to care rankings (Massachusetts, Iowa, Rhode Island, and Maine) also were among the highest on quality of care. States with low quality rankings tended to have high rates of uninsured residents. Even in the best states, quality of care falls short. Adults age 50 and older receiving all recommended preventive care ranged from a high of 50 percent in Minnesota to a low of 33 percent in Idaho. The percent of diabetics receiving basic preventive care services varied from 65 percent in Hawaii to 29 percent in Mississippi. Childhood immunization rates ranged from 94 percent in Massachusetts to less than 75 percent in the bottom five states. Death rates before age 75 from conditions that might have been prevented with timely and appropriate health care were 50 percent lower in the lowest-ranked states (Minnesota, Utah, Vermont, Wyoming, and Alaska) than the District of Columbia and the highest-ranked states (Tennessee, Arkansas, Louisiana, and Mississippi). Avoidable Hospitalizations Rates of potentially preventable hospital admissions among Medicare beneficiaries ranged from more than 10,000 per 100,000 beneficiaries in the five states with the highest rates (Mississippi, Louisiana, Kentucky, West Virginia, and Tennessee) to less than 5,000 per 100,000 in the five with the lowest rates (Hawaii, Utah, Washington, Alaska, and Oregon). "The scorecard tells us where we are. Now we need to decide where we're going," said Commonwealth Fund President Karen Davis. "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." The report is available.
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