A new State Scorecard report shows that the states of the US vary widely in quality, efficiency and equity of health care. Hawaii, the first US state to make it compulsory for employers to provide health insurance for their workers came out at the top of the list, with Mississippi and Oklahoma at the bottom.

The report, which was produced by the non profit, New York based Commonwealth Fund, follows the National Scorecard on US Health System Performance published last year. It assesses the state by state performance of American health care on 32 different indicators that between them cover access, quality, avoidable hospital use and costs, equity, and healthy lives.

Cathy Schoen, senior vice president at the Commonwealth Fund and one of the authors of the report said that in short where you live in the United States matters as far as getting the health care you need and the best opportunity to live a long and healthy life.

The report says that if all the states were able to reach the scores of those at the top, 90,000 lives would not be cut short due to lack of appropriate health care, 22 million people would have health insurance (this would halve the country’s uninsured) and the government would save 22 billion US dollars of health care costs.

Schoen and colleagues said that leading states outperform lagging states on many indicators, but there is room for improvement across the board. Action is needed at state and federal level, they wrote.

The report draws attention to these main points:

  • States vary widely in their health care performance and this means there is lots of potential for the nation overall to improve.
  • The states at the top of the scorecard consistently outperform those at the bottom. This shows that local and regional health systems as well as federal and state policies make a difference.
  • Across the country, better access is closely linked to better quality.
  • There are many opportunities to reduce costs, improve access to, and quality of health care.
  • Higher quality does not correlate with higher costs.
  • Without exception, all states have room for improvement.

The thirteen states at the top of the scorecard were: Hawaii, Iowa, New Hampshire, Vermont, Maine, Rhode Island, Connecticut, Massachusetts, Wisconsin, South Dakota, Minnesota, Nebraska, and North Dakota.

Many of these states have radically improved their health systems and have the fewest uninsured people.

The thirteen states at the bottom of the scorecard were: California, Tennessee, Alabama, Georgia, Florida, West Virginia, Kentucky, Louisiana, Nevada, Arkansas, Texas, Mississippi, and Oklahoma.

They rate above the national average in numbers of uninsured adults and children; have low take up of recommended preventive care; and high death rates from conditions that would respond to health care if it were available.

The report shows that states in the Upper Midwest and Northeast are often in the top 25 per cent, with those in the bottom 25 per cent being mostly concentrated in the South.

Not surprisingly, there are strong correlations between state policies and performance. As already mentioned, Hawaii ranks first in access to health care and was the first state to bring in compulsory health insurance for employees. For the last ten years Rhode Island has given incentives to Medicaid managed care plans that reach quality targets and it now ranks first on quality of care.

Maine, Massachusetts, and Vermont are top in equitable health systems. These states are acknowledged leaders in health care insurance coverage and quality benchmarking.

The report recommends the following actions:

  • More measurement of performance and benchmarking to give more visibility and drive change, especially in areas that show what practices and policies contribute to high performance.
  • Find out what contributes to variation so states can plan for improvement based on evidence.
  • Stimulate national leadership and encourage collaboration between public and private sectors to bring out the best in both.

The report’s summary concludes that:

“Benchmarks set by leading states, as well as exemplary models within the United States and other countries, show that there are broad opportunities to improve and achieve better and more affordable health care.”

“With health costs rising faster than incomes and straining family, business, state, and federal budgets, with access deteriorating, and with startling evidence of variable quality and inefficient care, all states and the nation have much to gain from aiming higher.”

“All states can do better”, it says, and suggests everyone should be asking the question: “Why not the best?”

“Aiming Higher: Results from a State Scorecard on Health System Performance.”
J. C. Cantor, D. Belloff, C. Schoen, S. K. H. How, and D. McCarthy.
The Commonwealth Fund Commission on a High Performance Health System, June 2007.

Click here for the full report and to access interactive map to see results for each state.

Written by: Catharine Paddock
Writer: Medical News Today