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The People's Republic of Hawaii at number one is no surprise.
How States Rank on Health Care
Michael Moore's new video SICKO covers the depressing state of privatized health-care in the U.S., but did you know that the state of Texas ranks next to last in providing access to affordable health-care to it's citizens?
Hawaii Is First, Oklahoma and Mississippi Are Last on Foundation's First State Scorecard on Health Care
By Miranda Hitti
WebMD Medical News
Reviewed by Louise Chang, MD
June 13, 2007 --WebMDHawaii leads and Oklahoma lags on a new state scorecard about health system performance.
The scorecard is the first of its kind from the Commonwealth Fund, a private foundation focused on health care.
The Commonwealth Fund rated states based on 32 indicators, including access, quality, cost, insurance, preventive care, potentially avoidable hospital visits, and premature death (death before age 75).
The top five states in order are Hawaii, Iowa, New Hampshire, Vermont, and Maine.
The bottom five states are Nevada, Arkansas, Texas, Mississippi, and Oklahoma.
A full list of state rankings follows later in this article.
Wide Range
The top-rated states scored two to three times higher than the lowest-ranked states.
"Where you live really matters in terms of your experience with the American health care system," Commonwealth Fund President Karen Davis told reporters at a news conference.
"The wide variation and gaps between leading and lagging states add up to substantial human and economic cost for the nation," says Cathy Schoen, the Commonwealth Fund's senior vice president for research and evaluation.
Schoen says that if all states equaled the top-rated states, there would be 90,000 fewer premature deaths before age 75 from conditions such as diabetes, infection, respiratory disease, and treatable cancers. In addition, 22 million more adults and children would be insured, cutting U.S. uninsured rates in half.
Room for Improvement
Every state has room for improvement -- even those leading the scorecard -- notes Schoen, who worked on the scorecard with other experts.
"Each of the top states has some indicators in the bottom half of the state distribution," Schoen says. In other words, though those states may rank highly overall, they're not acing every category in the scorecard.
Insurance tracked with the states' ratings.
"In general, states that did well in the overall rankings had the lowest rates of uninsured in the nation, and states that did poorly had the highest rates of uninsured in the nation," Schoen says.
But high ratings didn't always mean high costs.
"Indeed, some states have high quality and lower cost," Schoen says. She adds that "high costs tend to track higher rates of potentially preventable hospital use and 30-day re-admission rates, indicating a need for a focus on prevention and primary care and care coordination."
State Rankings
Here is the list of how the states and Washington, D.C., ranked overall. States with the same ranking are listed together.
1. Hawaii
2. Iowa
3. New Hampshire, Vermont
4. Maine
5. Rhode Island
6. Connecticut
7. Massachusetts
8. Wisconsin
9. South Dakota
10. Minnesota
11. Nebraska
12. North Dakota
13. Delaware
14. Pennsylvania
15. Michigan
16. Montana, Washington
17. Maryland
18. Kansas
19. Wyoming
20. Colorado, New York
21. Ohio, Utah
22. Alaska, Arizona, New Jersey
23. Virginia
24. Idaho, North Carolina
25. Washington, D.C.
26. South Carolina
27. Oregon
28. New Mexico
29. Illinois
30. Missouri
31. Indiana
32. California
33. Tennessee
34. Alabama
35. Georgia
36. Florida
37. West Virginia
38. Kentucky
39. Louisiana, Nevada
40. Arkansas
41. Texas
42. Mississippi, Oklahoma
Eight of the top ten are true-blue states...
The People's Republic of Hawaii at number one is no surprise.
I did a little legwork on this report. It may be worthwhile to look at. I am the free market type, so I disagree with some of their benchmarks, however, from what I read so far, it is material worthy of study.
Links:
Page from the source discussing the study:
Aiming Higher: Results from a State Scorecard on Health System Performance
Links within this page:
Full report 3096k PDF
Executive Summary 597k PDF
Chartpack 1261k PDF
Chartpack 2877k Power Point
State Data Tables 834k PDF
Some studies on the 32 indicators used:
1 Adults under age 65 insured: Employee Benefits Research Ins ute (EBRI) analysis of 2005 and 2006 U.S. Census Bureau Current Population Survey (CPS) March Supplement (U.S. Census Bureau, 2005, 2006).
2 Children insured: EBRI analysis of 2005 and 2006 U.S. Census Bureau CPS March Supplement (U.S. Census Bureau, 2005, 2006).
3 Adults visited a doctor in past two years: Rutgers Center for State Health Policy (CSHP) analysis of 2000 Behavioral Risk Factor Surveillance System (BRFSS) (NCCDPHP, BRFSS 2000).
4 Adults with a time in past year when they needed to see a doctor but could not because of cost: Rutgers CSHP analysis of 2002 and 2004 BRFSS (NCCDPHP, BRFSS 2002, 2004). 2002 data was imputed for one state.
5 Adult age 50 and older received recommended preventive care: Percent of adults age 50 and older who have received: sigmoidoscopy or colonoscopy in the last ten years or a fecal occult blood test in the last two years; a mammogram in the last two years (women only); a pap smear in the last three years (women only); and a flu shot in the past year and a pneumonia vaccine ever (age 65 and older only). Rutgers CSHP analysis of 2002 and 2004 BRFSS (NCCDPHP, BRFSS 2002, 2004). 2002 data were imputed for one state.
6 Adult diabetics received recommended preventive care: Percent of adults age 18 and older who were told by a doctor that they had diabetes and have received: hemoglobin A1c test, dilated eye exam, and foot exam in the past year. Rutgers CSHP analysis of 2002 and 2004 BRFSS (NCCDPHP, BRFSS 2002, 2004). 2002 data were imputed for six states.
7 Children ages 19–35 months received all recommended doses of five key vaccines: Percent of children ages 19 to 35 months who have received at least 4 doses of diphtheria-tetanus-acellular pertussis (DTaP), at least 3 doses of polio, at least 1 dose of measles-mumps-rubella (MMR), at least 3 doses of Haemophilus influenzae B (Hib), and at least 3 doses of hepa is B antigens. Data from the 2005 National Immunization Survey (NCHS, NIS 2005).
8 Children with both medical and dental preventive care visits: Percent of children ages 0–17 with one or more medical and dental preventive care visits during the past 12 months. Child and Adolescent Health Measurement Initiative (CAHMI) analysis of the 2003 National Survey of Children’s Health (CAHMI 2005).
9 Children with emotional, behavioral, or developmental problems received mental health care: Percent of children ages 1–17 with current emotional, developmental, or behavioral problems requiring treatment or counseling who received some type of mental health care during the past 12 months. CAHMI analysis of 2003 National Survey of Children’s Health (CAHMI 2005).
10 Hospitalized patients received recommended care for acute myocardial infarction, congestive heart failure, and pneumonia: Proportion of cases where a hospital provided the recommended process of care for patients with acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia for 10 indicators. The composite includes 5 clinical services for AMI (aspirin within 24 hours before or after arrival at the hospital and at discharge; beta-blocker within 24 hours after arrival and at discharge; and angiotensin-converting enzyme (ACE) inhibitor for left ventricular systolic dysfunction), 2 for CHF (assessment of left ventricular function and the use of an ACE inhibitor for left ventricular dysfunction), and 3 for pneumonia (initial antibiotic therapy received within four hours of hospital arrival, pneumococcal vaccination, and assessment of oxygenation). Analysis of 2004 CMS Hospital Compare data conducted by A. Jha and A. Epstein at the Harvard School of Public Health (DHHS n.d.).
11 Surgical patients received appropriate timing of antibiotics to prevent infections: Proportion of cases where a hospital provided prophylactic antibiotics within 1 hour prior to surgery and discontinued within 24 hours after surgery. Data from 2005 CMS Hospital Compare (DHHS n.d.), reported in AHRQ 2006 National Healthcare Quality Report (AHRQ 2006).
12 Adults with a usual source of care: Percent of adults age 18 and older who have one (or more) person they think of as their personal doctor or health care provider. Rutgers CSHP analysis of 2002 and 2004 BRFSS (NCCDPHP, BRFSS 2002, 2004). 2002 data were imputed for one state.
13 Children with a medical home: Percent of children ages 0–17 who have at least one preventive medical care visit in the past year; are able to access needed specialist care and services; and have a personal doctor/nurse who usually/always spends enough time and communicates clearly, provides telephone advice and urgent care when needed, and follows up after specialist care. CAHMI analysis of 2003 National Survey of Children’s Health (CAHMI 2005).
14 Heart failure patients given written instructions at discharge: Percent of heart failure patients with do entation that they or their caregivers were given written instructions or other educational materials at discharge. Data retrieved from CMS Hospital Compare database on January 25, 2006 (DHHS n.d.).
15 Medicare fee-for-service patients whose health provider always listens, explains, shows respect, and spends enough time with them: Data from 2003 National Consumer Assessment Healthcare Providers and Systems (CAHPS) Benchmarking Database (AHRQ, CAHPS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
16 Medicare fee-for-service patients giving a best rating for health care received: Percent of Medicare fee-for-service patients who reported a doctor’s visit in the last 12 months and gave a best rating for health care received. Data from 2003 National CAHPS Benchmarking Database (AHRQ, CAHPS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
17 High-risk nursing home residents with pressure sores: Data from 2004 CMS Minimum Data Set (CMS, MDS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
18 Long-stay nursing home residents who were physically restrained: Data from 2004 CMS Minimum Data Set (CMS, MDS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
19 Hospital admissions for pediatric asthma per 100,000 population: Data from 2002 Healthcare Cost and Utilization Project State Inpatient Databases (AHRQ, HCUP-SID 2002), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
20 Asthmatics with an emergency room or urgent care visit: Percent of adults age 18 and older who were told by a doctor that they had asthma and had an emergency room or urgent care visit in the past 12 months. Rutgers CSHP analysis of 2001, 2002, 2003 and 2004 BRFSS (NCCDPHP, BRFSS 2001, 2002, 2003, 2004).
21 Medicare hospital admissions for ambulatory sensitive conditions per 100,000 beneficiaries: Hospital admissions of fee-for-service Medicare beneficiaries age 65 and older for one of 11 ambulatory care sensitive conditions (AHRQ Indicators): short-term diabetes complications, long-term diabetes complications, lower extremity amputation among patients with diabetes, asthma, chronic obstructive pulmonary disease, hypertension, congestive heart failure, angina (without a procedure), dehydration, bacterial pneumonia, and urinary tract infection. Analysis of 2003 Medicare Standard Analytical Files (SAF) 5% Inpatient Data conducted by G. Anderson and R. Herbert at Johns Hopkins Bloomberg School of Public Health (CMS, SAF 2003).
22 Medicare 30-day hospital readmission rates: Fee-for service Medicare beneficiaries age 65 and older with initial admissions due to one of 31 select conditions who are readmitted within 30 days following discharge for the initial admission. Analysis of 2003 Medicare SAF 5% Inpatient Data conducted by G. Anderson and R. Herbert at Johns Hopkins (CMS, SAF 2003).
23 Long-stay nursing home residents with a hospital admission: Analysis of 2000 Medicare enrollment data and MedPAR file conducted by V. Mor at Brown University, under a grant funded by the National Ins ute of Aging (#AG20557, State Policies and Hospitalizations from Nursing Homes).
24 Nursing home residents with a hospital readmission within three months: Percent of long-stay residents hospitalized within three months of being discharged from a hospital to a nursing home. Analysis of 2000 Medicare enrollment data and MedPAR file conducted by V. Mor at Brown University, under a grant funded by the National Ins ute of Aging (#AG20557).
25 Home health patients with a hospital admission: Percent of acute care hospitalization for home health episodes. Data from 2004 Outcome and Assessment Information Set (CMS, OASIS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
26 Total single premium per enrolled employee at private-sector establishments that offer health insurance: Data from 2004 Medical Expenditure Panel Survey – Insurance Component (AHRQ, MEPSIC 2004).
27 Total Medicare reimbursements per enrollee: 2003 data from Dartmouth Atlas of Health Care (Dartmouth Atlas Project 2003). Total Medicare feefor- service reimbursements include payments for both Part A and Part B (exclude capitated payments). Reimbursement rates were indirectly adjusted for sex, race, and age, and were further adjusted for illness, and regional differences in price.
28 Mortality amenable to health care: Number of deaths before age 75 per 100,000 population that resulted from causes considered at least partially treatable or preventable with timely and appropriate medical care (see list), as described in Nolte and McKee (Nolte and McKee, BMJ 2003). Analysis conducted by K. Hempstead at Rutgers CSHP using 2002 mortality data from CDC Multiple Cause-of- Death file and U.S. Census Bureau population data (NCHS, MCD n.d.).
29 Infant mortality, deaths per 1,000 live births: Data from 2002 National Vital Statistics System (NVSS) (NCHS, NVSS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
30 Breast cancer deaths per 100,000 female population: Age-adjusted to US 2000 standard population. Data from 2002 NVSS (NCHS, NVSS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
31 Colorectal cancer deaths per 100,000 population: Age-adjusted to US 2000 standard population. Data from 2002 NVSS (NCHS, NVSS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).
32 Adults under age 65 limited in any activities because of physical, mental, or emotional problems: Rutgers CSHP analysis
Am I going to die? I live in Texas! (you know like the little
elf in the travelocity commercials)
nbadan hates the us government, but now he wants them to handle his healthcare???
you mother ers always shoot the messenger, while ignoring the message.
Private companies are ing us all over in health care costs, as the their profits trump patient care. The Repugs made it ILLEGAL for the fed govt to negotiate lower price with Big Pharma. WTF?
its no coincidence the best health care is concentrated in blue states and the worst is in red states
Only because the report favors socialized medicine.
SA210
John does have nice hair. But he tends to
exclude people from conversations. You know like
gang up with Hillary to shut people up.
You want to help people vote Republican
"Only because the report favors socialized medicine."
Private, for-profit health care delivers the minimum amount of health care (the ideal amount being zero, ie, your procedure is disqualified and/or your deductible is several $1000) for the highest price to the fewest people.
Last edited by boutons_; 07-16-2007 at 12:57 PM.
Technically we're third-to-last.
Woohoo!
Our current system has combined the worst of two worlds:
1) The current system of private insurance by publicly-traded corporations provides economic incentives for denying preventive care, resulting in exponentially higher costs in interventional care down the road. Many private insurers have responded to this inevitable surge in costs by finding ways to deny interventional care. They have an economic incentive to find creative ways to let expensive patients die, so long as it doesn't get them sued.
2) The current system of public insurance (Medicare) strives to pay for any and every procedure and pharmaceutical product, in order to buy the votes of the elderly. It also lacks any functional mechanism for rooting out fraud.
We have managed to find the way to employ the worst attributes of capitalism and of socialism simultaneously. Just about any other conceivable system would work better than this one, whether it were based upon free-market or collectivist principles.
I think the rich in America would like a health-care system similar to what Chile has. There is no public health care system. Those who can afford private health insurance enjoy good care at reasonable prices. Those who cannot afford it get sick and die in their cardboard shacks.
I think people are too attached to the idea that we have the best doctors in the world... We have doctors that can fight the rarest of diseases for anyone who can afford the treatment, but many others needlessly die of common ailments that could have been treated by anyone right out of med school.
Last edited by Spurminator; 07-16-2007 at 10:34 AM. Reason: removed sarcasm-implying quote marks
why not let people who can afford insurance keep it. and for those who cannot afford it let them get basic and preventative medical care from the govt.. Yoni and I get to keep our private insurance and ray will go on the govt dime.. see everybody wins..
We have the emerging problem in private insurance where companies let you pay your premiums for years, deny coverage for preventive care, then when you get sick down the road, they try to find a loophole to deny paying for your expensive care so you will die and end any future financial exposure.
The best solution to that may not be so much a single-payer system, as kidnapping insurance executives and their families, and forcing the executives to watch the slow torture and death of their loved ones before they too are killed. The rich need to know that they too can be killed (channeling Ann Coulter).
Denial of care like that hasn't happened to me, but it has happened to far too many of my acquaintances.
The Problem with that is that if you allow any type of private health care to remain, it will always pay doctors more than public health care and so you end up with the same system, the wealthy (or those who can afford private health insurance) will always have access to the better health care.
This is one of the reasons Hillarycare proposed to criminalize the practice of medicine outside of her healthcare program.
It's also one of the reasons universal healthcare will never succeed in a free society.
It's fine if it's better, so long as the salary for the government doctors is high enough to attract competent doctors. No one would expect for private care doctors to be the same quality. But you still have to get through med school.the wealthy (or those who can afford private health insurance) will always have access to the better health care.
Cost vs health... profit vs health.... one side loses out every time. I think the govt should mandate that if an insurance company denies needed healthcare that notice of denial should be done in person. Face to face.
The poor need not have exactly the same health care as the wealthy.
Assuming we want a system where we care about general health, the idea would be to define which essential services should be covered, and under what cir stances, and then any elective procedures beyond that would be covered solely by private plans.
It works well in theory, but requires some discipline by the state, because of course the right wing is going to want to reduce the list of "essential" services down as close to nothing as possible, while the left wing will want to make things like elective cosmetic surgery and spa vacations "essential."
This can get tricky. In Germany, for example, they control health care costs by paying doctors what the U.S. pays teachers. This means all their good doctors move to the UK.
Pssht. That's not so hard. You just show up flanked by two heavily-armed friends from Blackwater.
I don't think you're understanding my point.
Nothing would change. Whereas now you have those with insurance and those who depend on locally supplied indigent healthcare, with universal healthcare (that allowed for the retention of private coverage) you'd have those with insurance and those with socialized healthcare using the same doctors and facilities previously employed as indigent healthcare services.
No, the only way you level the playing field is to completely socialize medicine. Hillary Clinton understands this.
What she doesn't understand is that instead of raising the level of medicine, in America, she'll wreck it. Capitalism and Socialism are not good partners and they don't play well together.
We need to decide whether or not we're going to be a free markets country or another failed experiment in socialism.
Yoni how do you know what Hillary ' knows and doesn't know'? From talk radio to internet message boards I hear from people on the right telling us what people's motives are. Hillary has never once uttered the words 'universal healthcare' yet if you were to listen to fox news or talk radio that's all her opponenents talk about.
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