It is a sad commentary on America’s health care that where you live can determine if you live.
Health care reform requires attention to access, quality and cost, but also must take into consideration widely divergent geographic and societal differences. The need for federal action to address these issues is underscored by the recent release of “Aiming Higher, the results from the State Scorecard on Health System Performance evaluation by the Commonwealth Fund Commission on a High Performing Health System.”
The scorecard ranks the 50 states and the District of Columbia on 38 indicators for access, quality, cost and outcomes, and compares them to the results of the 2007 scorecard.
The differences among states are dramatic. Death rates vary from 64 per 100,000 in Minnesota to 158 per 100,000 in the District of Columbia. The data were collected before the full impact of the economic downturn, which means the current status is probably worse, as there has been erosion of insurance coverage for adults.
At the same time, coverage for children has remained steady, a positive reflection of SCHIP, which is a national program for coverage of children but one that does not exist for adults.
The overall relative performance of states did not change much between the two reports. Those at the top – Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire – remained at the top. Those at the bottom – Texas, Nevada, Arkansas, Louisiana, Oklahoma and Mississippi – remained at the bottom.
Colorado ranked 23rd in 2007 and 24th in 2009. This may seem to be a small change, but we slipped from 36th to 40th in access. This reflects the fact that 19.7 percent of Colorado adults are uninsured and 12.7 percent of children are uninsured, rates that are both higher than the median state rate. This lack of coverage in Colorado, unlike some other states, does not reflect that we are a poor state that cannot afford it. Actually, we rank 10th in median income. Equally bad, Colorado also scores in the last quartile in equity.
But the Commonwealth data also contain some good news about Colorado. We rank 28th in prevention and treatment, improving from 34th in 2007, and 15th in avoidable hospital use and costs of care.
Coloradans are basically a healthy bunch, as we rank 10th in healthy lifestyles, appearing in the first or second quartile in all the dimensions of this parameter except for suicide – where once again we rank in the bottom quartile.
The Commonwealth Fund information is gathered and provided to guide states and the nation to identify areas needing improvement. We should all pore over this report and use it to direct health-care decisions for our state and our country. Even the best need to do better, and we should no longer accept mediocrity or worse for America’s health.
Patricia A. Gabow, M.D., is chief executive officer at Denver Health, and serves on the Commonwealth Fund Commission on a High-Performance Health System.
