Finding large gaps in quality of care, access to care, avoidable hospitalizations and costs, equity, and healthy lives among states, the Commonwealth Fund’s scorecard is the first report of its kind to assess health system performance across these five dimensions on a state-by-state basis.
Compared on 32 indicators across five dimensions, the report, Aiming Higher: Results from a State Scorecard on Health System Performance, finds that no single state performed at the top across all categories. However, some states far surpassed others. Hawaii, Iowa, New Hampshire, Vermont and Maine performed the best, while states in the South comprised most of the lowest-ranking states. The differences between the high-performing states and low-performing states were dramatic; often a two- to three-fold variation existed.
The scorecard found that states performing highly on access to care, especially access to health insurance coverage, were more likely to rank highly on quality of care. Additionally, the scorecard did not find that states with higher costs were necessarily those with the highest quality. According to the report, some states are able to realize high quality at relatively low costs. States with the highest level of spending tended to have higher rates of preventable hospital use, including readmissions and admissions for diabetes, asthma, and other chronic conditions.
According to the report, if all of the states performed at the level of the top tier of states, the nation could prevent substantial human and economic costs: 90,000 lives could be saved annually and 22 million additional adults and children could have health insurance. Medicare could save $22 billion annually if high cost states lowered spending levels to that of average states.
Additional report findings:
- The percent of adults under age 65 who were uninsured in 2004-2005 ranges from a low of 11 percent in Minnesota to a high of 30 percent in Texas. The percent of uninsured children varies from five percent in Vermont to 20 percent in Texas.
- Quality performance for all states is less than desired. The percent of adults age 50 or older receiving all recommended preventive care ranges from a high of 50 percent in Minnesota to 33 percent in Idaho. The percent of diabetics receiving basic preventive care services varies from 65 percent in Hawaii to 29 percent in Mississippi. Childhood immunization rates range from 94 percent in Massachusetts to less than 75 percent in the bottom five states.
- Rates of potentially preventable hospital admissions among Medicare beneficiaries range from more than 10,000 per 100,000 beneficiaries in the five states with the highest rates to less than 5,000 per 100,000 in the five with the lowest rates (Hawaii, Utah, Washington, Alaska, and Oregon).
- On average, 78 percent of uninsured and 71 percent of low-income adults age 50 and older did not receive recommended preventive services.
- Death rates before age 75 from conditions that might have been prevented with timely and appropriate health care are 50 percent lower in the lowest-rate states (Minnesota, Utah, Vermont, Wyoming, and Alaska) than the District of Columbia and states with the highest rates (Tennessee, Arkansas, Louisiana, and Mississippi). Average death rates were 74.1 per 100,000 persons in the top five states compared to 141.7 per 100,000 persons in the bottom five states.
