Commonwealth Fund: Healthcare disparity widens between states

A report by the New York City-based Commonwealth Fund Commission has found there is a significant difference between the access, quality and cost of healthcare across state lines and that healthcare disparities among states continue to widen.

The report, “Aiming Higher: Results from the 2009 State Scorecard on Health System Performance,” is a follow up to a 2007 report by the foundation. The current publication found that the top-scoring states from the 2007 report generally continued to lead in overall performance and often set new benchmarks, which contributed to widening the gap between the highest to lowest ranking states.

The researchers used 38 indicators to rate states’ performance in accessibility, prevention/treatment quality, avoidable hospital use and cost, equity and healthy lives (i.e., percentage of adult smokers). The study found an observed two-to-threefold spread between top- and bottom-performing states on multiple indicators.

Geographical distinctions remained visible and continued the same general patterns as seen in the 2007 report. States in the New England and the upper Midwest regions scored the highest in the fields of access, quality and equity dimensions while western states fared better in the “healthy lives,” avoidable hospital use and costs of care dimensions, according to the report.

Also included in the key findings was that the average number of uninsured adults nationwide rose, as did healthcare costs. States with the highest readmission rates also tended to have the highest costs of care overall. In addition, the report found that healthcare quality improved in areas where outcomes were reported to the public, the Commonwealth Fund noted.

However, the majority of states made gains in health coverage for children due to federal and state support from the Children’s Health Insurance Program.

Citing their findings toward an “equity gap” in healthcare nationwide, the report’s authors proposed that the continuing and growing disparities in state performance point to the urgent need for a comprehensive national health system reform.

The scorecard pointed to substantial opportunities to improve. According to the report, if all states could reach the level achieved by the top-performing states:

• 29 million more people would have health insurance—cutting the number of uninsured by more than half;
• Nearly 78,000 fewer adults and children would die prematurely every year from conditions that could have been prevented with timely and effective health care;
• Five billion dollars could be saved annually by avoiding preventable hospital admissions and readmissions for vulnerable elderly and disabled residents.

The report found that national efforts to measure, benchmark and publicly report performance had a marked effect on quality improvements at the state level. Following the initiative to track and report hospital treatment data, nearly all states improved on measures of treatment for heart attack, heart failure, pneumonia and prevention of surgical complications.

Poorly coordinated care and inefficient use of resources continues to undermine care and drive up costs in many state healthcare systems, according to the report. The authors concluded that federal action is needed to raise the floor on performance levels across all states and create a supportive climate for innovation.

"If we can enact health reforms that give all states the opportunity to do as well as the best states we will save lives, improve quality and cut costs," said Commonwealth Fund President, Karen Davis.