By Mike Shields
KHI News Service
TOPEKA, June 13
Where you live in the U.S. matters when it comes to health, according to a
state-by-state comparison
released today.
Some said the dramatic variations in care and system performance
revealed by the report show it is time for universal health coverage nationwide. Others said it showed that if the weaker performing states could learn from the best, the difference would be counted in thousands of lives and billions of dollars.
“If all the states could do as well as the top states, 90,000 lives could be saved annually, 22 million more adults and children would have health insurance and millions of older adults, diabetics and young children would receive essential preventive care,” said Karen Davis, president of the Commonwealth Fund, the non-profit group that sponsored the report titled “State Scorecard on U.S. Health System Performance.”
In most of the 32 indicators used in the report,
Kansas
ranked somewhere in the middle, earning it an overall rank of 20 among the 50 states. But had it matched the top performing states, according to Commonwealth authors:
*
There might have been 520 fewer premature deaths;
*
62,055 more adults and 11,237 more children here would have health insurance;
*
29,576 more adult diabetics would have received recommended services; and
*
Almost $90 million would have been saved from the elimination of unnecessary hospitalizations.
Kansas earned its best ranking, 10th
in the nation, for the relatively low number of children who are uninsured. It was one of the worst states for the
percentage of heart patients given written instructions when discharged from the hospital. It also ranked poorly, 36th, for its relatively high number of deaths from breast cancer. The report also indicated disparities in Kansas when it comes to race, noting a significantly higher incidence of deaths among blacks that might have been avoided with proper health care. Citing 2002 data, the report ranked Kansas
21st
for its
incidence of white deaths amenable to health care, but 32nd for its black deaths amenable to health care. Various
earlier studies
by the Kansas Health Institute have shown disparities in health care for Kansas minorities.
In general, the report showed that those who live in southern states
have
weaker performing
health care systems
than those in the rest of the country and that those living in the northeast and upper Midwest
have better systems and outcomes. The top five states were Hawaii, Iowa, New Hampshire, Vermont and Maine. The poorest performers were Kentucky, Louisiana, Nevada, Arkansas and Texas with Mississippi and Oklahoma tying for last.
Robert St. Peter, president of the Kansas Health Institute, said the Commonwealth findings were important because “they show the clear connection between access and quality.
They also show that it doesn’t necessarily cost more to have a high performing system.”
The Commonwealth report came just two days after the federal Agency for Healthcare Research and Quality released its
state rankings
on health care quality.
The federal report used 129 indicators versus the Commonwealth”s 32. But each showed Kansas ranking mostly in the middle.
Those behind the reports and others said the documents are interesting for their particular information but are most useful for bringing attention to areas where states can improve amid a national push to coax more transparency and efficiency from the health system.
“It demonstrates that Kansas has its areas that need improvement,” said Marcia Nielsen, executive director of the Kansas Health Policy Authority, which is expected to develop its own
performance measurements. “We intend to study the results of these scorecards and rankings carefully.”
Nielsen said the agency is “in the final stages” of hiring a director of data policy and evaluation and “will soon begin work on gathering information on our health indicators.”
“To cut to the chase, what I think the indicators do is to provide us with identification of opportunities for improvement,” said Larry Pitman, president of the
Kansas Foundation for Medical Care
, a Topeka non-profit that works with state and federal governments and private providers to improve health care quality and reporting.
Pitman said there
is a broad range of reports available that compare quality of health care delivery including ones from the
Centers for Medicare and Medicaid Services
that compare hospitals, nursing homes and home health care providers.
But the challenge, he said, is developing a system of consistent, useful reporting that can guide practical, day-to-day decision making.
“Transparency or reporting of information is certainly on the rise,” Pitman said “Reporting of quality and cost information will continue to increase. The problem is that if we don”t have a consistent reporting mechanism the reporting will lose its luster in my opinion.”
Alan Weil, executive director of the National Academy for State Health Policy and a member of the Commonwealth commission that oversaw that group”s state rankings report said the best thing to be done with the rankings is for people “to look for examples in other states and start asking questions.”
Authors of the Commonwealth report have accepted an invitation from the Kansas Health Institute and will come to Topeka next month for a meeting with policymakers and stakeholders to discuss the rankings and how they might be used to improve health care in Kansas.
-Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
mshields@khi.org
or at 785-233-5443, ext. 123.