Although there were notable gains in areas of national priority, there remained persistent disparities between states for most measures, the report found.
“Where you live continues to matter, and it matters a lot,” said Cathy Schoen, senior vice president for policy, research and evaluation at the Commonwealth Fund. “We find wide geographic disparities across states and within states for vulnerable populations.” The report released Wednesday assessed each U.S. state on a total of 42 indicators between 2007 and 2012, the five years preceding implementation of major reforms of the Affordable Care Act.
The majority of states either failed to improve or got worse on two-thirds of the 34 indicators for which longitudinal data existed, the report authors said at a news conference. Indicators included numbers of uninsured children and adults; adults who went without care because of costs; use of mental health services; 30-day readmission rates; infant mortality; and death from colon and breast cancers, for example.
In 13 states, progress in certain areas was countered by equally as many, or more, setbacks in other areas.
There were also distinct regional differences. Among states performing in the top quartile, there were several in the Midwest, including Minnesota, Wisconsin and Iowa; the Northeast, including Vermont, Massachusetts and Delaware; and Hawaii. Several states in the South—such as Texas, Louisiana, Mississippi, Arkansas and Alabama—performed below average, ranking among the lowest quartile.
“In the United States, where you live has long been a major influence on the kind of healthcare you receive,” said Dr. David Blumenthal, president of the Commonwealth Fund. “That should not be true.”
There were, however, some positives. In areas of national priority, like hospital readmissions, safe prescribing and childhood immunizations, there were improvements in most states. Thirty-day readmission rates improved in 38 states, the report found. Authors link that to changes in Medicare reimbursement policies.
Last week, the Centers for Disease Control and Prevention reported an estimated 322 million illnesses, 21 million hospitalizations and 732,000 deaths will be prevented thanks to routine childhood vaccinations, an estimated net savings of $295 billion in direct costs. Combined national and state actions like these have the potential to promote performance gains across the country, researchers say. “The scorecard findings are not just statistics, but make a real difference in people's lives,” Schoen said. State-by-state estimations are provided to show the potential impact of low-performing states reaching benchmarks set by the top performers, she said. But all states have room for improvement, she says, as none are at the top of every indicator measured.
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