Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013

September 18, 2013

Authors: Cathy Schoen, M.S., David C. Radley, Ph.D., M.P.H., Pamela Riley, M.D., M.P.H., Jacob A. Lippa, M.P.H., Julia Berenson, M.Sc., Cara Dermody, Anthony Shih, M.D., M.P.H.
Contact: Cathy Schoen, M.S., Senior Vice President for Policy, Research, and Evaluation, The Commonwealth Fund cs@cmwf.org

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Visit the U.S. Health System Data Center to compare states' health system performance.Low Income Scorecard Datacenter

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Overview

Watch an interactive Commonwealth Fund explainer, A Tale of Two States: The Health Care Income Divide Visualized.

The Commonwealth Fund’s Scorecard on State Health System Performance for Low-Income Populations, 2013, identifies opportunities for states to improve their health systems for economically disadvantaged populations and provides state benchmarks of achievement. Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the Scorecard documents sharp health care disparities among states. Between leading and lagging states, up to a fourfold disparity in performance exists on a range of key health care indicators for low-income populations. There are also wide differences within states by income. If all states could reach the benchmarks set by leading states, an estimated 86,000 fewer people would die prematurely and tens of millions more adults and children would receive timely preventive care. Moreover, many benchmarks for low-income populations in the top states were better than average and better than those for higher-income or more-educated individuals in the lagging states.

Executive Summary

Ensuring that all people have equal access to high-quality health care to help them live healthy and productive lives is a core goal of a high performance health system. In the United States, however, where you live matters, particularly if you have low income. In many states, there is a wide gulf in access to and quality of care between those with below-average income and the rest of society.

Bridging the Income DivideRecognizing the importance of families’ economic status for affordable access to care and health status, The Commonwealth Fund’s Scorecard on State Health System Performance for Low-Income Populations, 2013, aims to identify opportunities for states to improve how their health system serves their low-income populations and to provide benchmarks of achievement tied to the top-performing states. Based on its assessment of 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the Scorecard documents sharp disparities among states in each of these areas.

The analysis finds that raising state health system performance to the top benchmark levels would make a critical difference for low-income populations. Between the leading and lagging states, there is often up to a fourfold disparity in performance on indicators of timely access to care, risk for potentially preventable medical complications, lower-quality health care, and premature death, affecting millions of Americans.

If all states could reach the benchmarks set by leading states for more advantaged populations, an estimated 86,000 fewer people would die prematurely, with potential gains of 6.8 million years of life; 750,000 fewer low-income Medicare beneficiaries would be unnecessarily prescribed high-risk medications; and tens of millions of adults and children would receive timely preventive care necessary to lessen the impact of chronic disease and help avoid the need for hospitalization.

Notably, the Scorecard finds that having low income does not have to mean below-average access, quality, or health outcomes. In fact, in the top states, many of the health care benchmarks for low-income populations were better than average and better than those for higher-income or more-educated individuals in the lagging states. With new nationally funded expansions of health insurance and an array of new resources and tools, all states will have a historic opportunity to greatly improve health and health care for vulnerable populations across the country.