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Study Shows Wide State Variance in Health Care

By Mary Agnes Carey, CQ HealthBeat Associate Editor

June 14, 2007 -- A new report from the Commonwealth Fund Commission on a High Performance Health System indicates states vary widely in health care quality, cost, and access.

Analyzing government health care data, the study ranks 32 indicators that include access, quality, avoidable hospital use, and costs. The five top-ranked states, Hawaii, Iowa, New Hampshire, Vermont, and Maine, all have high rates of insurance coverage, with nearly 90 percent of working-age adults insured, according to the scorecard of states' performance. Among the five lowest-ranking states, Nevada, Arkansas, Texas, Mississippi, and Oklahoma, insured adult populations range from 70 percent to 78 percent. In states with smaller uninsured populations, adults and children are more likely to receive essential preventative and chronic care and have ongoing connections to care, researchers found.

States in the Northeast and Upper Midwest often rank high in multiple areas listed on the scorecard, while states with the lowest rankings tend to be concentrated in the South. If all states could perform as well as the top-rated ones, 90,000 lives could be saved annually, 22 million additional adults and children would have health insurance, and millions of older adults, diabetics, and young children would receive essential preventative care, the study found. Public health programs also would fare better, with Medicare saving a potential $22 billion a year if high-cost states reduced their spending to levels of the average states.

"The differences we found between the top and bottom states were shocking, often a two- to threefold variation or greater," said report co-author and Commonwealth Fund Senior Vice President Cathy Schoen. "Where you live clearly matters: for access to care when you need it, the quality of care you receive, and opportunities to live healthier lives."

Researchers found no systematic connection between high spending and high-quality health care, with some states achieving high quality at relatively low costs. States with the highest levels of spending tended to have higher rates of preventable hospital use, including readmissions and admissions for diabetes, asthma, and other chronic illnesses that should be effectively treated outside the hospital. The scorecard also documents great variability across states in potentially preventable use of hospitals. For example, the rate of children admitted to hospitals for asthmas ranges from 55 per 100,000 in Vermont to 300 per 100,000 in South Carolina.

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