IN THE STATES: Big Variations In Quality and Access

Earlier this week, we looked at insurance coverage on a state by state (or more precisely -- district by district) level. Based on a similar concept, the Commonwealth Fund report, Aiming Higher: Results from a State Scorecard on Health System Performance, 2009, looks at how well -- or poorly -- states are performing on health care. The report looks at a number of indicators that represent health care access, quality, costs, and health outcomes; this includes avoidable hospitalizations, healthy lifestyles (like not smoking), and preventative care, such as routine checkups and screenings.

The report is a follow up on an earlier study from 2007, which mapped the same factors, and looks at each state and the District of Columbia. Some states got better over time, and some states got worse, though none of the states moved very far up or down on the scorecard. According to the report, many adults are losing their health care coverage and health care costs are on the rise, but there have been improvements in some areas -- particularly those targeted by public incentive programs (such as Medicare provisions requiring hospitals to report on quality measures, like patient mobility, in return for payment updates).

Karen Davis, president of the Commonwealth Fund, told USA Today the report found "shocking variations" in health status and health care across the nation. In DC and Louisiana, for example, about 29 per 100,000 women die from breast cancer annually, higher than the national average of 24.1, and far higher than states such as Alaska (17.7 deaths per 100,000 women) or Hawaii (19.0 per 100,000). Currently, Hawaii has the best health status on all indicators. In 2009, Hawaii climbed up from its 2nd place spot in 2007 and supplanted another high performer, Vermont, for first place. Massachusetts is the highest performer on access to care (thanks to universal coverage reforms initiated in 2006), but lags behind more than half of all states in avoidable hospital use and costs. California ranked in the top quarter of states in terms of "healthy lives" (longevity and personal health choices), but ranked near the bottom on access, prevention and treatment, and equity (protecting the health of vulnerable populations).

The Commonwealth Fund argued that the findings make the case for national health reform. "When we take action at a national level...we succeed," Karen Davis told USA Today. "States cannot go it alone. Health reform is needed on a national level."

See where your home state measures up on this scorecard or check out the interactive map: