Health care access, cost, quality, and outcomes vary greatly from one community to the next depending on the performance of the health care system available to residents. A report issued by the Commonwealth Fund Commission found Texas ranks near the bottom for health care access, prevention and treatment, avoidable hospital use and costs, as well as in overall population health.
The High Performance Health System Report is the first scorecard measuring how 306 local U.S. areas are doing on key health care indicators such as insurance coverage, preventive care, and mortality rates. Researchers at The Commonwealth Fund found significant differences between the best- and worst-performing localities.
Major U.S. cities also showed wide disparities on many key measures of health care, with San Francisco and Seattle ranking among the top 75 local areas in the country.
Disturbing for Texas healthcare is the states three largest cities – Houston, San Antonio and Dallas, cities with nationally recognized medical schools and research programs – finished near the bottom along with Corpus Christi and San Angelo. The lowest markets nationally were also all in Texas — Amarillo, Beaumont, Victoria, Abilene, Odessa, El Paso, Waco, Harlingen and McAllen.
The stark differences in health care add up to real lives and dollars. According to the scorecard, 66 million people live in the lowest-performing local areas in the country. If all local areas could do as well as the top performers, 30 million more adults and children would have health insurance, 1.3 million more elderly would receive safe or appropriate medications, and Medicare would save billions of dollars on preventable hospitalizations and readmissions.
The report, Rising to the Challenge: Results from a Scorecard on Local Health System Performance, 2012, and online interactive map rank local areas on 43 performance metrics grouped into categories that include access to health care, health care prevention and treatment, potentially avoidable hospital use and cost, and health outcomes.
The metrics include potentially preventable deaths before age 75, prevalence of unsafe medication prescribing, the proportion of adults who receive recommended preventive care, and the percentage of uninsured adults. The report finds that there is room to improve everywhere, with no community consistently in the lead on all of the factors that were measured. However, there were geographic patterns—local areas in the Northeast and Upper Midwest often ranked at the top, while local areas in the South, particularly the Gulf Coast and southern central states, tended to rank at the bottom on many measures.
“This first local scorecard provides a baseline for how health care systems are performing at the local level when it comes to the most essential functions, including whether people can get the health care they need, whether they receive timely preventive care and treatment, how healthy they are, and how affordable health care is,” said Commonwealth Fund Senior Vice President Cathy Schoen, a coauthor of the report. “The scorecard is a tool for local health care leaders and policymakers that allows them to focus on where their health care systems fall short, learn from the best-performing areas, and target efforts to improve where they are needed most.”
There were wide variations in performance among the nation’s largest cities. Many of the country’s biggest cities ranked highly: Boston, Minneapolis and St. Paul, Sacramento, San Francisco, and Seattle all scored in the top 75 areas for overall health system performance. In contrast, Dallas, Houston, Miami, and San Antonio scored in the bottom 75.
The report found significant variations within high- and low-income areas in the measures for prevention and avoidable hospital use and costs, with some low-income communities doing better than might be expected and some high-income communities doing worse. For example, areas with higher levels of poverty, including El Paso, Texas, Durham, N.C., and Columbia, S.C., ranked in the top half of the scorecard on preventable hospital use and costs, while several areas with lower levels of poverty, including Wilmington, Del., Hinsdale, Ill., Ridgewood, N.J., and Dayton Ohio, ranked in the bottom half.
Texas was found to have the highest rate of uninsured adults. In McAllen and Harlingen more than half the adults have no insurance. Three areas of the state ranked highest in the country for uninsured children.
More than 20 percent of adults in Texas receive no healthcare because of cost, tied with Florida, Georgia, Louisiana and Mississippi.
The state did have a couple of bright spots.
McAllen was found to have one of the lowest mortality rates for breast cancer and colorectal cancer; Victoria had less than four infant deaths per 1,000 live births; Austin has the country’s lowest rate tooth loss due to decay, infection or gum disease; and Dallas-Fort Worth was held as a model for creating a database that combine billing data from many payers and is used by hospitals and researchers to analyze trends in health care use across the region.
“The local scorecard spotlights the opportunities and challenges facing us as we try to achieve better health care experiences, better health, and more affordable care,” said Commonwealth Fund Commission on a High Performance Health System Chair David Blumenthal, M.D., Professor of Health Care Policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School. “Despite the large number of communities that lag relative to leaders, we see places with thriving health care systems, providing excellent care at a reasonable cost. The Affordable Care Act provides new resources and the opportunity to innovate in every state and local area. We must commit to working together to raise the bar so every community can do as well as the best among us.”