Researchers at the Mercatus Center at George Mason University have created the Healthcare Openness and Access Project, a set of tools providing state-by-state measures of the flexibility of and discretion that patients and providers have in managing health and healthcare.
According to the researchers, three important goals in healthcare are lowering costs, improving quality and broadening health insurance coverage and they cannot be attained by fixating solely on health insurance reform, HOAP found. In a report released this week, the authors contend that states have -- and should have -- substantial control over the delivery of healthcare, and not just when it comes to insurance. HOAP seeks to have a basis of comparison, to see what works in different states, to make maximum use of state powers in improving care.
HOAP examined a vast number of factors in ranking each state: whether they expand on federal tobacco rating limitations, put fewer restrictions on compounding pharmacies, has fewer medical device taxes, allows online prescribing, etc. The index is the result of equally weighted subindexes that measure the discretion patients and providers have over broad areas of healthcare, such as public health and telemedicine. Based on HOAP's criteria, Idaho ranks first in the nation; Montana, Missouri, Mississippi and Utah round out the top five. Georgia ranked last on the list.
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Several motivations prompted hope's creation. One is that, ultimately, progress on those three goals of health reform will require fundamental changes in the technologies and structures of care, and in how, where, when and why care is delivered. The authors believe those changes will be most effective not as top-down mandates based on centralized expertise, but rather as the results of a vast constellation of patients and providers innovating, experimenting, and extemporizing.
States matter, the report said. They possess a lot of power to determine which providers perform what services, the means by which they do so, their legal responsibilities in the event that patients suffer harm, and so forth. The HOAP index and subindexes suggest how the states differ in encouraging delivery-system innovation.
Perceptions about states do not always accord with reality, the authors said. A leftward tilt in the debate over the Affordable Care Act does not necessarily correlate with tight centralized control of healthcare at the state level; nor does a rightward tilt in the debate always comport with extensive patient-provider discretion. For example, HOAP suggests that Oregon, a reliably blue state, offers broad leeway to patients and providers while Georgia, a very red state, has some of the most restrictive healthcare laws and regulations in the nation.
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The HOAP index touts itself as a one-stop source of information on policy differences around the country. As an example, 48 states and Washington, D.C. forbid over-the-counter sales of oral contraceptives. So to many, that prohibition may seem to be the natural order of things -- a universal. But it is not without exception: California and Oregon do allow such sales. The authors suggest that perhaps this anomaly will persuade policymakers in other states to at least ask how that market functions in the two outlier states -- whether over-the-counter sales cause prices to drop, how patients and providers feel about that level of autonomy, and whether there are any measurable effects on health, positive or negative.
Researchers decided to omit certain variables because of their tendency to be politically charged, inspiring heated debate on the positives and negatives. Three examples are abortion, assisted suicide and vaccination exemptions, which are nowhere to be found in the HOAP index.
The report stressed that it was intended to be a conversation-starter, not necessarily a final authority on the healthcare picture in each state.
The full rankings and state-by-state comparisons can be found at www.mercatus.org/hoap.
Twitter: @JELagasse