According to a new report from the Commonwealth Fund Commission on a High Performance Health System, there are stark differences between communities state and nationwide when it comes to healthcare access, cost and quality.
In the scorecard, which was released Wednesday, researchers measured how 306 local U.S. areas are doing on key healthcare indicators such as insurance coverage, preventive care and mortality rates.
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 healthcare, with San Francisco and Seattle ranking among the top 75 local areas in the country, and Houston and Miami ranking in the bottom 75. An interactive map accompanying the report allows comparison of cities and communities across the country.
These differences in healthcare 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 the online interactive map rank local areas on 43 performance metrics grouped into categories that include access to healthcare, healthcare prevention and treatment, potentially avoidable hospital use and cost and health outcomes. The 43 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.
"This first local scorecard provides a baseline for how healthcare systems are performing at the local level when it comes to the most essential functions, including whether people can get the healthcare they need, whether they receive timely preventive care and treatment, how healthy they are and how affordable healthcare is," said Commonwealth Fund Senior Vice President Cathy Schoen, a coauthor of the report, in a written statement. "The scorecard is a tool for local healthcare leaders and policymakers that allows them to focus on where their healthcare systems fall short, learn from the best-performing areas, and target efforts to improve where they are needed most."
The report finds there is room to improve everywhere, with no community consistently in the lead on all 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.
"What we found in the report is that access to care is really fundamental at all the locations that ranked at the top," David Radley, Commonwealth Fund senior policy analyst and lead author of the report told Healthcare Finance News. "Clearly, access is foundational – few places can provide the highest quality care but don't have much access to care. However, even the highest-scoring places had certain areas where they did not perform very well."