Health Insurance and You!

Where you live has a huge impact on your health, in a variety of ways. Some areas have more pollution than others, which can affect your lung health. Dense cities and other high-traffic areas tend to encourage walking, which can affect the amount of exercise you get. And of course, where you live determines which doctors, hospitals, clinics, government resources, and other health services you are able to access.

Keeping in mind the importance of location, this week, the Commonwealth Fund released its first-ever Scorecard on Local Health System Performance, a report comparing 306 hospital referral regions across the United States based on the most recent data available. The regions were compared using 43 variables in four overarching categories: access to care, disease prevention and treatment, costs and avoidable use of hospitals, and outcomes. In general, areas in the northern Midwest and Northeast fared best and those in the South and Southeast fared worst, but every area had opportunities for improvement. The Northeast, for example, had higher avoidable costs than other regions.

Other key findings, selected from the report’s executive summary:

• Not enough older adults were receiving the recommended preventive screenings. The proportion who were getting screened ranged from 26% to 59%.
• A significant portion, ranging from 0.4% to 11% depending on location, of nursing home residents were in moderate to severe pain.
• Between 13% and 30% of emergency room visits were unavoidable.
• Infant mortality is still a significant problem in many areas. In the lowest-performing quarter of regions, there were between 9.4 and 14.4 deaths per 1,000 live births.

One might expect wealth to have a major impact on these results, but it wasn’t always a factor. Overall, areas with high poverty tended to have less access to care and higher rates of avoidable problems. But when it came to prevention and treatment quality, many poorer areas scored higher than expected, showing that the details of a local health system can have a positive impact.

And relating to health insurance:

• In all areas, children were more likely to be covered than adults, primarily because of federal and state programs such as Medicaid.
• Perhaps unsurprisingly, Massachusetts has the highest proportion of adults with health insurance, at nearly 95%. In contrast, a few localities in Texas had insurance rates as low as 47%.

“The findings show that local health system performance is linked across all dimensions – with better access to care associated with higher quality and better outcomes. This interconnectedness underscores the need for health insurance, payment, and delivery system reforms to improve care experiences and outcomes, while at the same time slowing cost growth,” conclude the authors in the executive summary.

Ultimately, they say, success at the local level will require strong leadership by communities and health providers, who will need to work together to set goals and find ways to meet them. Policies at the national and state levels are important as well, as they set the backdrop for local-level changes. Readers, in our current, constrained economic climate, what are the first steps for local providers and officials to take to improve their performance? If a local program is found to work well, should it be tested in and expanded to other areas?