May 13, 2008

Dr. Richard Feldman

Finding remedy for health-care blues

The Commonwealth Fund recently released a report that ranks the states on 32 indicators of health care, including access to care, avoidable hospital use and costs, quality, equity and healthy lives. You guessed it: Indiana fared poorly on yet another national report relating to health, ranking 38th overall among states.

The report shows a huge variation among states. The implication is that state health-care policy and specific ways local and regional health-care systems operate do make a difference.

The study found that there is opportunity for enormous improvement in health-care systems and consequently people’s health, particularly in lower-functioning states. But the country as a whole could do much better.

Not surprisingly, better health-care access is highly associated with better health, and there are great opportunities to decrease costs and increase quality of care. As this and other studies have found, higher quality is not associated with higher costs.

If all states could perform as well as the top states, the study found, we could:

Experience 90,000 fewer deaths before the age of 75 due to treatable conditions each year.

Reduce the uninsured rate by one-half.

Enable 4 million more diabetics and 9 million elderly to receive basic recommended care and avoid preventable complications by improving systems of chronic disease management.

Save billions of dollars annually by reducing preventable hospital admissions and avoidable re-admissions by improving hospital performance, preventing complications of chronic diseases, and better caring for vulnerable nursing home patients.

Save $22 billion to $38 billion per year in Medicare costs by creating higher-performing health-care systems.

Many best-performing states such as Hawaii, Maine, Vermont and Massachusetts lead the nation in reforming their health-care systems, expanding access, lowering uninsured rates and creating the best chronic disease management programs. They have the highest rates of preventive-care interventions, and the lowest avoidable mortality rates. These states maximize value by creating both quality and efficiencies. The highest-performing states combine enhanced access with strong primary-care systems to better assure that medical care is patient-centered and coordinated.

Indiana ranked 30th in access, 28th in quality, and 33rd in avoidable hospitalizations, health-system equity, and healthy lives. Indiana scored 39th lowest in the percent of adults who visited a doctor in the past two years, the immunization rate of children 19 to 35 months, and the quality of nursing home care. We rank 42nd in the percent of people older than 50 who receive recommended preventive health assessments and in the rate of colorectal cancer deaths. The infant mortality rate was 15th highest and the percent of home-health patients requiring hospital admission was 12th highest. Indiana scored well on only one indicator, the percentage of patients with a usual source of health care, at 10th highest.

The study’s major conclusion was that it will ultimately take federal intervention in addition to the best of state efforts to bring health-care coverage for all Americans. Only then can we even hope to attain the best quality and cost-effective medical care, absolutely dependent on access to the system.

State initiatives that improve the value obtained from their health care systems could be adapted for use on a national scale. Policymakers should take notice of what is achievable, especially in Indiana, so that people will receive the best health care our country and state can offer.

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You do math the way politicians do. Our sales tax went up by 16.67% to 7%.

Our sales tax went up by 1%. mMitch proposed it or agreed with it. The last time we got sold that bill of goods, by Gov. Bowen, the sales tax doubled, and the Ptoperty Tax Replacement Fund was established. Which gave legislators partial cover for almost 40 years.

The rise in property taxes is due almost entirely to local units of government and their spending. But the state set up the matriz for assessors to use. And when the autopsy is done on our property tax fiasco, that’s where the blame will be placed. Rightly.

Mitch rules

Funny how he knows my property tax bill has gone down, even though I’m still waiting to get my 3 bills for one year (instead of just two like in previous years). That doesn’t suggest a decrease to ME.