By Laura Tobler

Five states—Minnesota, Massachusetts, New Hampshire, Vermont and Hawaii—are the nation’s pacesetters for access to health care, the quality of services and lowering costs, according to the Commonwealth Fund’s Scorecard on State Health System Performance.

So what is the secret why these five states consistently rank among the nation’s most efficient and effective health care systems?  According to the authors of the report, it “may be the result of their willingness and wherewithal to address health system change with focused initiatives spanning the public and private sectors.” 

The scorecard ranks states and the District of Columbia on 42 measures of health care access, quality, costs and health status from 2007 to 2012. Sample measures include hospitalizations for children with asthma, adults who forego medical care because of cost and nursing home residents who get bedsores. The states’ performance, according to the report, showed little to no improvement in many measures since the last scorecard measured status in 2009. For every improvement in performance experienced across the country, there were nearly as many measures that declined. The bottom line is that all states have room to improve.  

Most states showed gains in childhood immunizations, safe-prescribing practices and patient-centered hospital care as well as reductions in hospital readmissions and cancer deaths. On the other hand, affordability and access to health care declined, more children lacked a medical home and adult obesity and suicides increased. The decline in insurance coverage and affordability of care can partly be attributed to the effect of the recession from 2007 to 2009.

The report shows significant geographic disparity in the performance of state health care systems, leading the authors to conclude that “where you live matters.” For example, the proportion of children who received routine preventive medical and dental visits ranged from a high of 81 percent in Vermont to a low of 56 percent in Nevada.

 In Hawaii, Massachusetts and North Dakota, the percentage of adults who went without health care because of costs was 9 percent compared to 21 or 22 percent in Arkansas, Florida, Mississippi, South Carolina and Texas.  Variations were partly attributed to “state policies and funding of health care programs, such as Medicaid, as well as in local norms and practices.” 

To learn more about your state’s ranking read the report.

Laura Tobler is a program director in NCSL's Health program.

Email Laura.

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.


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