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Current system not up to par

The Commonwealth Fund’s Commission on Higher Health Performance issued a National Scorecard on health system performance in the U.S. in September 2006, finding that the current system “[falls] far short of what is achievable on all dimensions of health system performance.”[1]

The study also found that if gaps in each of the performance measures were filled, $50 to $100 billion per year on health care spending could be saved and 100,000 to 150,000 deaths prevented.[2] The National Scorecard also cited a finding by the Institute of Medicine that “estimates national economic gains of up to $130 billion per year for insuring the uninsured.”[3]

Where you live matters: State Scorecard compares health care quality across states

A more recent report by the Commonwealth Fund, the State Scorecard on Health System Performance, found wide variation among states on their performance across five basic dimensions: access, quality, avoidable costs, equity, and healthy lives.[4] Some of overall findings of the study pointed to the link between better access and better quality of care, the disassociation between high quality and high costs, and the fact that all states have considerable room for improvement.[5] Variation in performance across regions was also pronounced, with the Upper Midwest and Northeast holding the greatest number of high-ranked states while the lowest ranked states were concentrated in the South.[6] States with high rates of uninsured adults usually also had historically low rates of employer-based coverage and subsequently a high percentage of the working population earning at or below 200 percent of the poverty line.

All states show significant room for improvement

Across the states, a sizable portion of children and adults on average do not receive “care consistent with established guidelines and professional recommendations” and these gaps are especially pronounced in minority groups and low-income populations, indicating that equity gaps exist across the spectrum of states.[7] Figure 1 from the State Scorecard indicates the level of improvement the U.S. could see if each state performed to the level of the highest ranked sate under each dimension.

Top states consistently rate well, bottom states consistently rate poorly

Figure 2 displays the scorecard comparing performance across the 51 states. The 13 states at the top quartile of the scorecard included Hawaii, Iowa, New Hampshire, Vermont, Maine, Rhode Island, Connecticut, Massachusetts, Wisconsin, South Dakota, Minnesota, Nebraska, and North Dakota.[8] The bottom quartile states included California, Tennessee, Alabama, Georgia, Florida, West Virginia, Kentucky, Louisiana, Nevada, Arkansas, Texas, Mississippi, and Oklahoma.[9] These states fell far behind the top states on multiple indicators across the dimensions.[10] How Texas fared specifically across these dimensions will be discussed more specifically in the next factsheet on the status of health care in Texas.

Figure 1: National Cumulative Impact if All States Achieved Top State Ranks

Source: Commonwealth Fund State Scorecard (June 2007)

** Click on chart to access the Report - go to p. 45 to view the chart **

Figure 2: Scorecard Summary of Health System Performance Across Dimensions

Source: Commonwealth Fund State Scorecard (June 2007)

** Click on chart to access the Report - go to p. 10 to view the scorecard **