If you live in Massachusetts, Hawaii and New Hampshire, you win some kind of state lottery for public health and welfare, according to this year’s reading from Scorecard 2023 on the performance of the state health system of the Commonwealth Fund.
Here’s a snapshot of the main findings of the annual study, a list of the fifty US states ranked by a combination of health system indicators.
Like Annie Burkey’s FierceHealth summed it up succinctly, the “Commonwealth Fund provides healthcare in south-eastern states with failing grades across the board.” I’ll give you more details on the top 10 and bottom 10 below: First, a bit of general context.
The Commonwealth Fund methodology covered,
- Access and affordability
- Prevention and treatment
- Cost and avoidable use
- healthy lives
- Reproductive care and women’s health
- income disparity, and
- Racial and ethnic equity.
One critical insight that is made quite clear by this chart in the report is that deaths from preventable and treatable causes increased substantially, especially in certain states between 2019 and 2021 amid the COVID-19 pandemic. On the right of the graph, we see Mississippi with the largest gap in preventable deaths before and after the pandemic, followed by West Virginia, Oklahoma, Arkansas, Tennessee, Louisiana, Kentucky, Washington DC, New Mexico, and Alabama.
Seven of these are in the bottom 10 states for health system performance (the other three are Nevada, Wyoming, and Texas).
Financial well-being is another key driver of personal health, so this state map featuring those with higher levels of medical debt is instructive, echoing other risk maps for social determinants of health factors. Here, too, medical debt tends to be higher in the southern US states.
Note that in Commonwealth Fund calculations, access and affordability are a key factor contributing to health system performance. And, an important contribution to access and affordability is having health insurance coverage.
This bar graph illustrates that the rate of uninsured American adults is highest in states where governors did not expand Medicaid, which are the states indicated by the orange bars. Here, the bottom ten are Texas, Oklahoma, Georgia, Florida, Mississippi, Wyoming, Nevada, Alabama, North Carolina, and South Carolina, with Nevada being the only state in the bottom 10 to have expanded Medicaid coverage for its citizens from health.
Among other factors that contribute to some U.S. citizens doing better in health and wellness than others, check out this map indicating states where many women did not receive early prenatal care relative to women residing in states where prenatal care was more accessible and/or available.
This 2023 health system performance scorecard added a new metric to the analysis: reproductive care and women’s health. This domain encompasses health outcomes and access.
In fact, the performance of the health system for women, children, and infants varies by state, “with large differences in preventable mortality and access to important health services,” the report observes.
“Women faced particularly severe challenges during the COVID-19 pandemic. These included delays in obtaining medical care and pregnancy complications stemming from the virus,” with women of color being particularly affected, exacerbating racial and ethnic disparities in health outcomes, the Fund states.
Health Populi Hot Spots: “Inadequate access to health services during and after pregnancy, combined with disparities in socioeconomic status, underlying health, and quality of care, have helped drive a maternal mortality rate in the US that is it is almost double the rates in other high-income countries.” explains the Commonwealth Fund.
This day marks the first anniversary of the annulment of Roe v. Wade (alias the Dobbs Decision).
I link to the website of the League of Women Voters, an organization I support and learn from; both my mother and mother-in-law were members of the LWV, pulling their own political muscles at a quite different sociopolitical time.
LWV acknowledges this anniversary by saying, “I look forward to a world where we can once again leave these options to the people who experience them firsthand…it shouldn’t matter your age, zip code, political or religious beliefs.”
Women’s health care is health care. Women’s rights are human rights. And ensuring this improves health system performance and indeed health outcomes for women and children.