Analysis: Bad care for poor, bad for all?

WASHINGTON, June 14 (UPI) -- States with the worst healthcare for the poor have the worst healthcare for everyone, health experts said this week.

"Health system performance -- which affects everyone -- is tied to how well the system treats the most vulnerable," said Alan Weil, executive director of the National Academy for State Health Policy.

A report ranking states on healthcare access and quality found those at the bottom of the heap overall -- like Texas and Mississippi -- had low-income and minority populations lagging the furthest behind in areas like covering the uninsured, making sure poor children get recommended screenings and closing racial gaps in infant mortality.

Meanwhile, four of the five states with the best access to care rankings -- Massachusetts, Iowa, Rhode Island and Maine -- also scored at the top of the quality rankings, according to the report released by the Commonwealth Fund. That means leaving vulnerable citizens behind could be costing the nation in both lives and money.

Variations between states were so wide that care for the wealthy in low-ranking states was almost on par with care for the poor in highly rated states in many areas examined by the study. About 56 percent of wealthier seniors did not get all recommended care in the bottom five states compared with 61 percent of low-income seniors in the top five states.

"Everyone's health suffers when the system fails to meet the needs of even a small number of people," Weil said.

Healthcare access for all of a state's residents also varied widely between top states and bottom states in the rankings. About one in 10 Minnesota adults was uninsured, while in Texas one in three adults lacked insurance.

The difference in children was even more striking. One in 20 children is uninsured in highly ranked Vermont, compared with about one in five in Texas.

Uninsurance and other barriers to healthcare access work their way into a state's healthcare system as a whole, Cathy Schoen, senior vice president of the Commonwealth Fund, told United Press International.

Successful states show a "consistent story of very high rates of insurance and secure insurance," Schoen said.

Because of the connection between quality, access and equity, making sure no one is left behind when it comes to healthcare could have a big impact on a state's physical -- and financial -- health, according to the report.

If all states could do as well as the top states, 22 million adults and children would gain health insurance coverage and 90,000 premature deaths would be prevented, the report says.

"Moving toward universal coverage with meaningful access is essential for achieving efficiency and effectiveness in healthcare services," said Joel Cantor, director of the Center for State Health Policy at Rutgers University.

But not everyone agrees that low quality can be blamed on equity and access problems.

Healthcare quality "is a complex area," Thomas Miller, a health policy fellow at the American Enterprise Institute, told UPI. "We've got to deal with a lot more complex problems upstream and downstream to address quality issues."

The Top 5 overall states were Hawaii, Iowa, New Hampshire, Vermont and Maine. The bottom-ranked state was Oklahoma, followed by Mississippi, Texas, Arkansas and Nevada.

States in the Northeast and Upper Midwest tended to rank higher, while the lowest rankings were concentrated in the South.