Isles lead nation in access to care
A study found Hawaii rates low in cancer deaths, but was weak in other treatments
Hawaii ranks first in the nation in providing access to health care to its residents, a national survey has found.
State officials credited Hawaii's wide availability of health insurance through employment and state programs.
Among the other findings: the state has the lowest rate of breast cancer deaths.
BEST IN NATION
A national survey ranked the states for best access to health care. Here are the top five:
3. New Hampshire
The study, covering the years 2002-2005, was prepared by a commission of the New York City-based Commonwealth Fund, a private foundation aimed at improving health care.
Areas where the islands need improvement include care for heart attacks, congestive heart failure and pneumonia, and the timely provision of antibiotics to surgery patients.
Isle residents have the best access to health care in the nation, according to a survey of all 50 states and the District of Columbia released today.
Hawaii's health care system ranks first overall in 32 performance measures scored by the Commonwealth Fund's Commission on a High Performance Health System. The measures were for the years 2002-2005.
Commonwealth Fund Senior Vice President Cathy Schoen, co-author of the report, noted "shocking" differences between the top and bottom states. "Where you live clearly matters: For access to care when you need it, the quality of care you receive, and opportunities to live healthier lives."
No state or group of states had top marks in all areas and even the top states "aren't doing as well as they could be" in key areas, said lead author Joel Cantor, director of the State Health Policy Center at Rutgers University.
The findings showed access to health care and quality of care are closely linked. The top five states overall -- Hawaii, Iowa, New Hampshire, Vermont and Maine -- have high rates of insurance coverage, with nearly 90 percent of working adults insured, the report said. Hawaii ranked fourth overall for avoidable hospital use and costs, eighth for healthy lives and 18th for quality of care.
In the healthy-lives category, Hawaii had the lowest rate of breast cancer deaths per 100,000 female population and placed sixth lowest in colorectal cancer deaths per 100,000 population.
"We seem to do very well with inpatient care," said Loretta Fuddy, state Health Department deputy director for administration. "We fell down in the area of patient education and hospital discharge planning and we need to look at a better job of screening and preventive care for adults over age 50."
Hawaii was rated poorly in some categories. The state ranked 49th in percentage of surgical patients receiving appropriately timed antibiotics to prevent infections; 47th for percent of heart-failure patients given written discharge instructions; 44th for percent of hospitalized patients receiving recommended care for acute myocardial infarction, congestive heart failure and pneumonia.
(Guidelines published by the American heart and stroke associations in the past two years aim to improve patient care with standardized treatments for coronary artery disease, heart failure and stroke.)
Fuddy attributed the state's No. 1 ranking for access to care to the state's prepaid health care act. Also within the last five years, she said, Gov. Linda Lingle and her administration have put "real emphasis on increasing the public sector care."
With low state unemployment and expansion in coverage, she said, "I think in the next go-around we will see a substantial drop in the uninsured rate."
Expansion of the state child-care health insurance program cut the uninsured rate for children from 10 percent in 2000 to 5 percent in 2005, Fuddy said.
Most recently, the state Department of Human Services has expanded health coverage for Medicaid-eligible adults, including preventive dental coverage, she noted.
Increased subsidies for hospitals and community health centers also provide more public access to care, she said.
The Health Department, with support from the Hawaii Medical Service Association and Kaiser Permanente, also has strongly emphasized healthy living with diet and exercise to prevent chronic disease, she pointed out.
The Department of Human Services-administered QUEST health care program for the first time is requiring plans to include a disease management plan, Fuddy said.
"They are looking at disease management to focus on asthma and diabetes, as well as options to look at obesity, congestive heart failure, high-risk pregnancy and HIV-AIDS."
If all states did as well as the top states, the Commonwealth Fund Commission reported, "90,000 lives could be saved annually, 22 million additional adults and children would have health insurance and millions of older adults, diabetics and young children would receive essential preventive care. Medicare could also save $22 billion a year if high-cost states moved down to spending levels of average states."