Report highlights wide variance in care quality across the nation

The first-ever report on the quality of care in 306 U.S. communities found a wide variance in the cost and quality of healthcare between and within states.

If all local areas could do as well as the top performers, the Commonwealth Fund report argues, 30 million more Americans would have health insurance, 1.3 million more seniors would receive appropriate medications and Medicare would save billions of dollars on preventable hospitalizations and readmissions. 

The report found that 66 million Americans live in the lowest-performing areas of the country. In the worst-performing areas of Southern states such as Louisiana, Georgia, Mississippi and Tennessee, the annual preventable death rate before age 75 tops 150 per 100,000, versus under 60 per 100,000 in parts of Washington and Colorado.

"This first local scorecard provides a baseline for how healthcare systems are performing at the local level when it comes to the most essential functions, including whether people can get the healthcare they need, whether they receive timely preventive care and treatment, how healthy they are, and how affordable healthcare is," Cathy Schoen, a co-author of the report, said in a statement. "The scorecard is a tool for local healthcare leaders and policymakers that allows them to focus on where their healthcare systems fall short, learn from the best-performing areas and target efforts to improve where they are needed most."

According to a summary of the report: 

• In California, the Santa Rosa area ranks in the top 10 percent of all local areas evaluated in the scorecard, while the Bakersfield area ranks in the bottom 25 percent; 

• In Illinois, Bloomington ranks in the top 25 percent overall while Chicago ranks in the bottom half, pulled down by high rates of people without health insurance, high costs and high rates of potentially avoidable hospital use; 

• In Kentucky, there was a 27-percentage-point difference between the best and worst areas when it came to making sure people with diabetes received tests for managing their disease effectively (61 percent in Covington vs. 34 percent in Lexington); 

• In Florida, Illinois, Indiana and Michigan, there was nearly a 20-percentage-point difference between local areas with the highest and lowest rates of hospitalization of nursing home residents; 

• The incidence of unsafe medication prescribing for the elderly was four times higher in Alexandria, La., (44 percent) than in the Bronx and White Plains, N.Y. (11 percent); and

• The proportion of women and men age 50 or older who received recommended preventive care, including screening for cancer, was more than twice as high in the best-performing area than in the worst-performing area (59 percent in Arlington, Va., versus 26 percent in Abilene, Texas).

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