NCPA - National Center for Policy Analysis

Scorecard on Local Health System Performance

March 30, 2012

The first-ever Scorecard on Local Health System Performance by the Commonwealth Fund allows Americans to assess the efficacy of their regions' health care quality on a number of criteria.  The comprehensive report, which conducted its studies in all 50 states, assessed 306 local health care areas, known as hospital referral regions, on 43 health indicators that fall broadly into four categories: access, prevention and treatment, costs and potentially avoidable hospital use, and health outcomes.

Generally, the study found that regions that tend to perform above average in one area of health care tend to perform well in the others as well.  Additionally, the variance between communities is substantial, with the best performers often enjoying a twofold to threefold advantage over the worst.

  • The rate of potentially preventable deaths before age 75 from causes amenable to health care ranged from a high of 169.0 deaths per 100,000 people (worst) to a low of 51.5 (best).
  • The proportion of older adults who received recommended preventive care was more than twice as high in the best-performing area than in the worst performing area (59 percent vs. 26 percent).
  • Nevertheless, even the best-performing areas failed to enact preventative care to a satisfactory degree, with a number of adults failing to follow standard practices such as cancer screenings.
  • The incidence of unsafe medication prescribing was also highly variable across local areas, with the rate among Medicare beneficiaries being four times higher in Alexandria, Louisiana (44 percent) than in the Bronx and White Plains, New York (11 percent).

Several broad patterns also emerged from the data:

  • The size of the population of the region in question was not a strong indicator of health outcomes.
  • The top-performing areas are concentrated in the Upper Midwest and Northeast, though each region generally lags behind in one of the four classifications.
  • Overall, communities with the highest rates of poverty scored among the lowest in more metrics, owing at least in part to the low rate of health insurance in those areas.

Source: David Radley, "Rising to the Challenge: Results from a Scorecard on Local Health System Performance, 2012," Commonwealth Fund, March 14, 2012.

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