In recent years, healthcare improved in nearly all U.S. communities more than it worsened, demonstrating that progress is possible with supportive policies and local efforts, according to The Commonwealth Fund's 2016 Scorecard on Local Health System Performance. However, in many communities there was little or no meaningful change.
The Commonwealth Fund's scorecard assesses the state of healthcare in 306 U.S. regional healthcare markets, known as "hospital referral regions," from 2011 to 2014. It uses three dozen indicators grouped into four main dimensions, including access and affordability of care; prevention and treatment; potentially avoidable hospital use and cost; and health behaviors and outcomes.
According to the report, only 14 out of 306 U.S. localities improved on a majority of the scorecard's indicators (17 or more).
Here are eight more findings on the geographic variability in health and healthcare, according to the report.
1. Persisting geographic differences in health outcomes may reflect differences in state policies, where the effects "trickle down" to local communities. Variance may also stem from socioeconomic factors and access to local resources, as well as local norms and practices, according to the report.
2. These findings, combined with the recently reported increase in U.S. mortality in 2015, suggest the national healthcare system needs to make greater investments to address social determinants of health, such as economic opportunity, housing, nutrition and environmental conditions. Additionally, care must be expanded to address mental and behavioral health needs.
3. The scorecard evaluated change over time for 33 of the 36 indicators by identifying instances of improvement or worsening that can be considered meaningful (at least 0.5 standard deviations larger than the indicators' observed rates between the two points of time). Akron, Ohio, and Stockton, Calif., stand out nationally for improving on more performance measures (19 out of 33) that could be tracked over time than any other locality. Another 12 regions improved on the majority of indicators (at least 17).
4. The ACA's major coverage expansions seem to have contributed to some of the most evident gains in performance. Between 2012 and 2014, the rate of uninsured working adults (between 19 and 64) fell by four percentage points or more in 189 local areas, according to the report. Several regions saw double-digit declines in the adult uninsured rates.
5. Other notable differences attributed to policy changes include Medicare's Hospital Readmission Reduction Program, created under the ACA, as well as quality reporting initiatives, such as Medicare's Hospital Compare, Nursing Home Compare and related websites, according to the report.
6. Local areas with a disproportionate share of low-income residents tend to have worse health system performance than areas with relatively smaller populations of low-income residents. According to the report, lower-income areas tended to rank below higher-income ones on three of the four performance dimensions: access to care, quality of care and health outcomes.
7. Compared to residents in higher-income areas, those living in lower-income areas are more likely to go without medical care because of cost (19 percent vs. 12 percent) and are more likely to die early in life from treatable conditions (106 vs. 68 deaths per 100,000 people).
8. However, some communities with large low-income populations stood out for high performance or for making the most significant progress. For instance, Santa Barbara, Calif., where 41 percent of the population lives below the threshold of two times the federal poverty level, ranked 38th overall, and four of the local areas with the greatest number of improved indicators have large low-income populations (Stockton, Calif., and Cape Girardeau, Mo.)