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Another State Ranking Report

Posted Aug 24 2008 3:36pm
The Commonwealth Fund reports (it's a big file) on Child Health, ranking states according to access, quality, cost and other factors (check out the map ).

Number 1 is Iowa, a state with a great family practice residency and a primary care oriented medical school, along with a quality research university. Good access to top-notch reasonably-priced health care probably trumped the reputation of places like Massachusetts, that suffer from high costs.

So much for branding. After all, the two most important people who went to Harvard dropped out before graduating.

Even Vermont could not come in first, given their unparalleled social programs, but cost was factor there as well. Washington and Wyoming were the only western states that came in the top half (remember I live in The Great American desert... think West). My biggest surprise is seeing Minnesota in the 2nd quartile. I would have expected the State to rank in the top 10. Managed care has negative its effects on physicians, provider organizations and the pharmaceutical companies but it represents a way of providing more rational care to patients. Minnesota has the greatest managed care penetration in the country, but the majority are for-profit entities.

Just musings... but one might wonder if managed care, a dirty word to physicians and patients alike, may lose any purported benefits in the hands of a for-profit entity. Perhaps it is another example of an academically brilliant concept that gets distorted when handed over to real people. Kind of like God!

Of course the problem with rankings is in the detail. The indicators include equity, which is notoriously difficult to define (which income cutoffs do you use) and something called "potential to leave healthy lives". Let's not lose sight of what these rankings tell us:

  1. There is way too much variation across states (but perhaps this is what the founding fathers would have wanted.) Let the states decide if they care about kids or health care.

  2. It is possible to score very high as well as possible to hit rock bottom. In other words, the rankings can distinguish between states. In addition, there is internal consistency and, I suspect, some degree of external validity also.

  3. A very interesting observation emerges from the executive summary ; quality and access correlate strongly. I recently heard from a CEO who was referring to managing physician performance that productivity was inseparable from quality (productivity=access). Even a clueless doc can do a great job, given three or four hours for a single patient. A physician's value to a community is measured differently than when measured one patient at a time. On a state level, quality is meaningless if there is no access.
The rankings are interesting, and it points to one incontrovertible fact: we could do better.
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