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    Vermont Tops List of Best Health Systems

    Commonwealth Fund Rates the Best and Worst States for Health Care
    By
    WebMD Health News
    Reviewed by Louise Chang, MD

    Oct. 8, 2009 -- As the debate over health reform rages on, Vermonters can rejoice: Their state has the best-performing health system in the nation.

    Meanwhile, states across the South and West are still struggling with high rates of uninsured residents, poor quality of health care, and wasteful spending.

    That's according to the Commonwealth Fund, in a report tracking the best and worst health systems across the country. The group says wide variation between states highlights the need for broad health reform from Washington.

    "Where you live matters" for access to medical care, costs, and quality in clinics and hospitals, says Kathy Schoen, senior vice president of the Commonwealth Fund.

    The report grades states on 38 indicators, including access to insurance, how many children receive regular "well care" and preventive visits, the degree to which states' residents live healthy lives, and how well hospitals do in preventing infections.

    Vermont topped the list, ranking highly across the 38 measures. Other top states included Hawaii, Iowa, Minnesota, Maine, and New Hampshire.

    Nevada, Arkansas, Louisiana, Oklahoma, and Mississippi were all at the bottom of the list. Those states suffer from poorly coordinated care, higher-than-average infant mortality rates, and high rates of smoking.

    Texas is also near the bottom of the list, in part because of a 22% rate of adults without health insurance -- the highest in the nation.

    "There is shockingly wide variation in the quality of health care across states," Karen Davis, the Commonwealth Fund's president, said in a conference call with reporters. "States cannot go it alone. Reform is needed on the national level."

    The report details some positive news. The number of uninsured children is down across the country, due largely to a recent expansion in the State Children's Health Insurance Program (SCHIP) shared by Washington and the states. Hospitals and nursing homes are also doing a better job of tracking quality and reporting the results publicly, the report states.

    At the same time, researchers warn that hospital quality -- based on readmission rates and other measures -- has not improved. Meanwhile, the number of adults without health coverage continues to march upward. Currently an estimated 47 million Americans have no health insurance.

    "It looks like an epidemic," Schoen said.

    "This is on the eve of the current recession," added Schoen, pointing out that the report's figures are based on 2008 data. "In other words, the worst is yet to come."

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