Reforming the Health Care System: State Profiles 2000 is a compilation of major health system characteristics for each state, the District of Columbia, and three territories. AARP's Public Policy Institute initiated the State Profiles series in 1990 to help guide policy discussions among public and private sector leaders in health care throughout the United States. This publication highlights selected indicators of state policy initiatives that address access and coverage concerns. It offers a snapshot of each state's health care landscape by providing a compilation of comparable state-level data on over 90 indicators.
Comparable state-level data are often difficult to obtain from a single source. The most reliable and up-to-date public and private data available were used to produce the state-level information in Reforming the Health Care System: State Profiles 2000. For questions regarding the data used, refer to the Data Documentation section at the back of the book. Reference to this section is particularly important to confirm the appropriateness of the data for specific applications and to understand the population represented.
Highlights of Reforming the Health Care System: State Profiles 2000 are presented below. These examples illustrate the wide variations — both highs and lows — across the United States along many key health care dimensions.
Maps of Health Reform
- As of June 2000, 29 states have established high-risk insurance pool programs to make comprehensive health coverage available to otherwise uninsurable individuals.
- In 15 states, legislators have mandated that hospitals report medical errors and/or adverse events. Five states and the District of Columbia have legislated that reporting of such events be voluntary. The definitions of medical errors and reporting procedures vary among the states.
- To help state residents obtain medications they need but cannot afford, 22 states have established pharmaceutical assistance programs.
- In 39 states and the District of Columbia, legislators have adopted statutes or regulations concerning the practice of acupuncture.
- By 2012, it is projected that Utah and Alaska will be the youngest states in the U.S. with over 30 percent of the population age 18 and under. Florida will be the oldest state with 19.4 percent of the population age 65 and older, followed by West Virginia (17.9%) and Oregon (16.9%).
- The percent of individuals age 85 and older is projected to exceed 2 percent of the total population in 7 states in 2000 and in 29 states by 2012.
- Median family income in 1998 dollars varies widely by state with Maryland having the highest ($61,001) and Arkansas having the lowest ($33,125).
- The income distribution of persons under age 65 and of those age 65 and older illustrate two distinct patterns. Compared to older persons, a greater percentage of those under age 65 have family incomes below the federal poverty level ($16,660 for a family of four in 1998), and a greater share have incomes above 200% of poverty. However, persons age 65 and older are more likely to have incomes between 100% and 200% of poverty than do their younger counterparts. State variations in income distributions reflect these same patterns.
- In 21 states, over 15 percent of persons under age 65 are living in poverty, while only the District of Columbia has over 15 percent of persons age 65 and older living in poverty.
- In all states, less than 10 percent of persons under age 65 have incomes between 100% and 135% of the federal poverty level (FPL). In contrast, 24 states have more than 10 percent of persons age 65 and older at that income level.
- Over 10 percent of persons under age 65 have incomes between 135% and 200% of FPL in 38 states. However, in all 50 states and the District of Columbia, over 10 percent of persons age 65 and older fall in that income range.
- In 35 states, more than 65 percent of persons under age 65 have incomes of 200% of FPL or above. By contrast, in only 9 states do more than 65 percent of persons age 65 and older with incomes above 200% of FPL.
- Vaccination rates for children 19-35 months meets or exceeds 80 percent in 29 states. The highs are 90.7 percent in Connecticut and 89 percent in Maine; the lows are 73.3 percent in New Mexico, 73.7 in the District of Columbia, and 74.8 percent in Arkansas and Texas.
- The states with the highest age-adjusted death rates from heart disease are Mississippi (181.4 per 100,000 population), District of Columbia (161.5) and West Virginia (160.9); the lowest are Utah (87.4), Minnesota (88.4), and Colorado (92.9).
- In 22 states, the percent of overweight adults is greater than the national average (32.4%).
- The states with the highest percent of adults reporting poor/fair health are West Virginia (23.9%), Kentucky (21.9%) and Alabama (21.3%); the lowest are New Hampshire (9.9%), Vermont (10.0%) and Arizona (10.3%).
Utilization of Services
- The number of emergency room visits per 1,000 population is highest in the District of Columbia (679.5), West Virginia (563), and Mississippi (518.3); it is lowest in Arizona (252.7), South Dakota (251.2), and Minnesota (241.9).
- The average number of prescription drugs sold at retail pharmacies is the highest in Tennessee (12.6) and West Virginia (12.1), and lowest in Alaska (5.1) and California (6.2).
- In 20 states, 10 percent or more of persons report not seeing a doctor due to cost. The highest percents are in Arizona (27.3%) and Mississippi (15.5%); the lowest are in Wisconsin (5.1%) and Delaware (5.8%).
- The percent of Medicare beneficiaries using home health services ranges from highs in Vermont (14.1%) and Mississippi (12.5%) to lows in Arizona (4.5%) and Hawaii (2.9%).
- States with the highest number of generalist physicians per 100,000 population are North Dakota (53) and Minnesota (49), and the lowest are Connecticut (18) and Massachusetts (18). States with the highest number of specialist physicians per 100,000 population are the District of Columbia (652) and Massachusetts (360); the lowest are Idaho (110) and Wyoming (118).
- The number of hospital beds per 100,000 population is highest in the District of Columbia (681) and North Dakota (624), and the lowest in Washington (189) and Utah (191).
- The number of Medicare home health agencies per 100,000 beneficiaries is highest in Wyoming (59), Louisiana (44), and Texas (42). New Jersey has the least (5) followed by Maryland and New York (8).
- The states with the highest percent of their populations underserved by primary care physicians are Mississippi (24.4%) and Louisiana (22.7%); and the states with the lowest are Hawaii (2.8%) and Maryland (4.5%).
- The percent of uninsured persons under age 65 is the highest in Arizona, Texas, and New Mexico with over one-quarter without health insurance. Hawaii (9.4%) and Minnesota (10.5%) have the lowest uninsurance rates in the country.
- The percent of uninsured low-income children (incomes less than 200% of FPL) is highest in Arizona (41.8%), Texas (38.2%), and Nevada (34.7%); and it is lowest in Hawaii (9.1%), Vermont (9.6%), and Rhode Island (11.7%).
- New Mexico (22.9%), Texas (21.3%), and Alaska (19.8%) rank the highest for uninsured persons age 50 to 64. In 8 states, less than 10 percent of persons age 50 to 64 are uninsured.
- The states with the highest percent of uninsured full-time workers and dependents are Arizona (21.6%), Texas (19.9%), and Tennessee (18.9%), while states ranking lowest are New Hampshire (9.2%) and Illinois (10.6%).
- As of October 1999, 12 states had expanded the maximum income for eligibility for Medicaid and/or Children's Health Insurance programs (CHIP) above 200% of poverty for children under age 19.
- There is wide variation in Medicaid enrollment by category of enrollee. The percent of Medicaid enrollees who are elderly is highest in North Dakota (17.3%) and North Carolina (14%) and lowest in Arizona (5%) and Utah (5.1%). The percent of Medicaid enrollees who qualify on the basis of disability is highest in Kentucky (28.6%) and Mississippi (27%) and lowest in Oregon (9.1%) and Hawaii (10.1%).
- The percent of poor individuals under age 65 enrolled in Medicaid is highest in Tennessee (59%), Vermont (58.9%), and Massachusetts (58.2%). The lowest percent is in Colorado (21.9%), North Dakota (25%), and Nevada (25.2%).
- In 7 states, more than two-thirds of all Medicare beneficiaries live in rural areas. In Montana, Vermont, and South Dakota, nearly three-quarters of beneficiaries reside in rural areas (76.0%, 74.4%, and 73.5%, respectively).
- The District of Columbia (28.6%), Mississippi (26.2%), and Tennessee (24.8%) have the highest percentages of Medicare beneficiaries with Medicaid, while Indiana (6.0%), North Dakota (6.0), and Iowa (6.2%) have the lowest.
- In Michigan, Delaware, and Hawaii, about 50 percent of Medicare beneficiaries age 65 and older have employer-sponsored health coverage in addition to their Medicare coverage, compared with less than 20 percent of beneficiaries in North Dakota, Mississippi, and South Dakota.
- Eleven states have HMO penetration rates greater than 35 percent, with Massachusetts and California leading at 53 percent and 52 percent, respectively. Ten states have penetration rates less than 10 percent, including North Dakota (2.5%), Wyoming (1.2%), and Alaska (0%).
- Enrollment in Medicare+Choice plans is highest in California (39.6%), Oregon (36.7%), and Arizona (36.3%). Seven states have less than 1 percent of beneficiaries enrolled in the Medicare+Choice program, with Montana, South Carolina, and Vermont having the least (.2%).
- Michigan, Montana, and Tennessee report 100 percent Medicaid enrollment in managed care, while Alaska and Wyoming report 0 percent.
- Eight states have passed managed care liability legislation, and 25 states require expedited review of grievances.
Expenditures and Financing
- Medicaid spending by category of enrollee (i.e., child, adult, elderly, disabled) differs among the states. The percent of Medicaid dollars spent on elderly enrollees ranges from highs of 44.1 percent in Connecticut and 42.5 percent in Pennsylvania to lows of 16.1 percent in New Mexico and Utah. Spending on disabled enrollees is highest in Illinois (50.8%) and Rhode Island (50.7%) and lowest in Hawaii (29.7%) and Texas (30.9%).
- Louisiana, Mississippi, and Missouri spend over 12 percent of their Medicaid budgets on prescription drugs, while the District of Columbia, Maryland, Minnesota, New Mexico, and Oregon spend less than 5 percent.
- Medicare payments per beneficiary range from a high of $7,548 in the District of Columbia to a low of $3,650 in North Dakota.
- Brangan, Normandy, Kelly Griffin, and Cathy McDougall. AARP PPI publication #PPI5719, D17303 (December 2000).
- While the most current data available were used to compile the chartbook, the sources from which and the years in which the data were collected vary from indicator to indicator. See Data Documentation section in the chartbook for details.
To request a copy of the full report, "Reforming the Health Care System: State Profiles 2000", please contact the Public Policy Institute at firstname.lastname@example.org.
Written by Normandy Brangan, Kelly Griffin and Cathy McDougall, AARP Public Policy Institute
May be copied only for noncommercial purposes and with attribution; permission required for all other purposes.
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