Health Care Varies Widely Based On Where You Live. Report Ranks Best, Worst States.

A new report highlights disparities and preventable deaths in the United States, highlighting rising medical-related deaths, disparities in maternal health care and access to health care.

The 2023 Commonwealth Fund Results on Public Health System Performance between 2019 and 2021 ranks states based on access and affordability of health services related to the Covid-19 pandemic, reproductive health access and outcomes, premature death rates, healthcare debt and other factors.

The five states with the highest overall health system scores are Massachusetts, Hawaii, New Hampshire, Rhode Island, and Vermont.

Mississippi, West Virginia, Oklahoma, Texas and Arkansas had the lowest scores.

Six of the 10 countries with the lowest scores are not expanding Medicaid eligibility programs. Rates of uninsured adults are higher in states not in the Medicaid expansion.

"Expanding their Medicaid program will be the first step in increasing the efficiency of their health care system," Sarah Collins, vice president of the Commonwealth Health Coverage and Access Trust, said in a press release.

"In almost all these states, there is a huge disparity between low-income and high-income people," he added.

Here are the main findings.

Ethnic diversity

People of color have the highest death rates from Covid-19, and blacks, American Indians, and Alaska Natives have the highest preventable death rates.

Outside of Hispanics, blacks and Native Americans have experienced the greatest declines in life expectancy due to structural inequality and systemic racism.

South Dakota has the highest preventable death rate among Native Americans; Washington, D.C., has the largest black population, while New Mexico has the largest Hispanic population.

Lori Ziffrin, senior vice president of the Commonwealth Trust for Promoting Health Equity, said changes in health and public policies must prioritize equity.

When we think about any intervention, we need to focus capital. When we design a health care system that focuses on the most marginalized, it improves care delivery and outcomes for everyone.

Mother's death

During the epidemic, maternal mortality increased among all women but disproportionately among women of color as communities across the country lost access to maternal health care.

Maternal mortality rates among American Indians and Alaska Natives more than doubled from 2020 to 2021, from an estimated 48 to 118 deaths per 100,000.

Similarly, the death rate of black women increased from 55 to 70 per 100,000 population.

The death rate for Hispanic women increased from 18 to 28 per 100,000. The rate for white women increased from 18 to 26.6 per 100,000 and for Asian Americans, Native Hawaiians, and Pacific Islanders from 13.6 to 18.8 per 100,000.

Zephyrin said the country must "invest in maternal health workers," including women, obstetricians, midwives and midwives.

Find reproductive health services

The report also analyzed state standards for access to reproductive care, with more than 12 states prohibiting abortion.

The five lowest-scoring states for reproductive and women's health care are New Mexico, Mississippi, Texas, Alaska, and Oklahoma, while the highest are Massachusetts, Rhode Island, New Hampshire, Maine, and Connecticut.

Nearly 30% of women in Texas and Florida do not receive prenatal care, compared to 11% in Vermont.

New Jersey, Alaska, Missouri and Arizona had the highest rates of women reporting postpartum visits, although the report did not have data for eight states, four of which are in the South.

Across the country, overall mortality among women increased between 2019 and 2021 due to higher maternal deaths, Covid-19 deaths and drug use.

Psychological health

Mental health-related deaths have reached alarming levels, with more than 200,000 people dying from drug and alcohol overdoses and suicide in 2021, up from 50,000 before the 2019 epidemic.

Adolescents and young adults with mental health needs do not receive health care: Nearly 60 percent of people ages 12 to 17 with untreated major depression need it, according to a 2020 federal survey report.

Hawaii has the highest number of adults age 18 and older with untreated mental illness at 69 percent.

Other highlights from the report:

• The scorecard measures those who die from preventable causes and those who can be treated with immediate medical intervention. Preventable deaths increased during the outbreak in all states, with Mississippi having the highest number of deaths among those under 75 at 518 per 100,000, followed by West Virginia, Oklahoma, Arkansas, Tennessee, and Louisiana.

• The South has the highest medical debt.

• In the year Since 2019, gun-related deaths have increased by 23%, partly due to increases in mass shootings and suicides.

This article originally appeared on USA TODAY: Health Standards Report: Which States Have the Best and Worst Access?

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