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Last week The Commonwealth Fund released its 2019 Scorecard on State Health System Performance. It looks at how the 50 states + D.C. are doing on a number of different performance metrics.
The primary takeaway is perhaps that there's huge variation across the country. The top 5 best-performing states (Hawaii, Massachusetts, Minnesota, Washington, and Connecticut) might as well exist in a different reality than the bottom 5 worst-performing states (Arkansas, Nevada, Texas, Oklahoma, and Mississippi). Something to keep in mind when considering comparisons of the performance of the U.S. internationally.
The Commonwealth Fund also produces international comparisons through its periodic "Mirror, Mirror" series. As an example, consider one of the indicators they use to rank nations on health care outcome: mortality amenable to health care:
Lower mortality there is good because it presumably indicates your system is performing better at preventing the deaths it can.
That particular indicator also shows up in the state scorecards. As it turns out, there is a vast difference between the state that performs best on that metric, Minnesota (54.7 deaths per 100K), and the state that performs the worst, Mississippi (142.4 deaths per 100K). From Mississippi's score card:
Now what do you notice?
One, that the U.S. average quoted here is way lower than what was used in the international comparison--that's odd and requires some explanation from The Commonwealth Fund.
Two, that the best-performing state is actually doing better than any of the countries used in the international comparison.
In fact, let's go to the map:
All the light teal states are performing in line with or better than the top-performing nations in the international comparison (Australia, France, Norway, Sweden Switzerland).
The dark teal states are performing in line with the next tier of performers in the international comparison (Canada, Germany, New Zealand, the U.K.). And indeed if the numbers used in the state scorecards are accurate, that's where the U.S. average actually is: right around where Germany, the U.K., and New Zealand are performing.
But then we've got a number of states (in dark gray), clustered in the southeast, that perform way worse than the rest of the country and the rest of much of the developed world.
The performance gulf between Minnesota and Mississippi is a lot bigger than the gap between Minnesota and the performance of other nations with vastly different financing systems--indeed our 'best' states can hang with or surpass most of the leading international lights on a variety of metrics.
The primary takeaway is perhaps that there's huge variation across the country. The top 5 best-performing states (Hawaii, Massachusetts, Minnesota, Washington, and Connecticut) might as well exist in a different reality than the bottom 5 worst-performing states (Arkansas, Nevada, Texas, Oklahoma, and Mississippi). Something to keep in mind when considering comparisons of the performance of the U.S. internationally.
The Commonwealth Fund also produces international comparisons through its periodic "Mirror, Mirror" series. As an example, consider one of the indicators they use to rank nations on health care outcome: mortality amenable to health care:
Lower mortality there is good because it presumably indicates your system is performing better at preventing the deaths it can.
That particular indicator also shows up in the state scorecards. As it turns out, there is a vast difference between the state that performs best on that metric, Minnesota (54.7 deaths per 100K), and the state that performs the worst, Mississippi (142.4 deaths per 100K). From Mississippi's score card:
Now what do you notice?
One, that the U.S. average quoted here is way lower than what was used in the international comparison--that's odd and requires some explanation from The Commonwealth Fund.
Two, that the best-performing state is actually doing better than any of the countries used in the international comparison.
In fact, let's go to the map:
All the light teal states are performing in line with or better than the top-performing nations in the international comparison (Australia, France, Norway, Sweden Switzerland).
The dark teal states are performing in line with the next tier of performers in the international comparison (Canada, Germany, New Zealand, the U.K.). And indeed if the numbers used in the state scorecards are accurate, that's where the U.S. average actually is: right around where Germany, the U.K., and New Zealand are performing.
But then we've got a number of states (in dark gray), clustered in the southeast, that perform way worse than the rest of the country and the rest of much of the developed world.
The performance gulf between Minnesota and Mississippi is a lot bigger than the gap between Minnesota and the performance of other nations with vastly different financing systems--indeed our 'best' states can hang with or surpass most of the leading international lights on a variety of metrics.
