Ohio Health Policy Review

Ohio infant mortality rate worsens, racial disparities persist

New statistics from the Ohio Department of Health released this week indicate that the child mortality rate in Ohio increased from 7.7 deaths per 1,000 live births in 2010 to 7.9 in 2011, and the figures for black infants remain much worse (Source: "Black-infant deaths worst of bad news," Columbus Dispatch, Nov. 29, 2012).

The figures were released Tuesday at the state's first summit aimed at reducing infant mortality in Ohio, which ranks 11th worst in the nation. The death rate for black infants is 15.8 per 1,000 live births last year, up from 15.5 the year before.

“The disparity between us and the rest of the nation is getting worse," said Dr. Arthur James, an obstetrician and gynecologist at Ohio State University’s Wexner Medical Center, who spoke to about 900 attendees at the Columbus summit.

Infant mortality is a measure of the number of infants who do not reach their first birthday. Ohio had 1,088 infant deaths in 2011.

HPIO releases Ohio Access Basics

At its forum this week titled "Coverage and Beyond: Understanding how coverage and access to care impact Ohioans," the Health Policy Institute of Ohio released its latest policy brief, Ohio Access Basics (pdf, 28 pages).

Modeled after HPIO's Ohio Medicaid Basics, the paper provides an overview of access to health care in Ohio. Among the topics covered in the paper are health insurance, barriers to access, oral health access, mental health access, health disparities and a description of the health care safety net in Ohio.

HPIO also has posted all of the presentations from the access forum on its website at www.hpio.net/events. Presenters at the event included Alan Weil, Executive Director, National Academy for State Health Policy (NASHP); John McCarthy, Ohio Medicaid Director; Dr. Sharon Hull, Professor, Family and Community Medicine at NEOMED and Medical Director of the Patient-Centered Outcomes Research (PCOR) Collaborative; and Angela Cornelius Dawson, Executive Director, Ohio Commission on Minority Health.

To learn more about HPIO's work related to improve access to health care for all Ohioans, visit www.hpio.net/access

Census study: Americans visiting doctors less than a decade ago

New national data from the Census Bureau found that working-age adults in the U.S. visit doctors less than they did 10 years ago (Source: "Doctor Visits Dropping, New Census Figures Show," New York Times, Oct. 2, 2012)

According to the report (pdf, 16 pages), people age 18 to 64 made an average of 3.9 visits to doctors, nurses and other medical professionals in 2010, down from 4.8 visits in 2001.

The report also found that non-Hispanic blacks were more likely to report their health as fair or poor (12.8 percent) compared with Hispanics (8.5 percent) or non-Hispanic whites (10.3 percent).

Study: Rate of ED use similar for those with Medicaid, private insurance

A new national study has found that while Medicaid patients visit emergency department at twice the rate of privately insured, their visits are typically for perceived emergencies, countering a common belief that poorer patients overuse EDs for routine care, the study's authors contend (Source: "Poor aren’t misusing ER, study finds," Reuters via Columbus Dispatch, July 12, 2012).

The study, conducted by the Washington D.C.-based Center for Health System Change found that one in 10 Medicaid patients used an emergency room for non-urgent care, compared with about 1 in 14 for patients with private insurance.

“If you picked a Medicaid recipient and a privately insured patient out of an (emergency department) waiting room and asked them both why they were there, the likelihood that they described symptoms we would call non-urgent is pretty similar,” said Emily Carrier, a researcher for the center.

The study also found that the reason Medicaid beneficiaries have higher ED use is the "well-established health-status differences with privately insured adults: higher illness burden, greater illness severity and higher rates of severe disability," according to the study.

Study: More Ohioans, Americans have unmet health needs due to cost

A news study by the Urban Institute found that nearly 1.3 million non-elderly Ohioans in 2010 reported having unmet health needs due to cost, an increase of 4.5% since 2000 (Source: “Nearly every state showed health access declines in 2010,” American Medical News, May 21, 2012).

Nationally, the share of adults 18-64 with unmet medical needs because of cost increased 20 percent from 2000 to 2010, according to the Robert Wood Johnson-funded report titled “Virtually Every State Experienced Deteriorating Access to Care for Adults over the Past Decade.”

The report found that adults without health insurance were much more likely to have a cost-related unmet health need. The study found that in 2010, 48.1 percent of uninsured adults fell into that category, compared to 11.2 percent of insured adults.

The Health Policy Institute of Ohio has identified “ensuring access to care for all Ohioans” as one of its four strategic objectives for informing health policy development in Ohio. HPIO has begun organizing and hosting a multi-stakeholder Health Access Collaborative that is exploring and advising policymakers on a wide variety of issues related to ensuring access to care for all Ohioans. The collaborative’s initial focus is on coverage and affordability, and ensuring a diverse and sustainable health workforce.

If you have questions about HPIO's health access work or would like more information, please contact Mary Wachtel at 614.224.4950 x307 or mwachtel@hpio.net.

Study: Scioto County men have lowest life expectancy in Ohio, Geuaga women the highest

A new national study of life expectancy at the county level found that men in Scioto County have the lowest expectancy of anyone in Ohio (Source: “Study: Scioto men have lowest life expectancy in Ohio,” Portsmouth Daily Times, April 24, 2012).

According to the study by the Institute for Health Metrics and Evaluations at the University of Washington, the average life expectancy of Scioto County men has increased from 69.7 in 1989 to 71.2 in 2009, but was still the lowest in the state. The southern Ohio region rounded out the bottom five in the state, with Pike County men reporting 71.3, Jackson men at 71.4, Adams men at 71.7, and Vinton and Meigs counties men tied at No. 5 with an average life expectancy of 71.8.

Geauga County women had the highest life expectancy (83 years) in the state, followed by Delaware County women at 82.2 years, Wood County women at 81.7 years, Hancock County women at 81.6 and Putnam County Women at 81.5 years.

Commonwealth study ranks Kettering best in state for health care

A new Commonwealth Fund study ranking 306 local areas in the United State based on the quality of health care concluded that Kettering is the best in Ohio (Source: “Health care in Kettering ranks best in the state,” Dayton Daily News, March 14, 2012).

Similar to the Commonwealth State Scorecard, the first-ever local scorecard ranks areas based on 43 indicators in four categories: access; prevention and treatment; costs and potentially avoidable hospital use; and health outcomes.

Of the 306 areas ranked, the Kettering area ranked 85. The next-highest-ranked Ohio area was Toledo at 124 and Akron at 132. Columbus and Youngstown were the lowest ranked areas in Ohio, at 207 and 219, respectively.

“The reality is every region, even the highest performing regions, have opportunities to improve and those opportunities differ,” said David Radley, lead author of the report.

Commonwealth report offers suggestions for sustaining, improving safety net hospitals

A new report from the Commonwealth Fund Commission on a High Performance Health System outlines strategies for increasing the financial sustainability of safety net hospitals and for improving the quality of care they provide (Source: “Can safety net hospitals be saved? New report offers some suggestions,” MedCity News, March 8, 2012).

According to the report, “Safety-net hospitals play an indispensable role in providing care to vulnerable populations. Yet, in the current economic environment, many safety-net hospitals face dire financial circumstances and struggle to provide care to growing numbers of low-income, uninsured, and Medicaid patients.”

Among the strategies outlined in the report are:

• Increasing Medicaid payment rates based performance
• Better targeting Medicare and Medicaid Disproportionate Share Hospital (DSH) payments to hospitals that serve uninsured patients
• Increasing support for safety-net hospitals’ access to capital

Ohio ranked 46th in Gallup Well-Being Index

Gallup has released its annual report of health and well being of state and local populations and Ohio has slipped from 45th to 46th in the nation (Source: "Report: Ohio near bottom in well being rankings,” Dayton Business Journal by Laura Englehart, Feb. 29, 2012).

The rankings are tabulated using state-level data based on daily surveys that measures factors such as work environment, health care access and emotional and physical health. The only states ranking lower than Ohio are Alabama, Arkansas, Missouri, Florida, Tennessee and Nevada. Hawaii was ranked No. 1, followed by North Dakota, Minnesota, Utah and Alaska.

According to the state report for Ohio (pdf, 17 pages), the highest ranked metropolitan area in the state is Cleveland, Elyria and Mentor, which is 103rd nationally. Toledo is the metro area with the lowest overall ranking at 161st.

Cincinnati hospital initiative aims to identify racial disparities

In the past year all of the major health systems in Cincinnati have trained registration staff to ask patients to self-report their race, ethnicity and language, in an effort to identify potential gaps in care for certain racial and ethnic groups (Source: “Effort under way to identify, address unequal care,” Hamilton Journal-News, Dec. 11, 2011).

The Greater Cincinnati Health Council initiative, called Cincinnati Expecting Success, first started at the end of 2009 and soon is expected to be expanded to physician practices. It is part of the Robert Wood Johnson Aligning Forces for Quality work being done in Cincinnati.

“We as a nation are aware there are health disparities. Cincinnati as a community wants to address it,” said Emily Seitz Pawlak, Mercy Health divisional director of patient access. “It’s all about at the end of the day providing culturally competent care.”