State sees progress on health
Tennessee’s uninsured rate falls to 15 percent
Tennessee has made gains in more than a dozen measures related to health, according to an analysis by the Commonwealth Fund. But the Volunteer State still ranks among the least healthy places in the U.S.
Among the 16 measures in which Tennessee improved, the largest gains came in improving the number of home health patients who got better at walking around, along with meeting benchmarks related to prescription use for Medicare and long-term nursing home facilities, according to the Commonwealth Fund’s 2017 Scorecard on State Health System Performance.
The state’s performance improvement set it above most other states, but the findings underscore how much more attention both health and health care need. The state ranked 44th.
People’s health is affected by more than prescriptions, doctor visits or coverage by health insurance, and there are many initiatives around the state that are trying to
make a dent in the poor medical marks the state routinely gets.
Often, though, improvements are made through a combination of health care and environmental initiatives, said Melinda Buntin, chairwoman of the Department of Health Policy at Vanderbilt University School of Medicine.
Infant mortality, she said, can be lowered through programs addressing housing and other factors as well as through health care access that helps keep women in better shape before pregnancy.
The Metro Public Health Department in Nashville is trying to tackle disparate rates of infant mortality across the city through a variety of initiatives. The state saw no marked improvement or worsening of infant mortality from 2012 to 2013, when there were 6.8 deaths per 1,000 births, according to the Commonwealth report.
The state’s uninsured rate fell, as did the number of people who put off doctor visits because of cost. But Tennessee did not see as much improvement as Kentucky, which expanded its Medicaid program under the Affordable Care Act.
In Tennessee, 16 percent of adults went without care in 2015 because of cost — down from 18 percent in 2013. The Bluegrass State saw a 7 percent decrease in the same time. In 2015, 12 percent of adults in Kentucky forewent care because of cost.
Kentucky outpaced Tennessee’s improvement by six measures, and saw more positive results in many of those. From 2013 to 2015, Kentucky’s uninsured rate fell from 21 percent of adults aged 19-64 to 8 percent. Tennessee, comparatively, fell from 20 percent to 15 percent.
The difference, said Sara Collins, vice president of health care coverage and access at Commonwealth Fund, is Kentucky’s approach to the options for providing coverage under the ACA.
The Commonwealth experts are concerned that improvement will stall in states under a drastic change to health policy direction. The Congressional Budget Office analysis of the current proposal by House Republicans brings some reversals in the future, Collins said.
“I think the burden of proof is on legislators who would propose to change the Affordable Care Act to show the changes … will preserve the gains that have been made,” said David Blumenthal, president of Commonwealth Fund.
Tennessee also had fewer adults under age 64 who had lost six or more teeth in 2014 than 2012. There were also fewer deaths from breast cancer in women.
The scorecard indicates some improvement in reducing readmission to hospitals — which is increasingly an industry focus.