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Editorial: States face a challenge in closing health care gap

Sep. 19, 2013 @ 12:03 AM

Not surprisingly, West Virginia and Kentucky have fared poorly in a new health study released this week, this one focused on how well low-income people are served.

The report, "Health Care in the Two Americas," was done by The Commonwealth Fund, a private foundation based in New York City that works to promote a high-performing health care system. It compared all 50 states and the District of Columbia to determine how they do in serving the health care needs of their total populations and their low-income residents.

To do that, the foundation gathered data related to 30 key indicators in four broad categories: access and affordability, prevention and treatment, potentially avoidable hospital use and healthy lives.

Overall, the report says a large percentage of the nation's low-income people are either not insured or underinsured. That means a lack of timely, affordable access to care, especially primary care, undermines health outcomes and contributes to higher medical costs. The variation in health-care performance varies more greatly among low-income groups than among higher-income people, according to the report.

Among the states and the District of Columbia, the study ranked West Virginia 41st and Kentucky 46th. Ohio did a little better, ranking 34th.

In line with other studies in recent years, both West Virginia and Kentucky lagged in the "healthy lives" category, which included such indicators as the percentage of people who smoked tobacco, were obese and reported they had fair to poor health, at least 14 bad mental health days and limitations on activity.

In West Virginia's case, the state ranked rather well in the percent of adults who had insurance coverage of some type, but cost was still a factor in causing a higher-than-average percentage of people to forego health care.

Both West Virginia and Kentucky also ranked at or near the bottom in the category of "potentially avoidable hospital use," which included eight indicators of hospital use, such as emergency room care, that might have been prevented or reduced with timely and effective care and follow-up care.

The report noted that states ranked at or near the bottom all have poverty rates among the highest in the nation, and that certainly includes West Virginia and Kentucky.

There are signs of hope. Both of those states plan to expand Medicaid coverage to more low-income people as part of the Affordable Care Act, which means hundreds of thousands of their residents will become eligible for health care coverage. That should make health care accessible to many more lower-income people.

Both states also have launched efforts to try to tackle the "healthy lives" shortcomings listed in the report by encouraging people to give up habits harmful to their health and become more active.

Beyond that, however, officials in West Virginia and Kentucky may want to take a look at states where income levels have proven to be less of a divide in the quality of health care services and outcomes. The report notes that several states have a far better record in this regard, and they may have structures in place that can be emulated.

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