North Carolina is the second to worst state in the country, including the District of Columbia, for healthcare based on a survey released by Wallet Hub on August 5.
The report used data from numerous sources including the U.S. Census, Centers for Disease Control and the Centers for Medicare & Medicaid Services to evaluate healthcare in each of the 50 states and the District of Columbia. The data was then assessed in three categories — cost, access, and outcomes.
Costs
The study looked at several aspects of healthcare costs for consumers. Costs of medical visits, hospital expenses, dental visits and monthly insurance premiums were all reviewed. The survey also considered out-of-pocket expenses and the number of adults who do not go to a doctor because of those costs. North Carolina ranked 50th, the second to the worst in the country for costs for patients.
Access
North Carolina also ranked 50th in the country for access to quality healthcare. The survey looked at data that included quality of the public hospital system, number of beds available per capita, wait times and transfer times for patients. It also looked at the number of physicians, nurses, specialists, and urgent-care center availability. The “access” portion also considered the number of adults and children who were covered by health insurance.
Outcomes
North Carolina came in 33rd for outcomes in the study. To determine each state’s rank, the study considered infant, child, and maternal mortality rates as well as the share of patients readmitted to hospitals. Life expectancy, cancer incidence, heart disease and Type 2 Diabetes rates were also considered.
When all the data was reviewed, the study determined that North Carolina was 50th out of 51 overall.
What needs to be done
The study involved asking several experts their views on the state of healthcare and what can be done to improve the outcomes and reduce costs for more Americans.
Carolyn A. Watts, Ph.D., is the Richard M. Bracken Chair and Chairman, Department of Health Administration, College of Health Professions, at Virginia Commonwealth University and believes that more options for health insurance will help communities that are lower on the list.
“Clearly residents without exchange options are made worse off by having few choices,” she said. “At present, the ACA provides some consistency in the benefit package that all plans must offer, but there can still be (and is) wide variation across plans in premiums, cost sharing, and covered providers in addition to such basic factors like customer service. With little to no competition among plans, consumers in these areas must either take what is offered by the remaining plan, find coverage off the exchange if it is available (which would mean giving up any subsidy for which the individual would be eligible through an exchange plan), or going without coverage.”
Watts notes that a report from the Kaiser Family Foundation found that 17 percent of enrollees in 37 percent of U.S. counties had only one option using the exchange while the number of providers on the exchange fell as well.
“The future of these markets will remain volatile as long as federal and state policy surrounding the ACA remains uncertain,” Watts said. “Every policy change that alters the incentives for consumers to purchase insurance changes insurers’ risk pools, which changes their decisions about premiums and market participation, and perpetuates/exacerbates the churn in the small group insurance market that the ACA hoped to reduce.”
Linda V. Green of Cain Brothers & Company Professor of Healthcare Management, Columbia Business School, Decision, Risk and Operations Division believes that consumers need to be informed and aware of what they are spending in order to reduce the costs.
“Aside from having comprehensive health coverage, one of the most important things a person can do is to question the need for any office visit, hospitalization, imaging, lab work, or procedure being recommended by their physician,” Green said. “It is well-known that there is a huge amount of overuse and waste in healthcare, based on evidence-based standards of care. Much of this is due to physician habits, the profit motive, and a disregard for the costs involved due to third party payment.
“Some of this is due to patients insisting on getting some treatment, e.g. an MRI for back pain or an antibiotic for a viral infection, that is highly unlikely to result in better clinical outcomes and can actually result in more harm than good, e.g. incidental, benign finding in the first case and an increase in antibiotic resistant bacteria in the latter case,” she said.
Stephen F. Gambescia, Ph.D., MEd, MBA, MHum, MCHES, a Professor with College of Nursing and Health Professions at Drexel University believes that healthcare reform is needed to improve the costs and outcomes for residents.
He believes substantial changes will be required to have “real reform” in healthcare. Among his ideas are the belief that the country needs to “dump insurance companies” because “health care and health insurance are two different activities” where we should pay more attention to providers rather than health insurance rules and regulations. He also believes that employers should get out of the business of healthcare because “when our property (labor) is linked, even tacitly, to our person (health care of), we abdicate control to our employer, and thus we misuse an inalienable right.”
Reporter Casey Mann can be reached at CaseyMann@Chathamnr.com.