Vermont leads the nation in the delivery of its health care, while Mississippi is rated the worst, according to a non-partisan study that compares all 50 states and the District of Columbia.

Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire ranked 1 to 5 in 38 indicators of health care.

At the bottom were Mississippi, along with Oklahoma, Louisiana, Arkansas, Nevada and Texas.

The Commonwealth Fund Commission’s “Scorecard on Health System Performance,” rated the states on access, quality, costs and health outcomes in a follow up to their 2007 report.

Overall, the states which did best on the Commonwealth scorecard were in New England and the upper Midwest, and the worst states were in the South.

Vermont, with only 640,000 residents, has nearly universal health care coverage with 93 percent insured. Its innovative “Blue Print for Health” focuses on prevention of chronic diseases.

“We’re small. There are 19 cities larger than the state of Vermont,” said Susan Besio, director for health care reform and Medicaid for Vermont.

“But I believe there is something unique about Vermont in terms of its culture,” she told ABCNews.com. “We want to take care of each other and we are a healthy state.”

In Mississippi, however, about 20 percent are uninsured despite having some of the highest rates of hypertension, diabetes and asthma.

According to the report, only 35.7 percent of adults 50 or over in Mississippi receive recommended screening and preventive care.

“When you compare Mississippi on almost any socio-economic profile, we are a struggling population that has a large percentage of low-income individuals, high unemployment rates, low rate of education,” said Robert Pugh, director of the Mississippi Primary Health Care Association.

The scorecard “paints a picture of health care systems under stress, with deteriorating health insurance coverage for adults and rising health care costs,” according to co-author Cathy Schoen, who is senior vice president of the commission.

“Where you live matters for access, quality of care and whether you live a long and healthy life. These wide and persistent gaps among states highlight the need for national reforms and federal action to support states.”

For example, 32 percent of working-age adults in Texas are uninsured, compared to only 7 percent in Massachusetts in the most recent survey.

“It’s very hard to have a high performing health care system and hospitals that do well for everyone if you have a high rate of uninsured in the state,” said Schoen.

In 1999-00, there were only two states with 23 percent or more of adults uninsured. But by 2007-2008 there were nine.

Children fared much better, due in large part to the Children’s Health Insurance Program (CHIP) under Medicaid. The number of states with 16 percent or more of children uninsured dropped from nine to three during the same time period.

Other findings of the report were that in a, costs rose and quality improved in areas where outcomes were reported to the public.

Vermont’s ‘Blue Print For Health’ A Model

The Green Mountain state was cited for its model “Blue Print” program. Launched by Republican Gov. Jim Douglas, it covers everything from teaching children healthy eating to helping seniors stay in their homes rather than going to costly nursing homes.

“You betcha, I feel good about the reforms we put in place,” Douglas told ABCNews.com. “It’s centered on quality and containing costs. Care shouldn’t start in the emergency room.”

All Vermonters are encouraged to have yearly exams and adults are notified when they are due for check-ups.

Douglas talks to children about “getting off the couch” and set an example just this week by joining elementary students on a walk to school.

With the second oldest population in the nation, Vermont subsizes care for seniors and the disabled to defray the costs of home care. Nursing home beds were reduced by 200 last year.

In one pilot program, electronic medical records can avert expensive tests like MRIs and x-rays. One emergency room doctor seeing a woman with stomach pains discovered in her online medication history that she had not filled her prescription for ulcer medicine.

“It takes time and so a lot of the fruits come from years of work and planning and cooperation,” said Douglas.

Health Care Affects a State’s Economy

But Mississippi, with the highest infant mortality and low birth rates in the nation, makes access to these Medicaid programs more difficult, according to Roy Mitchell, director of the Mississippi Health Advocacy Program (MHAP).

“I am not at all surprised we were 51st on the list,” he told ABCNews.com. “We are last on several health indicators. Our policy makers work hard at being last.”

Despite one of the highest matches of federal to state dollars in Medicaid funding, the state mandates “face-to-face” eligibility, requiring all new applicants and those reapplying for benefits to come in for an interview.

“As a direct result, 65,000 children have fallen off the rolls,” Mitchell said.

“Mississippi does virtually no outreach at all. They don’t publish where these face to face stations are and what times,” he said. “It’s a bureaucratic maze even to find out where to go. And when they get there they don’t have a certain document.”

Of those, about 77 percent would be eligible, he said. “It’s touted as fraud prevention.”

These disparities between the highest and lowest ranked states could be alleviated with national reform, according to Commonwealth.

The report emphasizes the need for insurance reform that rewards good outcomes, payment reform with an emphasis on prevention and advanced information systems that travel with the patient from physician to physician, saving time, money and preventing errors.

“What the scorecard is showing is that we have a system under stress, no matter where we live,” said co-author Schoen. “The costs are rising more than people’s incomes. We need to act.”

Schoen said she has hope for reform. “There is real leadership and people are taking reform seriously.”

Source: ABC News

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The rising cost of health care in the United States is forcing an increasing number of U.S. citizens to turn their sights on Mexico for expert and cost-effective medical attention. But what about the health care for the elderly Americans who are already residing in Mexico? Should they be covered by Medicare in Mexico or should they have to fly back to America every time they need major medical care? Can the medical care providers in Mexico be trusted with the health of American seniors? Here’s an excellent read that recently appeared in a Mexican newspaper.

According to Paul Crist, the founder and president of Americans for Medicare for Mexico (AMMAC), a non-profit organization dedicated to bringing Medicare coverage to seniors living in Mexico, of the 800,000 American citizens living in Mexico approximately 200,000 are over 60 years old and thus are at or near eligibility for Medicare benefits.

Christ has lobbied 85 members of the U.S. Congress and prepared a 34-page proposal in which he outlines the pros of extending Medicare to Mexico. Medicare is now spending 6,700 dollars per year per beneficiary in the United States. For the same care in Mexico, Crist estimates that it will spend only 3,400 dollars, which translates to a very substantial saving.

Crist says that if Medicare is extended to Mexico, the program would only work with health care providers approved by JCI.

Although the health sector in Mexico is regulated and certified by the Mexican General Health Commission, the task of getting JCI certification for Mexico’s private hospitals is of prime importance.

One of the main reasons for pushing for certification is that the North American Free Trade Agreement or NAFTA obligates the Mexican medical system to be on a par with the United States and Canada, allowing for the free flow of patients from border to border and for fair trade, much like in other economic sectors.

But there is another huge reason for this interest in JCI certification and that is Medicare.

Crist revealed that ten hospitals in Mexico have JCI accreditation but another 23 are seeking approval. Among those already approved are the American British Padre Hospital and the Santa Fe Hospital in Mexico City and the Christus Muguerza Hospital and the Hospital Tec de Monterrey in Monterrey.

The approval of Medicare would greatly benefit hospitals such as Christus Muguerza, a Texas chain that now has seven hospitals under construction across Mexico. They have the advantage because their headquarters is in Texas, which gives Medicare a bit more confidence in the quality service they are going to provide.

In a recent interview with Forbes magazine, David Warner, a professor of health care policy at the University of Texas at Austin and a specialist on Medicare in Mexico, stated that an in-depth pilot project is needed to better understand the economics, determine whether Mexican heath care meets Medicare’s quality standards and determine if the payment system is sufficiently free of fraud.

According to Forbes, the U.S government is concerned that creating a Mexican medical exemption might be too complicated and costly to implement and would open the door for Americans in other countries.

Crist figures that if Medicare were accepted in Mexico, the 64 percent of American retirees currently flying back to the United States for expensive care would opt for treatment nearer their homes, cutting Medicare overall costs by a minimum of 22 percent.

Source: Guadalajara Reporter

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