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First State Health System Scorecard Finds Mixed Picture for New Jersey, Many Opportunities to Improve:New Jersey ranks 26th overall - ranking 16th on quality, but 46th on cost and avoidable hospital use

Date

June 12, 2007

New Brunswick, N.J. - A new comparison of health care performance across the states paints a mixed picture for New Jersey and points to significant opportunities to improve.

The report, Aiming Higher: Results from a State Scorecard on Health System Performance, was supported by a grant from The Commonwealth Fund, a New York-based philanthropy, and compared each state to real world benchmarks for what has been achieved in states across the country. Co-authored by investigators at the Center for State Health Policy (CSHP) at Rutgers, The State University of New Jersey, and issued by The Commonwealth Fund Commission on a High Performance Health System, the scorecard is the first report to assess on a state by state basis how the health system is performing.

The report ranks states on 32 indicators grouped in five categories that include access, quality, avoidable hospital use and cost, equity and healthy lives. Overall, New Jersey ranks 26th on the State Scorecard, below its neighbors Connecticut (7th), Delaware (14th), Pennsylvania (15th) and New York (22nd).

New Jersey does very well on many quality indicators, but ranks near the bottom on avoidable use of expensive hospital care and high health care costs. The state shows just average performance on access, equitable care and healthy lives. "New Jersey's story is one of unmet potential, said Joel Cantor, Scorecard lead-author and director of the Rutgers' CSHP. "Our high costs and just average rates of health coverage are barriers to doing better."

Quality: Positive Picture with Room to Do Better

New Jersey achieves its best scores in quality of care, ranking 16th. The only indicators on which New Jersey ranks at the very top of states measure quality of care provided to hospitalized patients.

Across the life span, other quality indicators for patients outside the hospital are more mixed:

  • Only 42.5 percent of adults (age 50+) receive comprehensive screening and preventive services in New Jersey, paralleling the poor performance on this indicator nationwide.

  • High-risk nursing home residents in New Jersey are more than twice as likely to experience dangerous pressure sores (18.4 percent) than those in the best performing state (North Dakota, 7.6 percent).

  • Only 42 percent of New Jersey diabetics receive care recommended to keep that chronic disease in check, well below the best performing state at 65.4 percent (Hawaii).

  • New Jersey ranks near the bottom on the share of children at risk for mental health problems who receive mental health services, with only 58.7 percent of at-risk children receiving care in New Jersey.

    Cost and Avoidable Hospital Use: New Jersey Lags

    New Jersey's poorest showing is on indicators of avoidable hospital use and cost, where it ranks 46th. "We rely to an extraordinary degree on expensive hospital care compared to other states," said Cantor, "and we have the highest health care costs in the nation by key measures."

  • Medicare spent an average of $8,076 per enrollee in New Jersey in 2003 - the highest in the nation and nearly twice the lowest-cost state.

  • At least some of New Jersey's high Medicare costs are due to extensive use of hospital care for conditions that should often be effectively treated without hospital admissions. For instance, nearly one in four nursing home residents in New Jersey is hospitalized in a year, compared to 16 percent in the median state.

    Access, Equity and Healthy Lives: Middle of the Pack

    With its ranking in the middle of states on indicators of access to care, equitable care and healthy lives, the scorecard points to other areas where New Jersey has the great potential to improve:

  • New Jersey ranks 25th on access to care - with only average rates of health insurance coverage for adults and children. New Jersey's high proportion of immigrants, many of whom are not eligible for public coverage, and high health care costs raise challenges to improving access. Still, access in New Jersey falls short of that achieved by other high-income states.

  • New Jersey ranks 22nd in achieving equity for low income, uninsured and racial/ethnic minorities across 11 indicators of performance in the report.

  • New Jersey ranks 28th on a composite of five measures of healthy lives. The New Jersey death rate under age 75 for conditions amenable to medical treatment was 98.5 per 100,000 persons, just below the national average of 103.3 but well above the rate in the best state of 70.2 per 100,000 (Minnesota).

    Opportunities to Improve for New Jersey

    The scorecard points to substantial gains if New Jersey could reach levels achieved by the top performing states on key indicators:

  • There would be 2,300 fewer deaths in New Jersey before the age of 75 annually from conditions amenable to health care.

  • More than a half million uninsured adults and children in New Jersey would have coverage.

  • More than 100,000 adult diabetics in New Jersey would receive basic recommended care, helping to avoid renal failure and lost limbs.

  • Nearly 200,000 adults age 50 or older in New Jersey would receive essential preventive care.

  • Tens of thousands hospital admissions and readmissions would be prevented in New Jersey, savings millions of dollars.

    Patterns Across all of the States

    Clear patterns emerge in scorecard indicators across the states and among indicators:

  • Regional patterns. While no single state performed at the top across all categories, some states far surpassed others. States in the Northeast and Upper Midwest often rank high on multiple areas. In contrast, states with the lowest rankings are concentrated in the South. New Jersey stands out as performing below other states in the Northeast on many indicators.

  • Access and quality are connected. Across the country, the scorecard found that states that did well on access to care were also more likely to do better on quality of care.

  • High cost doesn't equal high quality care. Researchers found no systematic connection between high spending and high-quality health care. Some states achieve high quality at relatively low costs.

  • Opportunities to improve nationally. The scorecard points to the substantial gains for the nation if all states could reach levels achieved by the top performing states.

    "The report shows the need for action in four key areas: expanding health insurance to all; having better information systems to assess performance and guide change; analyzing the key factors that contribute to state variations; and national leadership and collaboration across public and private sectors," said Scorecard co-author and Commonwealth Fund Senior Vice President Cathy Schoen, "In addition, the report underscores opportunities for states to look to each other, as well as models of excellence within their own borders, to inform efforts to improve."

    Contact: Steve Manas

    732-932-7084, Ext. 612

    E-mail: smanas@ur.rutgers.edu

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