New York does a good job of providing access to health care for all, but doesn’t do as well when it comes to keeping health care spending down, according to a recent report of state health rankings.
Overall, New York’s health care system ranks number 14 among the 50 states and District of Columbia in the Commonwealth Fund’s 2019 Scorecard on State Health System Performance. That’s 10 spots higher than its ranking four years ago.
The rankings look at 47 measures in the areas of access to health care, quality of care, service use and costs, outcomes and income-based health care disparities. The most recent data included is from 2017, though some measures rely on older data.
New York stands out in the area of income-based health care disparities, ranking second in the nation for having the smallest disparities. But the relative lack of economically-based disparities doesn’t mean there aren’t significant geographic disparities in health care, said Steve Wood, director of insurance programs at ACR Health.
“While services are abundant in New York City and other large to mid-metropolitan areas like Albany, Syracuse, Rochester and Utica, providers become scarce in rural regions, which make up the majority of New York state,” he said via email. “Residents of more isolated areas may hold off on medical treatment because of that lack of access, transportation and knowledge of where to seek services. This has a domino effect on the general well being of communities and the state as a whole.
“People wait until they are very sick, or a chronic condition worsens, which then equals larger health care bills.”
By the numbers
New York’s other rankings include seventh in healthy lives, 17th in access and affordability, 26th in prevention and treatment, and 36th in avoidable hospital use and cost. But disparities creep into other areas as well.
The top-ranked indicators in New York included deaths by suicide, obesity among adults and relatively low out-of-pocket medical spending.
The suicide death rate is considerably higher upstate than in New York City. New York State Department of Health data from 2014 to 2016 shows a statewide, age-adjusted suicide rate of 8 deaths per 100,000 residents compared to a rate of 5.9 in New York City and a rate of 9.2 in Oneida County.
And state data puts the age-adjusted adult obesity rate for the state at 25.5 percent, but the rate is lower in New York City (22.9 percent) and higher in the rest of the state (27.5 percent). The rate in Oneida County is 35.4 percent.
New York fared the worst on indicators for the 30-day readmission rate to hospitals for those age 65 and older, for how much employer-sponsored insurance plans spend per enrollee and for the percentage of hospitals with lower-than-average patient experience ratings.
Hospital readmissions within 30 days of discharge are seen as a driver of increased health costs and have been the subject of federal and state programs to keep rates down. As for health plan spending per enrollees, only health plans in Alaska, Wyoming and Wisconsin spent more — a sign, the report’s authors argued, that health care prices are too high.
Increasingly patient satisfaction surveys are being used as a measure that factors into payments to hospitals. But New York hospitals have long fared poorly on these surveys compared to hospitals in other regions.
Wood said he’s seeing some current trends — since the data in the report — that might not bode well for keeping costs down for New York families in the future.
“We’re finding more and more employers not offering family coverage or not offering insurance at all,” he said in an email. “We often have individuals come to us for coverage for their children and/or spouses (one the health plan exchange or through state plans). Cost-wise, this works in their favor many times, but sometimes consumers end up paying more than if they went with their employer coverage.”
Contact reporter Amy Neff Roth at 315-792-5166 or follow her on Twitter (@OD_Roth).