Hawaii’s health system performance ranked best in nation

The Commonwealth Fund recently released the 2018 Scorecard on State Health System Performance, which analyzed more than 40 measures of health care access, quality, efficiency, health outcomes and disparities.

Hawaii ranks first in the nation overall. The state is also ranked either first or second in four of the five major categories.

Baseline scores are based off data from 2012 and 2013, with a few outliers. The 2018 scores are based off data from 2015 and 2016, with a few outliers.

For health system performance indicators, Hawaii ranks best in the nation in:

  • Adults who went without care because of cost
  • Employee health insurance contributions as a share of median income
  • Central line-associated blood stream infection (CLABSI)
  • Nursing home residents with an antipsychotic medication
  • Adults with any mental illness reporting unmet need
  • Potentially avoidable emergency department visits
  • Admissions for ambulatory care–sensitive conditions
  • Long-stay nursing home residents with a hospital admission
  • Total Medicare (Parts A & B) reimbursements per enrollee
  • Adults who have lost six or more teeth

Hawaii scores above the national average for all indicators in Healthy Lives, Avoidable Hospital Use & Cost and Access & Affordability, but has several scores well below the national average in Prevention & Treatment.

Hawaii ranks 30th for children without all components of a medical home, 42nd for children who did not receive needed mental health treatment, and 37th for hospital patients discharged without instructions for home recovery.

The state also ranks 46th for home health patients without improved mobility and 49th for adults with any mental illness who did not receive treatment. But, both of these measures saw improvement from the baseline data.

Hawaii did see some areas worsen, including employee health insurance contributions as a share of median income, hospital 30-day mortality and infant mortality.

Hawaii also has areas to improved in health disparity indicators despite being ranked best in the nation. The Commonwealth Fund defined disparity as the difference between the state’s low-income (under 200% of federal poverty level) and higher-income populations (over 400% of the federal poverty level).

The disparity indicators where Hawaii worsened compared to the baseline data are:

  • Adults without a usual source of care
  • Adults without all age- and gender-appropriate cancer screenings
  • Adults who smoke
  • Adults who have lost six or more teeth
  • Adults who report fair/poor health

With the exception of adults without appropriate cancer screens, where Hawaii ranks 47th, the state still ranks above the national average for these indicators.

The complete data set for Hawaii can be viewed here and the entire report can be viewed here.