State's annual checkup brings mixed results
Oregon ranks 17th among states for its health system performance, but continues to struggle with low childhood vaccination rates and deaths from suicide, alcohol and drugs.
The Commonwealth Fund’s 2019 Scorecard on State Health System Performance ranked all 50 states plus the District of Columbia on access, quality, service use, cost, health outcomes and income-based health care disparities.
Compared with other states, Oregon has lower rates of childhood obesity, avoids preventable hospitalizations of adults and has low rates of uninsured residents.
Oregon lagged on childhood vaccination rates and hospital mortality, according to the report.
All states continue to struggle with deaths from suicide, alcohol and drugs. Those deaths have been labeled “deaths of despair.”
Oregon has a high rate of deaths from alcohol, a medium rate from suicide and a low rate from drug overdoses compared with other states, the report said.
However, all states are seeing at least 3% growth in deaths from suicide and alcohol, and at least 16% percent growth from drug overdoses, the report said.
From 2005 to 2017, the drug overdose rate nationwide jumped 115%, while alcohol-related deaths climbed 37%, and suicide deaths increased 28%, the report said.
“What we’re seeing is a regional epidemic when it comes to premature deaths from suicide, alcohol and drugs,” said Dr. David Blumenthal, president of the Maryland-based Commonwealth Fund. “It’s going to take solutions that meet local need, and greater cooperation across all sectors — at both the federal and state level — to end the crisis that is shortening life expectancy in the United States.”
Previous research by Princeton professors showed deaths from suicide, drugs and alcohol rose dramatically among middle-aged white Americans without college degrees, reversing previous trends of increasing life expectancy.
The professors documented increasing pain, distress and social dysfunction in the lives of whites with a high school diploma or less. Marriage and labor force participation rates dropped along with a nationwide loss of good-paying blue collar jobs.
Meanwhile, addictive opioid pain pills and heroin flooded America. More recently, dealers have begun lacing a wide range of drugs with the potent and often deadly drug fentanyl.
Blumenthal said fentanyl is a major contributor to rising drug overdose deaths.
When it comes to health insurance premiums, the Scorecard on State Health System Performance said rising costs are putting a burden on working families with employer-based plans.
The average annual cost of health insurance for a family of four in America hit $18,687 in 2017, according to the Kaiser Family Foundation.
The average employee is paying $5,218 of that while the average employer is covering $13,469 of the cost, the foundation said.
For comparison, the annual cost of mortgage payments on a $250,000 house with no down payment is $16,105, according to online mortgage calculators.
The Scorecard on State Health System Performance tracked the drivers of health care spending increases. As spending rises, health insurance costs go up.
Spending on prescription drugs grew faster than other categories of health care, the report said.
Prescription drug spending rose 29% from 2013 to 2017, while use grew only 3%.
The cost of prescription drugs has triggered a wave of bills in Congress and the Oregon Legislature that try to rein in costs.
Lawmakers’ efforts to control costs include pegging prices in America to prices in other industrialized nations, making manufacturers list prices in ads and giving federal and state governments more power to negotiate prices.
“Manufacturers can set prices anywhere they want,” Blumenthal said.
The Pharmaceutical Research and Manufacturers of America trade group argues cost controls stifle innovation and reduce access.
PhRMA says middlemen such as insurers and pharmacy benefit managers aren’t passing along savings from rebates and discounts to consumers.
But many health care providers and lawmakers have been outraged by new drugs that came on the market costing $100,000 for a course of treatment — including certain cancer drugs and a cure for hepatitis C.
The cost of Hepatitis C treatment has since fallen as competitors released their own drugs.
Total spending on outpatient health care, including visits to doctors’ office, rose 19% from 2013 to 2017 while use remained flat, the 2019 Scorecard on State Health System Performance said.
Spending on inpatient care went up 10% during those years even as use fell 5%, the report said.
The report is available at scorecard.commonwealthfund.org.