The Commonwealth Fund’s recent ranking of state health system performance found Georgia’s overall rank had fallen from 35th nationally to 45th between 2009 and 2012. The decline is largely a consequence of the recession, and it shines a light on the frailty of our health care system.
The recession led to lower employment, lost income and a reduction of resources. It reduced access to affordable, available and appropriate care.
Georgia fell in every category of health care the Commonwealth Fund assessed except “prevention and treatment,” where it rose from 45th in the nation to 43rd. The state’s ranking fell in “access and affordability,” “avoidable hospital use,” “equity” and “healthy lives.”
The low ranking is explained in part by poor health habits. Twenty percent of Georgians smoke, 29 percent of adults are obese and 35 percent of children are overweight or obese.
The recession reduced employment and income, which resulted in fewer Georgians with private health insurance , fewer private and public resources for preventative health care, and reduced access to care. The percentage who were uninsured increased from 2008 to 2012. Fewer adults had a usual source of care, and fewer children reported having a medical home. Adults were more likely to put off care because of cost.
The recession has made health care less affordable and highlighted the scarcity of availability. As many as 20 percent of Georgians live in health workforce shortage areas. Georgia ranks 39th in physicians per capita. It has fewer primary care physicians per capita than any surrounding state except Alabama. It’s also among the 12 states with the most restrictive laws that limit scope of practice for mid-level providers who could help meet the demand for primary care.
The consequences of limited access to care are stark: Georgia ranks 42nd in avoidable deaths, 39th in years of life lost, 43rd in breast cancer deaths and 38th in infant mortality. The Commonwealth Fund estimates that if the state’s health system performed as well as the best state, there would be 4,300 fewer deaths annually, and almost 50,000 fewer emergency room visits for Medicare patients. More than 1 million adults and 400,000 children would have a usual source of care.
There is ample evidence that health care in Georgia and the nation is inefficient and expensive. A key element in improving care is to increase access. The Affordable Care Act provides an opportunity to increase access to care, but it will require action at the state level to improve Georgia’s health care system.
Professor Bill Custer oversees the Center for Health Services Research at Georgia State University.
