Published by: John Oswald on 6/2/2011 9:46:33 AM
In all of the different rankings of states and counties in terms of their health status and health care services, it has been somewhat unclear as to what the role of public hospitals or safety net hospitals has in impacting the “performance” of the health care system where they are located. To assess performance, there is a major emphasis on hospitals measuring quality of care and efficiency of care.
There is a great deal of discussion about how hospitals can improve the health of the population in the community where it is located. Out of these kinds of measures, models have been developed to assess the relative effectiveness of health care organizations, including hospitals, other providers, payers and even purchasers.
The graph below, which was in a recent Commonwealth Fund Report on High & Low Performance Health Systems, caught my eye. It attempts to show the relationship between the type of hospitals in a given state and the overall performance of the health system in that state.
Looking at the graph above, the bottom line is that states deemed to have the top performing health systems also have the larger percentage (95.7%) of state/local government-owned or community non-profit hospitals. Conversely, the lowest performing states have a much lower percentage of hospitals (68.1%) that are state/local government-owned or community non-profit hospitals.
This same relationship holds true for nursing facilities with 47.6% for the top states and 24.8% for the lowest states as the percentage of all nursing facilities being state/local government-owned or non-profit. In contrast, there is a much weaker relationship between hospitals in highly-integrated systems vs. those who are not.
So, what is happening? It seems that public hospitals and community non-profit hospitals are part of an underlying medical and political culture in high-performing states of a strong role of state government and extensive community-based collaboration. Along these same lines, the Medicaid benefits and the funding of public health are additional characteristics of high-performing states.
The overall conclusion is that public hospitals and community non-profit hospitals are synergistic with the overall medical/political culture of high-performing states. To some degree, they seem to directly contribute toward a states’ high-performance through long-term efficiencies, equity and quality of care. To a significant degree, the support of public hospitals and community non-profit hospitals in the state are a result of other underlying and related factors of the role of government and extent of community collaboration.
A final note is that future analyses of these data would be useful to separate out the community non-profit hospitals from the hospitals that are state/local government owned. These data would be available through NAPH and AHA databases. Presumably both types of hospitals would be positively associated with high-performance states, but it would be important to confirm that assertion.
When I mentally carry around in my head a top 5 or top 10 list of findings about public hospitals, this graph will certainly be one of them.