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In the United States, where a person lives determines the kind of health care available and the length and quality of life a person is likely to enjoy. The 2014 edition of The Commonwealth Fund’s Scorecard on State Health System Performance1 documents persistently wide geographic disparities, with some states consistently performing better than others on the scorecard’s 42 indicators of health care access, quality, efficiency, and outcomes (eFigure 1 in Supplement shows the 50 states and the District of Columbia ranked by quartile on a composite score aggregated from the 42 indicators of health system performance, using the most recently available data typically representing the year 2011 or 2012, or both). The scorecard reveals that performance either declined or failed to improve during the 5 years up to 2012 in the majority of states on two-thirds of the 34 indicators with trend data (eFigure 2 in Supplement shows the number of states and the District of Columbia in which performance improved, stayed the same, or worsened over a 4- to 5-year time span for each of the 34 trending indicators). The findings are sobering in their portrayal of a geographic divide among state health systems. No state is making widespread progress toward the achievable outcomes that all individuals should expect considering the substantial and increasing resources devoted to health care in the United States.
McCarthy D, Schoen C, Radley D. State Health System PerformanceA Scorecard. JAMA. 2014;312(2):131–132. doi:10.1001/jama.2014.5374
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