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Above-average health care spending doesn’t mean higher quality of care

Just because Ohio spends more than average for health care per resident doesn’t mean residents get above-average quality of care, says to Bill Hayes, president of the Health Policy Institute of Ohio. It also doesn’t mean Ohioans are healthier than average.

CLEVELAND, Ohio — Just because Ohio spends more than average for health care per resident doesn’t mean residents get above-average quality of care, says to Bill Hayes, president of the Health Policy Institute of Ohio. It also doesn’t mean Ohioans are healthier than average.

Hayes and some of his staffers visited Cleveland Friday to host a regional forum: What’s New in Ohio Health Policy. During the three-hour forum, Hayes went over results of the 2008 Ohio Family Health Survey (pdf), explained what the results say about the state’s health quality, spending and policies, and tried to put some of the results in the context of a “dismal” state budget for 2010 and 2011.

For instance, the Kaiser Family Foundation found in a 2004 survey the average Ohio resident (and his or her insurers) spend $5,725 a year for health care. That’s about 8 percent above the national average of $5,283 per person.

Yet, Ohio has above-average rates of illnesses such as heart disease, diabetes and depression, according to Improving Ohio’s Health System (pdf), a report put out by the Ohio Business Roundtable in April. As for quality of care, we get fewer preventive care (yearly foot exams for diabetics, for example) than our U.S. brethren, but we get superior care from our hospitals when we’re sick, according to the report.

One conclusion of the roundtable report: Ohio residents are “older and sicker than the U.S. population as a whole.”

So how do we do better? Hayes and his institute suggest increasing access to affordable health insurance and expanding coverage under Medicaid, the federally funded, state-administered health plan for the poor.

To address the coverage issue, Gov. Ted Strickland, with funding from the Robert Wood Johnson Foundation, formed the State Coverage Institute, Hayes said. This institute established two goals:

  1. Reduce the number of uninsured residents in Ohio by 500,000 by 2011.
  2. Increase the number of small businesses able to offer health insurance to their workers.

The coverage institute also recommends that we enroll more uninsured, eligible residents in the Medicaid program, and continue to promote wellness and disease-prevention and management programs, Hayes said.

In November, a diverse group of stakeholders, including Hayes’ institute, met at a summit to develop the Ohio Health Quality Improvement Plan, which was released this month and has yet to be implemented, he said. What emerged was a Vision for Healthy Ohio — a kind of policy road map to optimal health and wellness for state residents.

“To get to this vision, there’s a sense that we need to transform two things in Ohio,” Hayes said. “One is to create an affordable and sustainable health system. The second is to move away from just being a sickness care-focused world to a world that focuses on health.”

So, how do we get there? Promote health information technology, patient-centered medical homes and payment reforms, Hayes said. Inform and activate patients, and figure out how to measure health quality, he added.

How could health initiatives fare under Ohio’s two-year budget, which has a $3.2 billion hole in it and has yet to be finalized?

Federal stimulus and enhanced Medicaid matching dollars are “doing wonders” to fill the hole, Hayes said. But hospitals and nursing homes are opposing new fees that would bring in more federal Medicaid matching dollars.

We are likely to see expansions in programs for uninsured residents who don’t qualify for Medicaid, Hayes said. We’re also likely to see an expansion of the Medicaid program for children — the State Children’s Health Insurance Program, he said.

A newly created Ohio Health Care Coverage and Quality Council could get $10 million a year, $2 million of it going to develop health information technology — such as electronic health records — at doctors’ practices, he said. A federal stimulus match of 10-to-1 could boost that $2 million to $20 million for health information technology.

But there likely will be health care losers, too, including cuts in mental health care funding, he said.

“The governor also offered what we call the ‘stone soup’ expansion of health care,” Hayes said. “How to expand spending with no new money.” This expansion includes ways to bring more employer money into the health care system and likely will not benefit low-income residents, he said.

A past roll-back in state income tax likely will have to be rolled forward again to collect more revenue, Hayes said.