Rural people are the ones most affected by negative health care trends

    The Commonwealth Fund’s just-released 2018 Scorecard on State Health System Performance confirmed what other recent studies have shown: Life expectancy in the United States is going down while it continues to go up in other developed countries. And rural areas seem to be disproportionately affected.
    Some researchers have used one word to explain the sudden reversal in life expectancy trends in the United States: despair. That’s because of the rapidly rising number of suicides and deaths associated with alcohol and drug use in this country. The Commonwealth Fund reported that deaths from suicide, alcohol and drug use have increased 50 percent since 2005.
    The Scorecard, which assessed every state and the District of Columbia on 43 measures in five broad categories — access to health care, quality of care, efficiency in care delivery, health outcomes and income-based health care disparities — wasn’t all bad news by any means. In fact, most states made improvements between 2013 and 2016 in some or all of the categories. But several others, Nebraska in particular, saw a worsening in all five.
    The states scoring the highest overall were Hawaii (No. 1), Massachusetts, Minnesota, Vermont and Utah, while those scoring the lowest were Arkansas, Florida, Louisiana, Oklahoma and Mississippi (No. 51).
    But three of those bottom-ranking states — Arkansas, Louisiana and Oklahoma — were among the five states making the most improvements. At the other end of the spectrum, the five making the fewest improvements were New Hampshire, Utah, Maine, Wyoming and Nebraska (No. 51).
    The Commonwealth Fund’s researchers noted that progress in all categories is certainly possible in coming years but added that unless significant steps are taken, improvements in many states are not likely anytime soon.
    “If every state achieved the performance of the top-ranked state on each Scorecard indicator, the gains in health care access, quality, efficiency and outcomes would be dramatic,” the researchers wrote. “At the current rates of improvement, however, it may take many years or decades for states and the nation to see such progress.”
    That may portend a continuing decline in life expectancy in the United States.
    The Centers for Disease Control and Prevention reported in December that life expectancy in the United States declined for the second year in a row in 2016. U.S. life expectancy peaked at 78.9 years in 2014. It fell to 78.7 in 2015 and to 78.6 in 2016.

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