Healthcare access, quality and outcomes vary widely across communities in the U.S.

Healthcare access, quality, costs, and health outcomes all vary significantly from one local community to another, often with a two- to threefold variation in key indicators between leading and lagging communities, according to a report by the Commonwealth Fund.

The report compares 306 local health care areas in the U.S. and tracks 43 indicators spanning four dimensions of health system performance: access, prevention and treatment, costs and potentially avoidable hospital use, and health outcomes.

Key findings include: 

  • The percentage of uninsured adults ages 18 to 64 ranged from a low of about 5 percent in several areas of Massachusetts to more than half in the two areas in Texas with the highest uninsured rates. In all communities, children were more likely than adults to have insurance coverage, largely because of federal and state policy attention, though there were places where more than 20 percent of children lacked coverage.
  • The proportion of older adults who received recommended preventive care was more than twice as high in the best-performing area than in the worst-performing area (59% vs. 26%). Yet even in areas with the highest rates, too few adults age 50 and older received all recommended preventive care services, such as screening for cancer.
  • Overall, local areas in the Northeast and Upper Midwest often ranked in the top quartile of health system performance, whereas places with the lowest performance were concentrated in the South, particularly within the Gulf Coast and south-central states.
  • Areas in the Northeast tended to have strong performance on measures of access and prevention and treatment, but at times lagged other parts of the country on measures of potentially avoidable hospital use and cost.
  • The local areas that scored in the top quartile of overall health system performance often performed well on multiple indicators and across dimensions.
  • Overall, communities with the highest rates of poverty had among the highest uninsured rates and lowest rates of preventive care, pulling down their overall performance rankings.
  • There was considerable variation among highand low-income areas on two dimensions: prevention and treatment, as well as potentially avoidable hospital use and cost. 

The authors state that state policy leaders can use the report as a tool to target interventions to the communities with the greatest need and most to gain.

(Sources: The Commonwealth Fund,, June 13, 2012)