Health care quality is an important issue for Americans. As the population ages, chronic disease management and geriatric care are only two areas where the need is growing.
On the other end of the spectrum, medical care for children can help ward off potential problems in later years. Quality of health care is a very complex issue and includes many variables. Smoking, obesity rates, mental health issues, prenatal care, infant mortality, immunizations, access to care, air pollution and availability of primary care practitioners are only some of the factors which determine the quality of health care in a state or nation.
Other issues are insurance coverage, binge drinking and chronic diseases such as diabetes, heart disease and emphysema. In order to compare health care quality across states or at a national level, the same issues must be tracked and measured in the same way. Several organizations, such the United Health Foundation, the Centers for Disease Prevention and Control and the Commonwealth Fund, track and report health care quality data. Medicare and Medicaid are also good data sources for the populations they cover. Private health insurers may not be able to report on all health care quality measures or do not track and measure in the same way across the board, but most have a few standardized indicators, such as smoking prevalence or immunization status.
Access to Care
The Commonwealth Fund rates Florida as 44th in the nation for health care quality overall, but only 35th in terms of affordability and access to medical care. Lack of health insurance is a problem across the United States and undoubtedly affects overall health status since it limits access to care. In Florida, 21.3% of the population lacks health insurance, while the national average is less at 16.2%. Of Florida adults, 83% had health insurance in 2011; the national average is 85%. Florida had 25.8 family doctors for each 100,000 people in the population; the national average is 31.6.
Immunization coverage is very good in Florida, although the percentage of children immunized varies. In 2010-2011, Broward County had immunized 92.9% of kindergarteners, while Monroe County had an immunization rate of 93.6%. Miami-Dade County, however, lagged behind at 76.7%. The statewide rate was 91%, close to the national average.
Smoking is a problem in Florida. More than 2.5 million Florida adults smoke. However, the total percentage of adult smokers in Florida is 17.1%, below the national average.
Obesity and Diabetes
Obesity is on the increase; 27.2% of Florida adults are obese. More than 4 million Florida adults are obese and the number has increased by 1.7 million in the last 10 years. Diabetes, which is linked to obesity, has also risen. In the last 10 years, an additional 688,000 people have developed diabetes in Florida, an overall percentage of 10.4%. The national prevalence of diabetes is 8.7% and continues to rise at a rate of .3% annually.
Preventable hospitalizations are a good indicator of societal health, as hospitalizations reflect such issues as access to medical care and the number of physicians who manage chronic medical issues. In Florida, preventable hospitalizations rose from 62.5 to 64.2 per 1,000 Medicare enrollees, a sign that Medicare patients may not be getting routine preventive care and health maintenance. The national average is 68.2 preventable hospitalizations per 1,000 Medicare enrollees.
Florida has disparities in health as well. Certain population sub-groups may have more health problems for a variety of reasons ranging from genetic predisposition to certain conditions such as high blood pressure to problems with access to care. In Florida, non-Hispanic blacks are more likely to be obese and have diabetes than Hispanic and non-Hispanic whites.
Mental health is at least as important as physical health in the overall evaluation of health care quality. Access to mental health care is often limited because of lack of providers, and many health care organizations do not provide or limit coverage for mental health care. The measurement for mental health is self-reported “poor” mental health days in a given population. The national average of poor mental health days is 3.5 per month, while the average in Florida is 3.8.
Compared to Other States
Florida ranks 33 in the nation for overall health, as measured by the United Health Foundation. In comparison, Vermont, the highest ranking state, has a similar immunization rate, but lower rates of infectious disease, better rates of early prenatal care, a low rate of uninsured and a high number of primary care physicians for the total population. Although obesity growing in both states, obesity in Florida is a much bigger problem. Mississippi, the lowest ranking state, has a high prevalence of obesity and preventable hospitalizations, a high infant mortality rate and fewer primary care physicians.
Florida is Improving
As with any state, Florida has strengths and weaknesses in the health care arena. One area of strength for Florida is low levels of air pollution. Binge drinking prevalence is also low. Nationally, 15% of the population report binge drinking, while in Florida, only 13.6% of the population reported binge drinking in 2011. Florida’s overall rank is also improving, according to the United Health Foundation. In 2010, Florida ranked 36th out of all states, while in 2011, Florida ranked 33rd. In the state of Florida, almost 54% of adults rated their health as “excellent” or “very good” in 2010, close to the national average of 54.6%.