Health care in Texas ranks among the worst in the nation, dragged down by large numbers of uninsured and by the nation's most porous safety net, according to a scorecard and analysis released Thursday by the health care-oriented Commonwealth Fund.
Texas ranked 46th among the 50 states and the District of Columbia - slightly better than its showing of 48th two years ago, but still far behind high-performing states in New England and the upper Midwest.
Texas was ranked last in access to health care, and in equity - a measure of how minorities and low-income patients fared in the state's medical system. Texas has some of the nation's strictest eligibilily requirements for Medicaid insurance.
"There's no justification for any state to be far below the best state," which the scorecard identified as Vermont, said fund president Karen Davis. "What we found were shockingly wide variations in the quality of care between the states - as much as a two- or threefold difference."
In Massachusetts, for example, 92.8 percent of working-age adults had health insurance. In Texas, just 68.5 percent of working adults were insured, down from 70.4 percent in the last scorecard.
More than 35 percent of low-income Texas adults said they put off seeing a doctor for a medical problem because of the cost. In Maine, it was 16 percent.
"If you don't have insurance, you don't get timely and effective care," said fund vice president Cathy Schoen. "We know we can do better on prevention if we open the door to access."
The Commonwealth Fund, a private foundation based in New York, supports congressional efforts to overhaul the nation's health care system and expand health insurance to all Americans.
The fund's scorecard is one of the few measures available for comparing health care across the country. It relies on data reported by the states as well as federal surveys of Medicare patients and their hospitals and doctors.
While the fund uses the most recent data available, much of it is at least two years old. Davis warned that the results for the uninsured were certain to rise because of the economic recession.
Most states, including Texas, saw improvements in hospital care in the last two years, which the fund's researchers attributed to public benchmarks required by Medicare (available at www.Hospital Compare.hhs.gov). Texas achieved its best score - 13 of 51 - for Medicare patient satisfaction. Even that result, however, reflected a decline in satisfaction among patients in other states rather than an improvement in Texas.
Schoen said the state faces a long-term health threat from diabetes. Only 38.5 percent of adult diabetics received recommended preventive care in 2006-07, and the disease is spreading rapidly to younger Texans.
"Already you are starting to see dialysis centers built rather than playgrounds. That's a real misuse of resources, if we could just keep people healthy," she said.
Obesity raises the risk of developing diabetes. In Texas, the level of overweight or obese juveniles was 32.3 percent, compared with a national average of 30.6 percent. In Minnesota, it was 23.1 percent.
Despite the obesity finding, Texas faired pretty well on measures of mortality and smoking that the fund grouped under the heading "healthy lives" (21st in the nation). Infant mortality was 6.5 per 1,000 live births - 19th best. Colorectal cancer deaths were 16.8 per 100,000 - 15th best among the states.
Just 18.6 percent of Texas adults smoked in 2006-07 - a decline from five years ago, when 21.2 percent smoked. The national average was 20.1 percent.
But Davis, an economist who once taught at Rice University, said the number of uninsured adults in the state was an enormous problem.
"It's staggering that in Texas, where I lived for 10 years, over 30 percent of adults are uninsured. It simply is becoming impossible for average families to afford health insurance premiums," she said.
Research for the Commonwealth Fund's scorecard was assembled by the fund's Commission on a High Performance Health System. San Antonio Health Director Fernando Guerra is one of the commissioners.
Guerra said the handling of patients with H1N1 flu, now sweeping through Dallas and other parts of Texas, was indicative of the weaknesses in the state's health care safety net.
"The demand on the medical system is incredible," he said. "The system of emergency care can't keep up with it because at the front end [family doctors and clinics] we don't have available or accessible resources."