Texas ranked dead last in the federal government's latest report card on the delivery of health services, falling short in areas ranging from acute hospital care to home treatment of the chronically ill.
Texas scored 31.61 -- less than half of top-ranked Minnesota's 67.31 -- out of a possible 100 points in the Agency for Healthcare Research and Quality annual rankings. Rated "weak" or "very weak" in nine of 12 health delivery categories, Texas dropped from 47th place in 2010 to 51st in 2011, behind all other states and Washington, D.C.
"There are a lot of places Texas can make improvements," said Dr. Ernest Moy, the federal agency's medical officer and the scorecard's lead author.
"We're not comparing it to some fantasy world, we're comparing it to other states around the nation."
Moy downplayed Texas' fall from 2010, noting that Texas, Louisiana, Oklahoma and Arkansas tend to fluctuate near the bottom of the annual scorecard.
Moy acknowledged Texas' poor showing was partly the result of its heavily uninsured population -- the nation's highest, at more than 25 percent -- but said it was also due to the weak delivery of care in different settings and clinical areas.
Texas' worst mark came in the home health care setting, where it was rated very weak for care provided to elderly and disabled who live at home. Among clinical areas, it was rated very weak for diabetes care.
Texas fared best -- average -- in the mortality rates and potentially avoidable complications of privately insured people.
It ranked below average in those areas for people without insurance and those covered by Medicaid or Medicare.
State officials minimized the rankings.
"Our office is reviewing the study, but at first glance it appears to be an extremely broad report that goes well beyond the parameters of the state Medicaid program and doesn't take into account our diverse population," Catherine Frazier, press secretary for Gov. Rick Perry, said in a statement.
Frazier said Texas will "continue to fight the federal government for more flexibility to address our health care challenges, which is crucial to effectively improving our health care system."
Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, said in a statement that the report card "includes services far beyond our state Medicaid program, but it does reinforce the need for improving access to preventive services."
She said regional partnerships the agency is forming to make better use of Medicaid funding will help do that.
155 quality measure
The scorecard, designed to help politicians, policy-makers, private insurers and state and federal agencies identify their state's strengths and weaknesses, is based on 155 quality measures, including success of preventive care, disparities in treatment among ethnic groups and the effectiveness and cost of care for patients with chronic or terminal conditions such as diabetes and cancer.
Among the findings:
1 Texas was worst of all states in caring for breast cancer patients under 70 and in home health-care for patients with respiratory problems, urinary incontinence and chronic pain.
1 Texas' highest scores came in nursing home care, cancer and maternal and child health care. The first two were rated average, maternal and child health care slightly above average.
1 Texas ranked above the national average in the quality of care provided to Hispanics and blacks, compared to care provided to whites.
Minnesota was followed by Wisconsin, Maine, Massachusetts and Iowa atop the report card. West Virginia, Arkansas, Oklahoma and New Mexico finished above Texas at the bottom.
"This report card shows that insured or not, Texans generally aren't getting the quality care they should," said state Rep. Garnet Coleman, D-Houston, a longtime member of the House public health committee and critic of the state's limited Medicaid program. "It shows what we know -- that we're at the bottom."
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