Tucson could improve its health, new report says

Data from a New York-based nonprofit, The Commonwealth Fund, ranks Tucson 163rd out of 306 metropolitan areas in a score based on 36 indicators of health care and health quality. Phoenix ranked below Tucson, at 180th.

Honolulu, Hawaii, was ranked first and Hattiesburg, Mississippi, was ranked last. Higher performing areas were generally in the Upper Midwest, New England, Hawaii and the San Francisco Bay area. Lower rankings, which were concentrated in the West and South, frequently correlated with lower income areas.

People in poor communities are more likely to go without needed medical care because of the cost, receive a high-risk prescription drug and die early from treatable causes, the survey found.

The report showed wide variances across the country on many indicators. The percentage of adults who have lost six or more teeth because of tooth decay, infection or gum disease, for example, was 2 percent in Santa Cruz, California, and 26 percent in Kingsport, Tennessee.

In Tucson, it was 10 percent.

The good news locally is that Tucson improved over its adjusted ranking of 171st for 2012, which was the last year the Commonwealth Fund released its health system scorecard.

Areas where Tucson improved, according to the latest report, include its composite hospital safety scores, potentially avoidable emergency department visits among Medicare beneficiaries, and colorectal cancer deaths.

The rate of local colorectal cancer deaths — 14 per 100,000 people in Tucson — is lower than both the national average and the Arizona rate.

The bad news is that even on some of the indicators where Tucson improved, the city still ranked in the middle or lower half of the communities surveyed.

For example, Tucson’s rate of uninsured children improved from the last report in 2012, but at 11 percent is still one of the highest rates in the country.

And the percentage of adults in Tucson who went without health care in the past year because of cost — 15 percent — improved in this year’s report, but it’s still higher than the U.S. average and much higher than the 6 percent rate reported for Waterloo, Iowa, and Bloomington, Illinois.

But the data in the 2016 Commonwealth report is predominantly from 2013 and 2014, stressed Dr. Francisco Garcia, who is director of the Pima County Health Department.

“There is a whole cottage industry of ranking one community or another, and the devil is always in the details,” Garcia said. “It’s mostly based on 2013-14 numbers. So on insurance status we don’t look so good but it’s not a real time thing.”

Indeed, Tucson’s rate of uninsured adults is listed as 18 percent in the report while more recent estimates place it as 10 to 12 percent, largely because of the effects of federal health reform. Garcia said that if the data were more current, Tucson would look better, though he agreed that the community still has a lot of room for improvement.

A Pima County Community Health Needs Assessment released in January said that access to care and poverty are two big obstacles to overall local health — both factors that are reflected in The Commonwealth Fund report.

“This report confirms a lot of the priorities in our Community Health Needs Assessment,” Garcia said. “In that sense it’s a really good thing, it makes us think more critically about those indicators.”

Garcia questioned the report’s claim that Tucson adults are more obese than they were in the 2012 data. He cites other data that show adults here are more engaged in physical activity than a majority of Americans.

One thing that did ring true was the lack of dental care. The Commonwealth Fund Report says that nearly 1 in 5 Tucsonans — 19 percent — did not visit a dentist in the last year. That statistic puts Tucson among the worst communities in the country for that particular indicator.

Garcia noted that Arizona’s form of Medicaid, which is called the Arizona Health Care Cost Containment System , does not cover routine dental care for adults.

“That is huge because we have a fairly significant percentage of people who use Medicaid,” he said.

The report also suggested Tucsonans have problems accessing primary care, an issue that Garcia said merits further study.

“On a per capita basis we have more providers than other communities, but that doesn’t always translate into better access,” he said. “I want to dig into that one.”

Commonwealth Fund officials said that nationwide, the indicators that improved did so largely because more people had insurance coverage and could afford needed health care. Also, health-care providers performed better on quality and efficiency measures, such as limiting preventable hospital readmissions.

Nationwide, the scorecard found that while health care improved more than it worsened in nearly all U.S. communities, improvements were often modest.

The report found two key areas of concern — obesity rates rose in about a third of communities and rates of premature deaths from treatable conditions were mostly unchanged in nearly all areas.

The Affordable Care Act , state-level action and public and private initiatives have had an impact on local health care, the report says.

Largely because of the ACA’s coverage expansions, the percentage of working-age adults without health insurance fell in nearly all local areas — dropping by 4 percentage points or more in 189 local areas between 2012 and 2014, the report says.

“Moving forward, we hope that local areas will integrate the lessons from this scorecard into their efforts to ensure that everyone has health insurance, can afford the care they need, and can get the right care at the right time,” Commonwealth Fund President Dr. David Blumenthal said in a prepared statement.

If all communities could do as well as those that rank highest on the scorecard, 19 million more children and adults would have health insurance and there would be 100,000 fewer premature deaths from preventable causes, officials with The Commonwealth Fund said.