State dead last in health care report
Capitol Report for dailies for week of June 17, 2997
By Jim Campbell
OPA Capitol News Bureau
Oklahoma finds itself submerged to the lowest depth alongside frequent bottom dweller Mississippi in a national ranking of health care performance, a gloomy distinction suggested for years in numerous statistical studies and perhaps now outdated.
Fewer Oklahomans have health insurance than residents of higher ranking states and neither do they do much on average to help themselves live longer or healthier.  As detailed in reports from the state Health Department, Oklahomans smoke more, exercise less, eat less stuff that's good for them and lead the nation in heart disease deaths.   
The latest bad news is from "Aim Higher; Results from a State Scorecard on Health System Performance" by the Commonwealth Fund, a private foundation supporting better health care in the United States and abroad through research and grants.
Oklahoma and Mississippi rank 50th overall, although Oklahoma might move up with recent legislation and initiatives. Hawaii is No. 1.
In criteria scored, Oklahoma ranked 49 in access, 43 in quality, 50 in potentially avoidable hospitalization, 50 in equity and 47 in healthy lives.
Dr. Michael Crutcher, state health secretary, points out that figures in any such report are "at least two, three, even four or five years old" and may not reflect the present situation. 
Crutcher said the Health Department's State of the State's Health Reports have repeatedly stressed that Oklahomans' shorter average lifespan is due to unhealthy choices such as smoking, poor nutrition and lack of exercise. The slogan of the current governor's Strong and Healthy Oklahoma initiative, he said, is "Eat better, move more and be tobacco free."
Negative alarms for economic development also have been sounded. 
At the local level, these issues are emphasized in the statewide Turning Point program.
Healthier living issues also have been addressed in legislation restricting smoking, raising the tobacco tax and restoration of physical education in schools, the secretary said. 
Oklahoma improved access to care through such measures as Senate Bill 424, the All Kids Act, raising eligibility for children to 300 percent of the federal poverty level, and House Bill 1225, or OPEIC, expanding state-subsidized private insurance provided by employers, Crutcher said.
"Another major component of the report is the issue of quality and we need to work on that," with hospitals, physician groups and other providers, he said.
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A physician instrumental in passage of the All Kids and OPEIC acts says he is now looking forward to finding ways to increase insurance among people who could buy insurance but do not. 
"They say, 'well, I'm healthy' and try to get by," said Rep. Doug Cox, R-Grove, an emergency room doctor and House Public Health Committee chairman. "I don't think the government should mandate that people get insurance but it could do things to make them want to."
Cox said the Commonwealth Fund report spotlights problems states must consider. 

"The numbers have been there all along, but we've been able to ignore them," said Cox. "We're going to be forced to do things differently because health care is consuming more and more of the state budget."
And the big boom in ailing baby boomers is still to come.  
Also vice chairman of the House Health and Human Services Committee, Cox said education still is No. 1 in Oklahoma expenditures and health care is No. 2, but there are states where health care already has ascended to the top.
He said increased use of insurance relates directly to another issue in the report, avoidable hospitalization, as well as routine and expensive use of ERs.
Although he works in them, he said emergency rooms geared to treating trauma and serious illness "are a terrible place" to get help for conditions that could be more efficiently treated in a doctor's office.
Cox, who will begin an interim study on denial of insurance this September, said there are possibilities for health care savings through expansion of such physician-extender programs as use of physician assistants to treat more routine conditions. The problem is, he said, some insurance companies will not provide reimbursement for people treated by PAs.
He said 34 percent of patients he now sees in the ER have no insurance of any kind and more than 29 percent of them will never pay a penny of their bill, shifting costs to people with coverage or ability to pay cash.
Most of them, he said, are working hard at jobs with no health benefits or paid too little to afford health insurance and still support their families.
Some of them, he said, might be eligible for Veterans Administration or Indian Health Service (IHS) care.
Sometimes, he said, he sees tribal members in the emergency room who could have gone to an IHS clinic but tell him the wait is shorter at the hospital.
Other health legislation this year includes health savings accounts by Rep. Kris Steele, R-Shawnee, Health and Human Services Committee chairman, and a Health Care Consumer Transparency Task Force by House Speaker Lance Cargill, R-Harrah.
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