Missouri's health care system ranks in the bottom half of state systems nationwide, according to scorecards released last week by a national health care research group. The state's rank fell slightly from its position in a similar report in 2007.
The Commonwealth Fund, a non-partisan organization, ranked the state 36th in the nation in a report comparing states across 38 benchmarks of health care access, quality, costs and health outcomes. In the group's 2007 report, Missouri ranked 31st in the nation.
Commonwealth Fund Senior Policy Director Rachel Nuzum said Missouri's rank likely fell because the number of residents with access to preventive care was down compared with the previous report.
"Access and equity were the main factors that caused the score to fall," Nuzum said. "The states that have gone above and beyond in terms of providing access generally had higher scores."
Stan Hudson, project director for the MU Center on Health Policy, pointed to two state level changes he said decreased access to primary care for many residents. Hudson said MO HealthNet, which provides health care to seniors, reduced its eligibility thresholds.
He also said the state is facing a workforce health care crisis, with too few primary care physicians to provide preventive care that helps workers avoid major illnesses. Hudson said this problem has grown since 2005, when the state stopped tracking where physicians physically practice and how much of their time they spend in primary care.
"We really don't know where the primary care physicians are and where they are spending most of their time, so we really can't see where the gaps are," Hudson said.
Nuzum said most states, including Missouri, did not see dramatic changes in their ranks from 2007. Nuzum said Missouri's rank might have fallen not because health care in the state necessarily worsened, but because health care in other states improved.
She also noted a disparity in rankings among northern and southern states nationwide. Many states in the top 10 are crowded in the Northeast, with several states bordering Missouri ranking near the bottom, including Oklahoma at No. 50. Nuzum said many northern states had state initiatives specifically aimed at making health care more affordable and accessible.
"In the Northeast and the Midwest in general, we see a lot more public health plans," Nuzum said. "We definitely saw a correlation between states that had high access scores and also had high scores."
Carl Bearden, state director of the Missouri chapter of Americans for Prosperity, a conservative group, said in an e-mail the Commonwealth Fund report and other similar studies prepare data with a certain bias toward more publicly funded health care.
He said the group had ignored the difference in Medicaid reimbursements between different parts of the country, which he said contributed to doctors seeing fewer elderly patients.
"The end result of this policy is often that doctors decline to see Medicaid patients due to the low reimbursement rates," Bearden said. "Missouri falls into this category."
Bearden also said proposals by Democrats in Congress would not improve access among Missouri residents and said a universal health care program could end up hurting state programs by increasing health care costs in state budgets and forcing states to make cuts from existing programs.
"State budgets will be further damaged if the Obamacare proposal is passed as many elements expand the Medicaid program requiring states to spend more," Bearden said. "That doesn't save money, it just shifts the responsibility."