Overall, the state improved by two spots to rank 39th overall, compared with two years ago when nonprofit think tank The Commonwealth Fund released its initial state scorecard. The biggest improvement here came from more minority adults and uninsured people getting checkups and other recommended preventative care.
Meanwhile, 20 percent of the state's working-age adults being uninsured and a rate of 118 preventable deaths per 100,000 residents were among findings in Tennessee's most recent tracking that concerned one of the authors.
"There are symptoms of a health system under stress across Tennessee," said Cathy Schoen, senior vice president at the New York-based Commonwealth Fund, which supports overhaul of the health-care system.
"We're losing coverage for working-age adults, and costs are increasing faster than incomes in almost all states," Schoen added about the broader trends. "There's substantial room for improvement in the health-care system."
Nationwide, states that led the group's 2007 report card generally continued to lead in this year's study, which is based on 38 indicators in the areas of access, prevention/treatment quality, avoidable hospital use and costs, healthy lives, and how vulnerable groups such as those with low incomes fared vs. a national average.
Vermont, Hawaii, Iowa, Minnesota, Maine, and New Hampshire led the nation as top performers on a majority of indicators.
Alabama, Florida, Kentucky, Texas, Nevada, Arkansas, Louisiana, Oklahoma, and Mississippi joined Tennessee in ranking in the bottom quarter of states for both 2007 and 2009.
Tennessee still lags in some preventative care areas, as 71 percent of the uninsured went without basic services such as checkups despite improvements among them and minorities.
Fewer than half of diabetics, for instance, received recommended care such as eye and foot exams or having blood-sugar levels checked. Also, just 42 percent of adults older than 50 received care such as flu shots and screenings for colon or breast cancer.
Citing little or no across-the-board improvement in hospital admissions and readmissions from nursing homes, the report put a spotlight on what its authors said is a need for better coordination of care across various health settings.
Craig Becker, president of the Tennessee Hospital Association, agreed that better coordination of care is needed. He said how hospitals, doctors and other providers are paid for care is part of the problem.
"There is no incentive to coordinate care, nor are there incentives to provide chronic care," Becker said. He also said gains in other states could have overshadowed some of the improvements in Tennessee. "We improved in a lot of things, but so did everybody else."
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