Commonwealth Fund Scorecard on State Health System Performance, 2019 Texas Ranking Highlightsa How Health Care in Texas National Rank 2019 49 Overall Change from baseline -6 of 51 Rank Among Southwestern States 2019 3 Has Changed Change from baseline of 4 0 Access & Affordability 51 -1 4 0 Prevention & Treatment 45 +3 2 +2 Avoidable Use & Cost 42 -1 3 0 Healthy Lives 23 -4 2 -1 Health Care Disparities 48 -20 3 -1 b 6 14 25 l Improved l Worsened l Little or No Change HI Worse than average overall performance MA MN WA CT VT RI IA CO NH UT ME WI CA NY ND OR ID MD NJ PA NE DC SD MI MT DE IL VA AK KS AZ OH NC NM IN Better Than Better than average overall performance WY AL TN KY SC GA MO FL LA WV AR NV OK MS TX Top-Ranked Indicators Most Improved Indicators Adults with any mental illness reporting unmet need Nursing home residents with an antipsychotic medication Drug poisoning deaths Home health patients without improved mobility Adults who have lost six or more teeth Diabetic adults without an annual hemoglobin A1c test Bottom-Ranked Indicators Indicators That Worsened the Most Uninsured children Hospital 30-day mortality Uninsured adults Preventable hospitalizations ages 18–64 Adults who went without care because of cost Children who did not receive needed mental health care Estimated Impact of State Improvementc Top state in the U.S. Top state in the Southwest region Texas could expect the following gains if performance in the state improved to the top level at these national and regional benchmarks: 4,131,303 2,311,235 more adults and children, beyond those who already gained coverage through the ACA, would be insured 2,487,983 1,243,992 fewer adults would skip needed care because of its cost 1,523,676 234,412 95,564 5,973 more children (ages 19–35 months) would receive all recommended vaccines 10,898 5,852 fewer premature deaths (before age 75) would occur from causes that are potentially treatable or preventable with timely and appropriate care 861,902 294,764 more adults would receive age- and gender-appropriate cancer screenings fewer employer-insured adults and elderly Medicare beneficiaries would seek care in emergency departments for nonemergent or primary-care-treatable conditions Table 1. State Health System Performance Indicator Data by Dimension Dimension and indicator Data year State rate 2017 Children ages 0–18 uninsured 2017 Adults age 18 and older without a usual 2017 source of care Adults age 18 and older who went without 2017 care because of cost in past year Individuals under age 65 with high out-ofpocket medical costs relative to their 2016-17 annual household income Employee insurance costs as a share of 2017 median income Adults age 18 and older without a dental 2016 visit in past year State ranking Data year State rate U.S. Change over average timeb Baseline 24 12 4 51 2013 30 20 Improved 11 5 1 49 2013 13 8 Improved 32 23 12 49 2013 33 24 No Change 20 14 8 51 2013 19 16 No Change 11 10 5 32 2013-14 12 11 No Change 8.0 6.9 4.8 41 2013 7.9 6.5 No Change 19 16 10 48 2012 18 15 No Change 2019 Scorecard Prevention & Treatment Adults without all age- and genderappropriate cancer screenings Adults without age-appropriate flu and pneumonia vaccines Diabetic adults without an annual hemoglobin A1c test Elderly patients who received a high-risk prescription drug Children without a medical home Best state rate 2019 Scorecard Access & Affordability Adults ages 19–64 uninsured U.S. average Baseline 2016 37 32 24 45 2012 34 31 Worsened 2017 65 62 54 40 2013 66 64 No Change 2016 9.6 12 5.6 10 2015 15 16.9 Improved 2015 13 11 5 41 -- -- -- -- 2017 56 51 39 44 2016 59 51 Improved 37 32 18 46 2016 36 32 No Change 40 22 4 46 2016 24 18 Worsened 31 29 15 33 2012 35 32 Improved 13.7 13.9 12.8 15 2010-13 13.0 13.2 Worsened 0.87 0.89 0.36 29 2015 0.97 0.99 Improved 33 45 9 15 -- -- -- -- 30 25 20 47 2013 44 39 Improved 16 15 7 27 2013 27 21 Improved 17 21 16 2 2009-11 20 21 Improved 62 56 42 46 2009-11 65 59 Improved Children without age-appropriate medical and dental preventive care visits in the 2017 past year Children who did not receive needed 2017 mental health care Children ages 19–35 months who did not 2016 receive all recommended vaccines Hospital 30-day mortality 2014-17 Central line-associated bloodstream infections (CLABSI), Standardized Infection 2016 Ratio Hospitals with lower-than-average patient 2017 experience ratings Home health patients without improved 2017 mobility Nursing home residents with an 2017 antipsychotic medication Adults with any mental illness reporting 2014-16 unmet need Adults with any mental illness who did not 2014-16 receive treatment Table 1. State Health System Performance Indicator Data by Dimension (continued) Dimension and indicator Data year State rate Hospital admissions for pediatric asthma, 2015 per 100,000 children ages 2–17 Potentially avoidable emergency department visits Ages 18–64, per 1,000 employer2016 insured enrollees Age 65 and older, per 1,000 Medicare 2015 beneficiaries Admissions for ambulatory care–sensitive conditions Ages 18–64, per 1,000 employerinsured enrollees Age 65 and older, per 1,000 Medicare beneficiaries Skilled nursing facility patients with a hospital readmission Long-stay nursing home residents hospitalized within a six-month period Home health patients also enrolled in Medicare with a hospital admission Adults with inappropriate lower back imaging Employer-sponsored insurance spending per enrollee Medicare spending per beneficiary State ranking Data year State rate U.S. Change over average timeb Baseline 67.6 87.2 21.7 17 2012 114.3 142.9 Improved 159.9 142.2 115.9 46 2015 175.6 159.0 Improved 198.3 196.9 138.3 30 2012 185.6 187.8 Worsened 2016 7.2 5.3 5.3 36 2015 5.3 4.6 Worsened 2017 46 43.9 21.7 31 2013 50.6 47.7 No Change 2016 3.5 3.1 2.4 42 2015 3.4 2.9 No Change 2017 41.1 41 19.7 30 2013 41.5 43.5 No Change 2016 21 19 11 43 2012 22 20 No Change 2016 20 15 5 44 2012 23 17 Improved 2017 15 16 14 5 2013 15 16 No Change 2016 64.2 68.9 57.7 7 2015 64.8 71.1 No Change 2016 $5,481 $4,882 $3,255 42 2013 $5,110 $4,697 No Change 2017 $10,848 $9,534 $6,195 49 2013 $10,381 $9,081 No Change 2019 Scorecard Healthy Lives Mortality amenable to health care, deaths per 100,000 population Breast cancer deaths per 100,000 female population Colorectal cancer deaths per 100,000 population Suicide deaths per 100,000 population Alcohol-related deaths per 100,000 population Drug poisoning deaths per 100,000 population Infant mortality, deaths per 1,000 live births Adults who report fair or poor health Best state rate 2019 Scorecard Avoidable Hospital Use & Cost Ages 18–64, per 1,000 employerinsured enrollees Ages 65–74, per 1,000 Medicare beneficiaries 30-day hospital readmissions U.S. average Baseline 2014-15 95.3 84.3 54.7 38 2010-11 93.3 85.3 No Change 2017 19.7 19.9 15.6 26 2013 20.2 20.8 No Change 2017 13 12.9 9.3 32 2013 14.7 14.6 Improved 2017 13.4 14 6.6 11 2013 11.7 12.6 No Change 2017 7.9 9.6 5.5 12 2013 6.5 8.2 No Change 2017 10.5 21.7 8.1 4 2013 9.3 13.8 No Change 2016 5.7 5.9 3.5 18 2012 5.8 6 No Change 2017 19 17 9 41 2013 17 16 Worsened Adults who smoke 2017 16 16 9 17 2013 16 18 No Change Adults who are obese 2017 33 31 23 32 2013 32 29 No Change Children who are overweight or obese 2017 31 31 21 30 2016 33 31 No Change Adults who have lost six or more teeth 2016 7 10 6 5 2012 8 10 No Change Table 2. State Disparity Indicator Data Dimension and indicator Data year Lowincome rated Disparitye State ranking Data year 2019 Scorecard Disparity Lowincome rated Disparitye Change over timef Baseline Adults ages 19–64 uninsured 2017 43 -35 51 2013 52 -42 Improved Children ages 0–18 uninsured Adults age 18 and older without a usual source of care Adults age 18 and older who went without care because of cost in past year Individuals under age 65 with high out-of-pocket medical costs relative to their annual household income Adults age 18 and older without a dental visit in past year Adults without all age- and gender-appropriate cancer screenings Adults without age-appropriate flu and pneumonia vaccines 2017 13 -8 34 2013 17 -12 Improved 2017 45 -22 51 2013 42 -24 No Change 2017 37 -28 51 2013 34 -27 Worsened 201617 25 -23 15 201314 25 -23 No Change 2016 31 -19 51 2012 26 -13 Worsened 2016 44 -19 50 2012 37 -10 Worsened 2017 67 -6 13 2013 70 -12 Improved 2017 68 -34 47 2016 69 -29 No Change 2017 47 -23 47 2016 39 -11 Worsened 2016 31 -6 13 2012 38 -12 Improved 2015 86.7 -47.1 8 2012 145.9 -79.3 Improved 2014 360.5 -182.8 21 2012 328.7 -168.1 Worsened 2015 99.7 -56.3 28 2012 98.2 -38.6 Worsened 2015 59.3 -30.4 30 2012 67.6 -32.6 Improved Adults who report fair or poor health 2017 29 -19 9 2013 27 -19 No Change Adults who smoke 2017 20 -9 6 2013 18 -6 Worsened Adults who are obese 2017 39 -6 5 2013 41 -13 Improved Adults who have lost six or more teeth 2016 10 -6 1 2012 12 -7 Improved Children without a medical home Children without age-appropriate medical and dental preventive care visits in the past year Children ages 19–35 months who did not receive all recommended vaccines Hospital admissions for pediatric asthma, per 100,000 children ages 2–17 Potentially avoidable emergency department visits, Medicare beneficiaries age 65 and older, per 1,000 beneficiaries Hospital admissions for ambulatory care–sensitive conditions, Medicare beneficiaries age 65 and older, per 1,000 beneficiaries 30-day hospital readmissions among, Medicare beneficiaries age 65 and older, per 1,000 beneficiaries Notes (a) The 2019 Scorecard rankings generally reflect 2017 data. The 2019 Scorecard added or revised several performance measures since the May 2018 Scorecard report; rankings are not comparable between reports. Rank change from the baseline period represents states' rank difference from the baseline data year (generally 2012 or 2013). Positive values represent an improvement in rank; negative values are a worsening in rank. (b) Trend data available for 45 of 47 total Scorecard indicators. Improved/worsened denotes a change of at least one half (0.5) standard deviation larger than the indicator’s distribution among all states over the two time points. No change denotes no change in rate or a change of less than one-half standard deviation. (c) Estimated impact if this state’s performance improved to the rate of two benchmark levels — a national benchmark set at the level of the best-performing state and a regional benchmark set at the level of the top-performing state in region (www.bea.gov: Great Lakes, Mid-Atlantic, New England, Plains, Rocky Mountains, Southeast, Southwest, West). Benchmark states have an estimated impact of zero (0). Equivalent estimated impact based on national and regional benchmarks indicate that the best observed rate in the region was equal to the best observed rate nationally. (d) Rates are for states' low income population, generally those whose household income is under 200% FPL. (e) Disparity is the difference between the states' low-income and higher-income (400%+ FPL) populations. (f) Improvement indicates that the low-income rate improved and the disparity between low- and higher-income populations narrowed; worsening indicates the low-income rate worsened and the disparity between low- and higher-income populations widened.