Pennsylvania

Pennsylvania spends more money per capita on healthcare than most states, and costs keep climbing.

• Pennsylvania spent about $73.4 billion on healthcare in 2004.[1] Pennsylvania’s healthcare bill keeps going up, at a 6% average annual increase between 1991 and 2004.[2]
• Pennsylvania spent more on healthcare per capita in 2004 ($5,933) than the national average ($5,283).[3]
• Between 2001 and 2005, family premiums in Pennsylvania increased 38.2%, while median earnings of people purchasing family coverage increased by only 2.2%.[4]
• People who buy health insurance through their small business (2-50 employees) cannot be excluded due to health condition but can pay very high rates.[5]
• The self-employed and people who must buy individual policies have few protections: no restrictions on the price and no access for pre-existing conditions. Blue Cross Blue Shield acts as an insurer of last resort.[6]

Too many patients in Pennsylvania are injured by unsafe care, but the state has taken strides to improve hospital quality.

• Pennsylvania has strong laws giving the public hospital-specific information about hospital care cost, quality, and safety, including hospital infections and mortality rates.[7]
• The Pennsylvania Healthcare Cost Containment Council’s (PHC4) latest report on certain hospital-acquired infections found that 30,237 patients in PA hospitals in 2006 suffered an infection due to their medical care, a rate of 19.2 per 1,000 cases. In 2005, the infection rate was 12.2 per 1,000 reported cases.[8]
• The mortality rate for those patients was 12.3%, while the mortality rate for patients without a hospital infection was 2.1%. In addition, patients with a hospital infection stayed, on average, about 15 days longer than patients without an infection.[9]
• Patients with a hospital infection are charged more for their hospital stay ($175,964 on average compared to $33,260 for patients without such infections).[10]
• People may get infections in part because patients undergoing surgery receive appropriately timed antibiotics at a lower rate than the national average.[11]
• Although the true number of patients harmed by medical errors in each state is a well-kept secret, the Institute of Medicine estimates as many as 98,000 Americans die from these preventable mistakes each year. These errors range from giving the wrong medication to doing surgery on the wrong part of the body, transfusion errors and more.[12]

But Pennsylvania faces challenges.

• 10% of Pennsylvania residents (about 1.2 million people) remained uninsured between 2005 and 2006.[13]
• A smaller percentage of mothers began early prenatal care (73% in Pennsylvania compared to 84% nationally).[14]
• The state had a higher infant mortality rate than the national average (7.3 infant deaths per 1,000 births in Pennsylvania compared to 6.6 elsewhere).[15]
• Pennsylvania had a higher incidence of cancer than the rest of the nation (493 per 100,000 Pennsylvania residents compared to 460 nationwide).[16] In particular, Pennsylvanians experienced a higher incidence of advanced stage breast cancer and colorectal cancer.[17]
• Nursing homes scored worse than the national average on important quality of care measures, such as help with daily activities, worsened mobility, depression, pressure sores, and incontinence. Further, Pennsylvania facilities are more likely to leave urinary catheters in residents too long, which put them at a high risk of infection.[18]
• Pennsylvanians have a better experience of home healthcare. A higher percentage of home health patients take their oral medicines correctly, have less shortness of breath, and less incontinence. Fewer have to be admitted to the hospital.[19]

Footnotes:

[1] http://www.statehealthfacts.org/profileind.jsp?ind=592&cat=5&rgn=40

[2] http://www.statehealthfacts.org/profileind.jsp?ind=595&cat=5&rgn=40

[3] http://www.statehealthfacts.org/profileind.jsp?ind=596&cat=5&rgn=40

[4] http://www.rwjf.org/files/research/042508ctuwfinalembargoed.pdf

[5] http://www.statehealthfacts.org/profileind.jsp?cat=7&sub=86&rgn=40

[6] http://www.statehealthfacts.org/profileind.jsp?cat=7&sub=87&rgn=40

[7] http://www.consumersunion.org/campaigns/CHART%20adverse%20event%20%20mortality.pdf; www.phc4.org; http://www.phc4.org/council/act14.htm; http://www.consumersunion.org/campaigns/CU%20Summ%20HAI%20state%20rpting%20laws%20as%20of%201-08.pdf

[8] http://www.phc4.org/reports/hai/06/nr041008.htm PHC4, the independent state agency, explains that the 2006 hospital infection rate is higher than the rate reported in 2005, largely due to an expansion in the hospital-acquired infection reporting categories and improved reporting by hospitals.

[9] Hospital-Acquired Infections in Pennsylvania: Calendar Year 2006, Pennsylvania Healthcare Cost Containment Council, April 2008, pp.5 http://www.phc4.org/reports/hai/06/docs/hai2006report.pdf

[10] Ibid 9.

[11] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=PA&level=1&region=0&compGroup=N

[12] Institute of Medicine, To Err is Human, Kohn, Linda, Corrigan and Donaldson, 2000, pp.26, 35.

[13] http://www.statehealthfacts.org/profileind.jsp?cat=3&sub=39&rgn=40

[14] http://www.statehealthfacts.org/profileind.jsp?cat=2&sub=12&rgn=40
Reflects 2004 data.

[15] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=PA&level=1&region=0&compGroup=N Reflects 2004 data.

[16] http://www.statehealthfacts.org/profileind.jsp?ind=64&cat=2&rgn=40 Reflects 2003 data.

[17] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=PA&level=1&region=0&compGroup=N Breast cancer diagnosed at advanced stage among women age 40 and over and colorectal cancer diagnosed at advanced stage among men and women age 50 and over (incidence per hundred thousand).

[18] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=PA&level=6&region=0&compGroup=N; http://www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html#

[19] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=PA&level=4&region=0&compGroup=N