There were more than 24 million overnight hospital stays in the United States in 2017 alone. While the likelihood of a full and speedy recovery following treatment varies depending on the nature of the illness or condition, other factors, including the quality of medical care, can play a significant role.
There are over 6,200 hospitals in the United States, and not all of them are equally effective. While it is difficult to precisely determine the quality of a specific health care system, there are certain measures that can be indicative of overall quality of care.
24/7 Wall St. created an index of three such measures at the metro area level to identify the cities with the worst health care system outcomes.
The first measure we included in our index is the metro area level hospital readmission rate — or the share of Medicare patients readmitted to the hospital within 30 days of initial discharge. The second index component is the hospital mortality rate — or the share of Medicare patients who die within 30 days of admittance to a hospital. The third and final measure is the rate of preventable hospitalizations — or the frequency at which Medicare patients are admitted to a hospital for conditions that could or should have been treated in an outpatient setting.
In an interview with 24/7 Wall St., Matthew Fiedler, a fellow with USC-Brookings Schaeffer Initiative for Health Policy, explained that while these measures can be useful in determining the quality of care for a given hospital or health care system, they can also be the product of other factors unrelated to the quality of care.
“Variation across areas does seem to reflect differences in how well the health system is working,” Fiedler said. “But you also have to be very cautious.”
How good the hospital is at delivering care and ensuring appropriate follow-up after the patient is discharged is only one broad set of factors that can influence the measures used to create this list. “And the other broad bucket of factors is what types of patients is the hospital treating,” Fiedler said.
Indeed, the socioeconomic characteristics of a metro area population do appear to have an impact on the measures used to rate health care system performance, including those related to personal health. For example, unhealthy patient behaviors like smoking, sedentary lifestyles, and poor diets, can contribute to higher readmission rates and higher mortality rates. In fact, based on measures such as these, many of the cities on this list have relatively unhealthy populations. Here is a look at the least healthy city in each state.
It is also likely no coincidence that in the majority of metro areas on this list, most households have far lower incomes than the typical American household. “I think there are certainly mechanisms […] that would cause less advantaged areas to have less effective health care systems,” Fiedler said. These include hospital facilities having fewer resources and an insufficient number of doctors in an area.
Many of the cities on this list rank among the poorest nationwide. Here is a closer look at the 50 poorest metro areas in the United States.