25 Cities Where You Don’t Want to Get Sick

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20. Hanford-Corcoran, CA
> 30-day hospital readmission rate: 16.1%
> Mortality within 30 days of hospitalization: 13.4%
> Preventable hospitalizations: 53.3 per 1,000 Medicare enrollees
> No. of physicians: 39.4 per 100,000
> Median household income: $61,663

There are just 39 primary care physicians per 100,000 residents in the Hanford-Corcoran metro area, the 12th least of any metro area nationwide. A low doctor-to-population ratio can contribute to preventable hospitalization — with less access to outpatient services, residents may be more likely to visit the hospital for primary care-sensitive conditions, putting themselves at increased risk of infection or increased frailty from inactivity. There are 53 preventable hospitalizations per 1,000 Medicare enrollees in Hartford, eight more than the corresponding U.S. average.

Another possible indication of a poorly functioning healthcare system is the percentage of patients who return to the hospital within a month of discharge. In Hanford, 16.1% of patients return to the hospital within 30 days of discharge, among the most of any U.S. metro area.

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19. Longview, TX
> 30-day hospital readmission rate: 17.5%
> Mortality within 30 days of hospitalization: 12.0%
> Preventable hospitalizations: 50.2 per 1,000 Medicare enrollees
> No. of physicians: 56.6 per 100,000
> Median household income: $51,296

In Longview, Texas, those who are hospitalized are more likely to be readmitted within a month of discharge than those in every other U.S. metro area. Though unplanned readmissions are usually not the hospital’s fault, they can also be caused by such avoidable conditions as a surgical wound infection. In Longview, 17.5% of people discharged from hospitals are readmitted within 30 days, well above the 15.3% readmission rate nationwide.

Preventable hospitalizations are also more common in Longview than they are nationwide. An overreliance on hospital care can be indicative of insufficient outpatient treatment, and in Longview, access to outpatient care may be limited by the availability of doctors. There are only about 57 primary care physicians for every 100,000 people, substantially lower than the national ratio of 75 per 100,000.

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18. Monroe, MI
> 30-day hospital readmission rate: 16.5%
> Mortality within 30 days of hospitalization: 12.5%
> Preventable hospitalizations: 59.1 per 1,000 Medicare enrollees
> No. of physicians: 31.5 per 100,000
> Median household income: $61,916

One factor affecting the quality of health care in Monroe may be the relative lack of doctors in the metro area. There are just 31 primary care physicians per 100,000 residents in Monroe, less than half the national concentration of 75 doctors per 100,000 Americans. With less access to outpatient treatment, Monroe residents may be more likely to visit the hospital for primary care-sensitive conditions, putting unnecessary strain on hospital resources.

Monroe is the only metro area in Michigan, and one of only three metro areas in the Midwest, to rank on this list.

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17. Port St. Lucie, FL
> 30-day hospital readmission rate: 16.8%
> Mortality within 30 days of hospitalization: 12.4%
> Preventable hospitalizations: 56.8 per 1,000 Medicare enrollees
> No. of physicians: 46.6 per 100,000
> Median household income: $55,714

In Port St. Lucie, Florida, 16.8% of patients are hospitalized again within 30 days of their discharge. High 30-day readmission rates can sometimes be indicative of lower quality care in area hospitals, and only six other metro areas nationwide have a higher readmission rate than Port St. Lucie.

The area’s poor performance in measures of quality of care may be partially due to an overreliance on hospitals as a primary treatment option. There are about 57 hospitalizations for conditions that should have been treated in an outpatient setting for every 1,000 Medicare enrollees in Port St. Lucie, a higher share than in the vast majority of U.S. metro areas and well above the national preventable hospitalization rate of 45 per 1,000.

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16. Johnstown, PA
> 30-day hospital readmission rate: 16.3%
> Mortality within 30 days of hospitalization: 13.3%
> Preventable hospitalizations: 52.7 per 1,000 Medicare enrollees
> No. of physicians: 82.4 per 100,000
> Median household income: $45,084

Poorer areas tend to have underperforming hospital systems and worse health care overall. In Johnstown, the typical household has an income of just $45,084 a year, nearly $17,000 less than the U.S. median.

One possible indication of poor hospital quality is high patient readmission. While readmissions are often no fault of the hospital, readmissions can occur due to poor post-acute care, medical complications during initial hospital stays, or inadequate patient discharge instructions. In Johnstown, 17.2% of all heart attack patients return to the hospital within 30 days of discharge, the third highest share of any metro area.