The Journal Gazette
Saturday, March 28, 2020 1:00 am

Report: State high in medical supplies, lax in spending

BRIAN FRANCISCO | The Journal Gazette

Indiana is among states that spend the least money per person on public health, and it lags nationwide averages for hospital staffing capacities.

But Indiana has more hospital beds, intensive care unit beds and ventilators than many other states.

Those are among the findings of a report on coronavirus preparedness released this week by the Commonwealth Fund, which advocates for affordable and accessible health care.

“It is sort of a mixed bag on some of the capacity side,” David Radley, senior scientist for the Commonwealth Fund, said about Indiana's metrics in a telephone interview.

The Hoosier State appears “well positioned” on medical supplies for the COVID-19 pandemic, Radley said.

“The physician capacity is a little bit lower. It's not terribly lower,” he said.

Sara Collins, the organization's vice president of health care coverage and acRcess, said: “It's hard to imagine that a state could maintain a level of capacity all the time for a crisis like this. But the planning has to happen ahead of time so that that kind of crisis can be managed so the impact isn't as significant on states.”

The New York City-based nonprofit group analyzed state-level data related to adult health risk factors, health system capacity and resources, insurance coverage and cost-related access barriers for adults.

Indiana spends $14 per capita on public health, the Commonwealth Fund reported, compared with a nationwide average of $37. Only four states, including neighboring Ohio at $13, spend less than the Hoosier State.

Per-capita public health spending ranges from $7 in Missouri to $137 in New Mexico.

“I think it's unsurprising that we don't spend money on public health and we don't do well on public health,” Abraham Schwab, a philosophy professor and medical ethicist at Purdue University Fort Wayne, said in an interview.

Schwab noted that Indiana ranked 41st last year in the United Health Foundation's “America's Health Rankings,” which compared states on 35 measures of behavior, environment, policy, clinical care and medical outcomes. 

Indiana has fallen steadily in the rankings since placing 30th in 1990.

But Schwab pointed out that New Mexico came in at only 37th in the latest “America's Health Rankings.”

“They are spending a lot of money, and they're not much better than we are. You can spend money on a problem and not solve it,” Schwab said.

He suggested states do a better job of tailoring public health programs to address their worst health problems, such as the high rates of infant mortality and obesity in Indiana. 

COVID-19, the contagious respiratory disease that by Friday evening had killed about 27,000 people around the world in recent months, including about 1,500 in America, might prompt reassessments of public health needs by government officials nationwide, Radley said.

“It could very well be that some states react after the acute part of this sort of COVID life we're in now and they reallocate dollars that are going elsewhere to the public health budgets,” he said.

“We want to see what kind of choices they end up making.”

The Commonwealth Fund reported that Indiana has 3.5 hospital beds and 0.47 ICU beds per 1,000 adults, more than the national averages of 3.0 hospital beds and 0.34 ICU beds.

Only three states and the District of Columbia have more ICU beds per 1,000 adults than Indiana.

And Indiana has 23.1 full-feature mechanical ventilators per 100,000 people, compared with the national average of 20.5.

Dixie Platt, vice president of communications for the Indiana Hospital Association, said in an email that “Indiana's hospitals, in partnership with the State, are also rapidly expanding capacity to address the expected needs of patients during this public health emergency.”

The Commonwealth Fund's study on coronavirus readiness found that Indiana is below national averages for its numbers of hospital, ICU and triage clinicians, physician assistants, nurse practitioner and additional physician capacity, all per 100,000 people.

“How many physicians you have is ultimately driven by market demand and the interest of physicians in practicing in a particular area,” Schwab said.

“Obviously you could put incentives in place, but that's a guessing game as to whether or not that would be effective.”

Health care systems “operate at the level they need to operate at,” Radley said. “When you look over time, some of these measures of capacity don't change very much.”

He doubts the United States could build up a reserve force of physicians and nurses for activation during a health crisis.

“I think it would be difficult to implement because of how specialized the training is to work as a clinician,” he said, adding that “you're seeing it to a degree” as retired doctors and nurses and the military pitch in to treat people infected by the coronavirus.

Collins said disease prevention efforts by the federal government “would be where we would want to focus rather than just build in capacity that would be used only very rarely.”

The Commonwealth Fund reported that 11% of Hoosiers ages 19 to 64 lack medical insurance; the nationwide rate is 12%.

Indiana's share of residents most at risk of contracting the coronavirus – people older than 60 and chronically ill adults – is 45%, a percentage point above the national figure.

The average patient deductible for employer-provided health insurance is $2,898 in Indiana and $2,992 nationwide.

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