When it comes to access to healthcare, Hawai'i leads the nation, according to a national report card released this week.

In terms of the quality of care, the state falls into the second tier, however, ranking 18th on the New York-based Commonwealth Fund's report "Aiming Higher: Results from a State Scorecard on Health System Performance."

The report compiles previously reported figures to come up with its 32 measures of cost, insurance coverage and medical quality, ranking states by how well they perform on each of the measures.

Overall, Hawai'i ranked No. 1.

"Where you live matters for getting care when you need it, getting the right care and the opportunity to live a long and healthy life," says Cathy Schoen, a senior vice president at the fund and one of the report's co-authors. The New York-based Commonwealth Fund is a private foundation that studies health issues.

Hawai'i was singled out for having a mandatory insurance law in place since 1974, which requires employers to offer health insurance to employees who work more than 20 hours a week.

"Currently, our state has one of the lowest rates of unemployment, and that may account for our increases in the number of people insured," said Janice Okubo, spokeswoman for the state Department of Health.

FEWER UNINSURED

From 2000 to 2005, the rate of uninsured adults in Hawai'i dipped slightly, and only 3 percent reported being unable to afford necessary healthcare.

During the same time period, the rate of uninsured children dropped from 10 percent to 5 percent, due in part to the expansion of the state Department of Human Services' Med-QUEST program, which provides free or subsidized health coverage to needy residents, Okubo said.

The other states rounding out the top five were Iowa, New Hampshire, Vermont and Maine.

Marilyn Matsunaga, former administrator of the state Health Planning and Development Agency, said the top five states all have a quality certificate of need program aimed at improving the quality of healthcare while keeping costs reasonable.

Hawai'i's program has been in place since 1974, the same year the state passed its mandatory insurance law.

"Both on the supply and demand side, we've tried to be very reasonable and equitable in how our healthcare system operates," Matsunaga said.

The lowest-performing states were Kentucky, Louisiana, Nevada, Arkansas, Texas, Mississippi and Oklahoma.

The report comes amid a growing focus on efforts to measure medical quality, from hospital death and infection rates tracked by Medicare to insurer efforts to measure performance of doctors and hospitals.

ROOM TO IMPROVE

Using data mainly gleaned from government agencies, such as Medicare, the Census Bureau and the Centers for Disease Control and Prevention, the report concludes all states could do better. But even lower-ranking states do some things right.

Hawai'i earned top spots for diabetics having access to preventive care, Medicare hospital admissions for ambulatory-care sensitive conditions, total Medicare reimbursements per enrollee and breast cancer deaths.

On the other hand, it ranked 41st for the percentage of adults over 50 who received recommended screening and preventive care, 44th for the percentage of hospitalized patients who received the recommended care for acute myocardial infarction, congestive heart failure and pneumonia, 47th for the percentage of heart failure patients given written instructions at discharge and 49th in the percentage of surgical patients who received the appropriate timing of antibiotics to prevent infection.

The report concluded that if Hawai'i were to perform at top levels in every category, it could insure another 13,629 adults, provide comprehensive primary care to 46,419 children and save $1,327,000 by reducing Medicare re-admissions.