'Deaths of Despair,' Premature Deaths on the Rise, Report Finds

'Deaths of Despair,' Premature Deaths on the Rise, Report Finds

The combined death rate from suicide, alcohol, opioids, and other drugs rose 50 percent from 2005 to 2016, a report from the Commonwealth Fund finds.

The 2018 Scorecard on State Health System Performance (HTML or 62 pages, PDF) found that the combined death rate from suicide, alcohol, opioids, and other drugs increased in all states — and doubled in Delaware, Ohio, New Hampshire, New York, and West Virginia. In addition, the report found that the rate of deaths from treatable medical conditions rose nationally and in two-thirds of states between 2014 and 2015 after a decade-long downward trend, while 56 percent of adults and 18 percent of children with mental illness received no treatment.

At the same time, the study found that between 2013 and 2016 the adult uninsured rate fell at least 5 percentage points in forty-seven states, while in nearly three-quarters of states substantially fewer adults had to forgo needed care due to cost, with states opting to expand Medicaid eligibility under the Affordable Care Act seeing the largest drops in rates of uninsurance and cost-related barriers to care. The report also found that healthcare disparities within and between states varied widely; in Alabama, which has not expanded Medicaid eligibility, low-income adults were nearly seven times as likely as high-income adults (33 percent vs. 5 percent) to forgo needed care because of cost, whereas in Pennsylvania, which has expanded Medicaid eligibility, the gap was narrower (17 percent vs. 9 percent).

According to the index, the states ranked at the top — Hawai'i, Massachusetts, Minnesota, Vermont, and Utah — performed about twice as well, on average, as states ranked at the bottom — West Virginia, Florida, Louisiana, Oklahoma, and Mississippi. The report also found that many states are not getting good value for their healthcare spending, with high rates of emergency department visits for non-emergency care even among those who have insurance coverage and nearly a third of adults not receiving recommended cancer screenings.

"Insurance coverage is a necessary but not sufficient condition for improving health care and outcomes," the report's authors note. "Urgent concerns such as the opioid crisis may call for new initiatives. With states assuming ever greater responsibility for the future of health policy, it will be more important than ever to continue tracking the performance of the health system throughout the country."