Texas Near Bottom for Medicare Services

Dr. Stephen Jencks at the Centers for Medicare and Medicaid Services is encouraged. "We've had a lot of bad news about quality over the last few years, and to see that it's clearly improving is very heartening."

Dr. Jencks and his colleagues at the CMS analyzed medical records from every state. They wanted to see if Medicare patients received high quality care for breast cancer, diabetes, heart problems, pneumonia and stroke. Their findings appear in the Journal of the American Medical Association. In 1998 and 99, about 69 percent of Medicare patients received appropriate care. In 2000-2001, that figure went up to about 73 percent of patients.

"That sounds like a small difference, but it is a huge difference to achieve that nationwide in just two years."

Still, Dr. Jencks warns that care is not yet what it should be. "I would hate to see people say, ah, well, things are getting better so we don't need to work on them as hard."

Some states need to work harder than others. Which states provided the best health care to Medicare patients? The top five are New Hampshire, Vermont, Maine, North Dakota and Utah. The states that rank at the bottom of the list for quality Medicare services are Arkansas, Texas, Mississippi, Louisiana and Puerto Rico. But Dr. Jencks cautions that even a ranking of number one doesn't mean care in that state is perfect.

"I think there's a real danger in focusing on the fact that one state is a bit better than another and losing sight of the fact that in every state there is a major opportunity to improve care."

Dr. Jencks stresses that the quality problems he found are not caused by individual practitioners. These are problems with the systems in which care is provided. He says system improvement should be every state's priority.