While Arizona has demonstrated an impressive commitment to disaster preparedness, the state suffers from critical deficiencies in a number of key areas ranging from a shortage of specialists and hospital beds to a paucity of medical liability reforms.
Strengths. Arizona has made significant efforts to improve Disaster Preparedness. Despite receiving a below average amount of federal funding for disaster preparedness – only $9.51 per person – there is a patient tracking system, as well as a statewide medical communication system with one layer of redundancy. Arizona also ranks 12th and 16th, respectively, with regard to the per capita rates of nurses and physicians registered in the state-based Emergency System for Advance Registration of Volunteer Health Professionals program.
Despite the state’s poor grade in Access to Emergency Care, the state has demonstrated accomplishments in this area. Arizona’s Medicaid fee levels for office visits are the fourth highest in the nation – 140 percent of the national average. In addition, reimbursement rates for office visits have increased 16.2 percent since 2004–2005. This is particularly important in Arizona where 10.4 percent of the adult population is enrolled in Medicaid.
Challenges. One of the state’s greatest shortcomings in Public Health and Injury Prevention is especially low immunization rates. Fewer than three-quarters of Arizona’s children (aged 19–35 months) are immunized, compared to 80.6 percent nationally. Meanwhile, only 65.4 percent of adults aged 65 years and older receive their annual influenza vaccine. In addition to immunization shortcomings, Arizona has among the nation’s highest rates of homicides and suicides and unintentional fall-related fatal injuries (24.8 and 11.8 per 100,000 people, respectively). A lack of funding for injury prevention may hamper efforts to reduce these rates. Arizona ranks 47th in the nation with regard to total injury prevention funds ($18.42 per 1,000 people).
Arizona’s most stifling medical liability issues include the state’s relatively high average medical liability insurance premiums for primary care physicians and specialists ($22,798 and $87,175, respectively). The state also lacks additional liability protections for EMTALA-mandated emergency care, a medical liability cap on non-
economic damages, and pretrial screening panels to discourage frivolous lawsuits.
Arizona’s Access to Emergency Care crisis is threefold. First, the state faces a critical workforce shortage in many areas, falling among the bottom five with regard to ear, nose, and throat specialists (2.2 per 100,000 people); orthopedists and hand surgeon specialists (7.1 per 100,000); and registered nurses (560.8 per 100,000). Second, Arizona falls among the lowest ranking states with regard to uninsured adults and children (22.3 and 17.0 percent, respectively). Lastly, the state also scores poorly with regard to the rate of emergency departments, staffed inpatient beds, and psychiatric care beds.
Recommendations. Emergency physicians in the state report that Arizona is facing serious crowding and boarding issues in emergency departments and hospitals, as well as a lack of on-call specialists. As part of an effort to attract and maintain a broader workforce, Arizona should take immediate action to improve the Medical Liability Environment. While caps on non-economic damages have been declared unconstitutional, the state should enact policy requiring expert witnesses to be of the same specialty as the defendant and requiring pretrial screening panels to discourage frivolous law suits. In addition, instituting additional liability protections for EMTALA-mandated emergency care may encourage more specialists to be on call in the emergency department, where more high-risk patients present themselves.
As noted above, the state lacks significant resources with regard to emergency departments, staffed inpatient beds, and psychiatric care beds, which may also contribute to issues of boarding and crowding. Arizona must work closely with hospitals and other facilities to identify ways to increase capacity and serve a larger population.
Finally, Arizona would benefit significantly from ensuring that more children and adults have adequate health insurance. The high rates of uninsured residents, combined with a depleted workforce, hamper access to adequate preventive and emergency care.