While Idaho continues to boast one of the best Medical Liability Environments in the nation, it still lacks focused planning in Disaster Preparedness and key provisions for improving the Quality and Patient Safety Environment, and it suffers from a severe workforce shortage.
Idaho's Medical Liability Environment benefits from several important reforms that have been implemented over the years. The state's medical liability cap on non-economic damages reduces out-of-control medical malpractice payments, and mandatory pretrial screening panels help weed out frivolous lawsuits. Idaho also has instituted apology laws and abolished joint and several liability. The environment is further strengthened by a relatively high number of insurers writing medical liability policies (25.5 per 1,000 physicians) and only 1.4 malpractice award payments for every 100,000 people.
Idaho showed some strengths in Public Health and Injury Prevention, having among the lowest HIV diagnosis and infant mortality disparity ratios in the nation (1.1 and 1.4, respectively). The highest HIV diagnosis rate (among Hispanic persons) is only 1.1 times greater than the lowest rate. Idaho's denizens also demonstrate healthy habits: Few adults smoke (17.2%) or engage in binge drinking (16.6%), and Idaho's infant mortality rate is among the top 10 in the nation (4.8 per 1,000 live births).
Although Idaho ranks poorly in Access to Emergency Care, there are some bright spots. It has the lowest hospital occupancy rate in the country, with 52.6 of 100 staffed beds occupied. The state has good access to emergency departments (ED) and an admirably low median time from ED arrival to departure (238 minutes). The vast majority of the state's children can see a provider when necessary (96.7%).
Idaho ranks among the bottom 10 states for its Quality and Patient Safety Environment due to a lack of funding and relatively few policies and procedures designed to better support the safety and quality of emergency medical care. The state lacks funding for a state emergency medical services (EMS) medical director and does not require adverse event reporting, which would help discover and prevent medication- and medical equipment-related issues. Idaho lacks statewide field triage protocols and a uniform system for providing pre-arrival instructions, which could help in the administration of life-saving care while awaiting EMS arrival. Only half of all hospitals in the state collect data on race/ethnicity and primary language, and fewer have or are planning for a diversity strategy (26.9%).
In Access to Emergency Care, Idaho continues to struggle with a severe workforce shortage, with low rates of numerous specialty care providers. The state needs an additional 3.6 primary care providers and 1.2 mental health providers per 100,000 people, pointing to a sharp problem in accessing basic care. The state has relatively few staffed inpatient beds for its population (243.3 per 100,000 people), and the shortage of psychiatric care beds has intensified substantially since 2009, dropping from 29.0 to 13.8 per 100,000 people.
Finally, Idaho's Disaster Preparedness policies are in need of enhancement and revision. Idaho is one of the weakest states in this category largely due to a lack of state-level disaster planning. For instance, the state does not have just-in-time training systems in place; nor does it have state or regional strike teams or medical assistance teams. Idaho also lacks a patienttracking system and a process for incorporating emergency physician input into state planning.
Idaho could benefit greatly from improving its Quality and Patient Safety Environment. In 2013, the state passed legislation to begin developing systems of care for stroke and heart attack, which could standardize care across the state and improve patient outcomes. The state should also invest in a funded EMS medical director position to oversee the implementation of these systems; it should also develop a uniform system for providing pre-arrival instructions and field trauma triage protocols. These changes would go a long way toward improving patient safety and the quality of care throughout the state.
Idaho should take steps to strengthen its Disaster Preparedness. It needs to incorporate emergency physician input into the state's planning and share its all-hazards plan with all EMS and essential hospital personnel. Idaho also should incorporate plans for medically fragile populations, such as patients dependent on medication for chronic conditions and mental health patients, into its medical response plan. Finally, implementing state or regional strike teams or medical assistance teams would help enhance the state's ability to respond quickly in an emergency.
Idaho must work to improve Access to Emergency Care by addressing the specialist (particularly on-call specialist) and primary care workforce shortages. Failure to improve access to on-call specialists in the ED ultimately may result in poor health outcomes. The state should also address its limited mental health care resources.