Illinois has implemented comprehensive systems and programs that reflect well on the state’s commitment to Disaster Preparedness and the Quality and Patient Safety Environment. However, serious problems exist elsewhere, including a shortage of health care providers, poor Medicaid reimbursement policies, and a highly unfavorable Medical Liability Environment.
Strengths. Illinois’ commitment to improving the Quality and Patient Safety Environment has been demonstrated through funding for quality improvement of the emergency medical system, implementation of a uniform system for providing pre-arrival instructions, maintenance of a statewide trauma registry, and ongoing efforts to develop a stroke system of care. In addition, the state requires reporting of adverse events and hospital-based infections.
Illinois also appears to have accomplished a great deal in the area of Disaster Preparedness, especially with regard to the ability to manage volunteer health professionals. The state provides additional civil liability protections to health care workers during a disaster, and is capable of verifying credentials and assigning volunteers to one of the four Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) levels in the state. Illinois had 42.3 physicians registered with ESAR-VHP per 1 million people, ranking 10th among the states. In addition, the Illinois Medical Emergency Response Team has received state and federal recognition for numerous disaster response efforts.
Challenges. The Medical Liability Environment in Illinois fares quite poorly. The average malpractice award payment ($543,983) is the highest of any state, as is the average medical liability premium for primary care physicians ($71,467). Illinois lacks pretrial screening panels and liability protections for EMTALA-mandated emergency care. In addition, compared with other states, Illinois has a very low number of insurers writing medical liability policies (2.6 per 1,000 physicians), which may be indicative of the reluctance of insurers to maintain their share in the market due to the high malpractice payments that have been awarded.
Illinois is facing a shortage of primary care and mental health professionals, as well as certain specialists. An additional 448 full-time primary care providers and 75 full-time mental health professionals are needed to serve the Illinois population in those two categories of providers alone. The shortage of health care workers may be exacerbated by the low Medicaid reimbursement rates for office visits. Illinois’ Medicaid fee levels for office visits are 71.1 percent of the national average.
There are a few noteworthy problems in Illinois related to Public Health and Injury Prevention. Illinois ranks 48th among the states for the percentage of people who are binge drinkers (19.3 percent). The high rate of binge drinkers may be reflected in the relatively high percentage of traffic fatalities that are alcohol-related: 47.0 percent compared to a national rate of 42 percent.
Recommendations. Above all, Illinois must maintain the medical liability reforms that have been enacted and strive to further improve its Medical Liability Environment. While the state faces a challenge to its medical liability cap on non-economic damages, policymakers must keep in mind the positive effects this and other reforms have on the state’s ability to attract and maintain an adequate health professional workforce, in essence improving the quality and timeliness of care. In addition to maintaining current reforms, Illinois should strive to implement additional liability reforms such as instituting pretrial screening panels and abolishing joint and several liability.
Increasing Medicaid reimbursement rates should be strongly considered to help attract and retain much needed primary care physicians and specialists, while at the same time improving the quality and accessibility of care for Medicaid beneficiaries.
Illinois should take steps to address hospital crowding and the boarding of patients in emergency departments, which have been identified by emergency physicians in the state as priority concerns. One possible contributor to the problem is the state’s low rate of emergency departments (12.4 per 1 million people compared to an average across the states of 19.9 per 1 million people). The state could also work to increase the numbers of inpatient and psychiatric care beds (309.5 and 20.0 per 100,000 people, respectively), both of which are less than the average state (358.3 and 29.9 per 100,000, respectively).