Illinois falls from 27th to 45th place for its overall emergency care environment is largely due to major setbacks in its already challenging Medical Liability Environment and a failure to keep pace with other states in improving Disaster Preparedness.
Illinois's strongest performance was for the Quality and Patient Safety Environment, largely due to a number of important policies and procedures that have been put in place. Illinois has a strong prescription drug monitoring program and a statewide trauma registry, which help ensure patient safety and quality improvement. It has also developed or is developing a system of care for stroke patients and ST-elevation myocardial infarction patients. These plans, along with triage and destination policies, help ensure that these patients receive prompt care in the most appropriate setting to enhance their chances for favorable outcomes. The state is currently adopting the new trauma triage guidelines for pre-hospital and trauma center activation, using the Centers for Disease Control and Prevention recommendations as baseline criteria.
Illinois has improved slightly in Access to Emergency Care over the past 5 years, having increased its per capita rates of emergency physicians, neurosurgeons, plastic surgeons, and registered nurses. It also has better-than-average health insurance coverage for children, with only 6.2% of children lacking insurance and 16.5% underinsured.
Illinois has several strengths in Public Health and Injury Prevention, especially in traffic safety. The state has one of the lowest rates of traffic fatalities (6.1 per 100,000 people) and a high rate of seatbelt use (92.9% of front-seat occupants). Strong child safety seat and seatbelt legislation and distracted driving laws are currently in place, and the state has below-average rates of bicyclist and pedestrian deaths.
Illinois's ranking for its Medical Liability Environment fell sharply, from 34th to 50th in the nation, placing it near the bottom for medical liability support for emergency care. The state has fallen behind in the types of medical liability reforms enacted in other states over the past 5 years and has earned a reputation as a litigation environment unfavorable to defendants and prone to excessive verdicts. Compounding these issues, provisions for periodic payments and the state's medical liability cap on non-economic damages were ruled unconstitutional in 2010. Currently, Illinois has the second highest average malpractice award payments in the nation ($599,439). Average medical liability insurance premiums for primary care physicians are also second highest in the country and premiums for specialists are $36,000 more per year than the national average. Illinois currently has virtually no medical liability reforms in place to discourage frivolous lawsuits.
In Public Health and Injury Prevention, Illinois could do more to combat causes of chronic disease and illness in its population. The state has very low rates of immunization against influenza and pneumonia for older adults and a relatively high rate of binge drinking among adults (23%). Despite an average rate of adult obesity, the child obesity rate in Illinois is among the highest in the country (19.3%). Illinois also has a high cardiovascular disease disparity ratio, indicating that there are populations in the state who may not be receiving adequate preventive care.
The most pressing problem in Illinois is the state of its Medical Liability Environment. Without reform and a reversal of recent trends, the state risks losing its most qualified doctors and medical professionals to states where there is more protection against unnecessary lawsuits and excessive verdicts. Unfortunately, medical liability reform has not fared well in the Illinois court system to date.
While changes in a number of Disaster Preparedness indicators from 2009 may partially explain the significant grade drop, Illinois now ranks well below most other states in this category. In 2012, the state's Department of Public Health sought legislation to enhance immunity for its health care responders during an emergency but was unsuccessful. Adopting liability protections might help the state increase the per capita numbers of physicians, nurses, and behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals, which are currently among the lowest in the nation.
Dwindling Medicaid reimbursement rates are another challenge for accessing needed care, especially with full implementation of the Patient Protection and Affordable Care Act and Medicaid expansion underway. The state has one of the lowest Medicaid fee levels for office visits, at only 57.9% of the national average, and rates have been stagnant since 2007. Illinois needs to increase Medicaid payments to attract more physicians to serve the Medicaid population and meet the state's growing need for primary care.