Category Grades
27C 45D
Access to Emergency Care:
39D- 24D
Quality/Patient Safety:
8A- 22C+
Medical Liability:
34D 50F
Public Health/ Injury Prevention:
28D+ 29D+
Disaster Preparedness:
8A- 43F

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.

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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.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 9.9 12.1
Emergency physicians per 100,000 pop 13.3 15.1
Neurosurgeons per 100,000 pop 1.9 2.2
Orthopedists and hand surgeon specialists per 100,000 pop 8.1 8.6
Plastic surgeons per 100,000 pop 2.0 2.3
ENT specialists per 100,000 pop 3.0 3.2
Registered nurses per 100,000 pop 815.0 962.5
Percent of children able to see provider 94.1
Level I or II trauma centers per 1M pop 4.4 3.3
Percent of population within 60 minutes of Level I or II trauma center 92.5 95.8
Accredited chest pain centers per 1M pop 1.0 3.2
Percent of population with an unmet need for substance abuse treatment 8.8 9.0
Pediatric specialty centers per 1M pop 3.0 2.4
Medicaid fee levels for office visits as a percent of the national average 71.1 57.9
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 0.0 0.0
Percent of adults with no health insurance 15.6 17.5
Percent of adults underinsured 6.7
Percent of children with no health insurance 9.5 6.2
Percent of children underinsured 16.5
Percent of adults with Medicaid 6.6 9.7
Hospital closures in 2006/2011 0 1
Staffed inpatient beds per 100,000 pop 309.5 288.6
Hospital occupancy rate per 100 staffed beds 66.6 64.1
Psychiatric care beds per 100,000 pop 20.0 21.1
Median time from ED arrival to ED departure for admitted ED patients 265
State collects data on diversion YES YES

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $10.90 $8.47
State budget line item health care surge YES
ESF-8 plan is shared with all EMS and essential hospital personnel YES NO
Emergency physician input into the state planning process YES, YES YES
Public health and emergency physician input during an ESF-8 response YES, NO
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) YES, ACCREDITED YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO NO
Medical response plan for supplying dialysis NO NO
Mental health patients included in medical response plan NO
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers LOCAL LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing NO
Just-in-time training systems in place STATEWIDE NR
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO NO
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES NR
Bed surge capacity per 1M pop 576.3 290.0
ICU beds per 1M pop 250.5 248.5
Burn unit beds per 1M pop 5.1 5.0
Verified burn centers per 1M pop 0.155611168 0.2
Physicians registered in ESAR-VHP per 1M pop 42.3 3.1
Nurses registered in ESAR-VHP per 1M pop 32.2 20.0
Behavioral health professionals registered in ESAR-VHP per 1M pop 1.4
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, NO NO
Percent of RNs that received emergency training 42.2 36.4

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 25.2 22.0
Lawyers per physician 0.9 0.7
Lawyers per emergency physician 18.9 14.6
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -7 -4
Malpractice award payments per 100,000 pop 0.7 1.4
Average malpractice award payments $543,983 $599,439
National Practitioner Databank reports per 1,000 physicians 14.9 17.6
Apology laws: Apology is inadmissible as evidence in a court of law NO
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 2.6 2.9
Average medical liability insurance premiums for primary care physicians $71,467 $27,593
Average medical liability insurance premiums for specialists $77,494 $94,220
Presence of pretrial screening panels NONE NO
Pretrial screening panel's findings admissible as evidence N/A N/A
Periodic payments are: required, granted upon request, at court's discretion UPON REQUEST OR AGREEMENT OF PARTY(IES) NO
Medical liability cap on non-economic damages $350,001-500,000 NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished NO NO
Collateral Source Rule/Provides for Awards to be Offset YES
State provides for case certification YES YES
Expert witness required to be of the same specialty as the defendant YES NO
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 3.0
Pedestrian fatalities per 100,000 pedestrians 3.4
Percent of traffic fatalities alcohol-related 47.0 35.0
Percent of front occupants using restraints 90.1 92.9
Child safety seat/seat belt legislation - score out of a possible 10 points 7 8
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 4
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 79.6 77.3
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 66.4 54.7
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 60.0 62.5
Fatal occupational injuries per 1M workers 33.3 29.2
Homicides and suicides (non-motor vehicle)(per 100,000) 15.3 15.9
Unintentional fall-related fatal injuries (per 100,000) 4.8 7.0
Fire/burn related fatal injuries (per 100,000) 1.2 0.8
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.2 0.2
Rate of unintentional poisoning-related deaths (per 100,000) 9.0
Total injury prevention funds per 1,000 persons $162.61 $162.29
Dedicated child injury prevention funding NO
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 7.4 6.8
Percentage of adults who binge drink 19.3 23.0
Percentage of adults who currently smoke 20.5 20.9
Percentage of adult population who are obese (BMI > 30.0) 25.1 27.1
Percentage of children who are obese 19.3
Cardiovascular disease disparity ratio 2.8
HIV diagnosis disparity ratio 11.0
Infant mortality disparity ratio 2.7

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES NO
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 22.2 30.1
Adverse event reporting required YES NO
% of counties with Enhanced 911 capability 83.5 85.4
State has a uniform system for providing pre-arrival instructions YES YES
State uses CDC guidelines for state field triage protocols NR
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients YES
State has or is working on a PCI network or a STEMI system of care YES YES
State has triage and destination policy in place for STEMI patients YES
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients YES
Prescription drug monitoring program score (range 0-4) 3
% of hospitals with computerized practitioner order entry 31.4 85.0
% of hospitals with electronic medical records 51.9 95.0
% of patients with AMI given PCI within 90 minutes of arrival 48 94
Median time to transfer to another facility for acute coronary intervention 45
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 67.0
% of hospitals with or planning to develop a diversity strategy or plan 50.2

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