Minnesota's commitment to Public Health and Injury Prevention is reflected in low fatal injury rates and a fairly healthy population. Additionally, its citizens enjoy comparatively good access to physicians and medical facilities. However, Minnesota has fallen behind in putting uniform policies and practices in place for promoting quick and effective response to emergencies both during disasters and in everyday situations.
Minnesota continues to rank among the top performing states in Public Health and Injury Prevention, with a demonstrated commitment to injury prevention funding for children and the elderly and a high level of overall funding ($485.48 per 1,000 people). It has very low rates of homicides and suicides; fire- and burn-related deaths; and poisoning-related deaths, which include drug overdoses. Minnesota's only poor rating is its rate of fall-related deaths (14.8 per 100,000 people), which is significantly higher than the national average (9.5 per 100,000 people). The state has relatively high rates of immunizations among both older adults and children and one of the lowest infant mortality rates in the nation (4.5 deaths per 1,000 births).
Minnesota has improved its Access to Emergency Care ranking since the previous Report Card and boasts the highest per capita rate of physicians accepting Medicare in the nation (5.5 for every 100 beneficiaries). The state has relatively high Medicaid fee levels for office visits (112.1% of the national average). Minnesota fares well with low proportions of adults with no health insurance (10.1%) and inadequate insurance (6.5%) and a fairly low proportion of children with no health insurance (6.4%). There are some insurance gaps, however, as the state's children have the highest rate of underinsurance in the nation (23.2%). Minnesota has fair per capita rates of specialists and certain facilities, such as emergency departments and level I and II trauma centers, but has exceedingly low rates of accredited chest pain centers.
Minnesota's ranking in the Quality and Patient Safety Environment fell substantially, in part due to a lack of state-wide policies and procedures for enhancing emergency medical services (EMS) systems. The state did not report funding for a state EMS medical director position. Minnesota also lacks a uniform system for providing pre-arrival instructions that could offer an opportunity to provide life-saving care, and it does not have state field triage protocols in place. It has, however, increased the number of emergency medicine residents to be close to the national average and has been working on a percutaneous coronary intervention (PCI) network or ST-elevation myocardial infarction (STEMI) system of care.
The strength of Minnesota's Disaster Preparedness planning has also slipped compared with other states. Minnesota has particularly strong systems in place to ensure an adequately trained medical response, with just-in-time training systems in place statewide and a high percentage of nurses who have received disaster training (48.2%). However, Minnesota's medical response plan does not specifically address patients dependent on medication for chronic conditions, patients dependent on dialysis, patients on psychotropic medication, and mental health patients. Despite a high bed surge capacity (1428.1 per 1 million people) and availability of burn unit beds (11.2 per 1 million people), Minnesota has a very low number of ICU beds available in the event of a disaster (226.4 per 1 million people).
Minnesota should work to further enhance its safeguards for Quality and Patient Safety in its emergency care system by exploring destination policies to ensure that stroke and STEMI patients are triaged to the most appropriate medical facilities. Adopting other state-level standards, such as field triage protocols and uniform systems for providing pre-arrival instructions, would also improve the overall environment.
Minnesota's Medical Liability Environment could be stronger. While the state has the second lowest medical liability insurance premiums for primary care physicians ($4,202) and specialists ($16,674), it lacks some needed liability protections for health care providers. The state does not have a cap on non-economic damages, which may help reduce what are some of the highest average malpractice award payments in the nation ($584,175). Minnesota should also protect its emergency care providers with additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act.
Minnesota should explore its high rates of binge drinking and lack of access to substance abuse treatment and ensure that there are systems and processes in place for education, outreach, and treatment. The state should also take note of the few psychiatric care beds available (17.7 per 100,000 people) and work to fill the gap in mental health providers (0.5 full-time providers needed per 100,000 people), which may alleviate emergency department boarding of mental health patients.