Missouri has a strong Disaster Preparedness system with plans, policies, and facilities in place for an effective disaster response and above-average Access to Emergency Care. However, the state also has a challenging Medical Liability Environment, worrisome chronic disease risk factors, and high rates of preventable deaths.
Missouri has worked to improve its already strong Disaster Preparedness by instituting a statewide patient-tracking system and including patients dependent on dialysis in its medical response plan. These and other policies and procedures help ensure that the medically vulnerable are cared for in the event of a disaster and that disaster data are tracked and monitored to ensure a quick and nimble state response. Missouri also has high per capita rates of burn unit beds (13.1 per 1 million people) and intensive care unit beds (372.3 per 1 million people). The state has a demonstrated commitment to training, with an above-average number of drills and exercises conducted with hospitals. Missouri has the second highest rate of behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals (74.6 per 1 million people) and is among the top 10 states for physicians and nurses registered, as well.
Missouri ranks sixth in the nation for Access to Emergency Care. An overall strong health care workforce bolsters this grade, with above-average per capita rates of many types of specialists. Missouri also has adequate hospital capacity, with high per capita rates of staffed inpatient beds (366.1 per 1 million people) and psychiatric care beds (52.6 per 1 million people). The state also has above-average rates of accredited chest pain centers, level I and II trauma centers, and emergency departments. Although Missouri's Medicaid fee levels for office visits need attention, at only 76.8% of the national average, they are at least trending in the right direction, with a 14.4% increase since 2007.
Missouri has fallen in the Medical Liability Environment rankings. Missouri's $350,000 cap on non-economic damages was struck down by the state Supreme Court in 2012, eliminating a key protection for health care providers in a state where the average malpractice award payments are almost $130,000 higher than the national average. The state's medical liability insurance premiums for physicians are also higher than average. In addition, Missouri has few other protections in place for its health care providers. It does not provide for pretrial screening panels, which can help prevent frivolous lawsuits, and does not have rules requiring expert witnesses in medical liability cases to practice in the same specialty as the defendant or to be licensed to practice medicine in the state.
Missouri faces several challenges in Public Health and Injury Prevention. The state has one of the lowest rates of funding for injury prevention ($13.36 per 1,000 people) in the nation, which may be reflected in higher-than-average preventable death rates in several areas, including homicides and suicides, traffic fatalities, poisoning-related deaths (which include drug overdoses), and fire- and burn-related deaths. Adults in Missouri have high rates of cigarette smoking (25.0%) and are more likely to be obese (30.3%) than adults in most states. Although Missouri's infant mortality rate is only slightly higher than average (6.6 deaths per 1,000 live births), the state has one of the highest infant mortality disparity ratios in the nation, with the non-Hispanic Black infant mortality rate being 3.6 times greater than that of the racial or ethnic group with the lowest rate.
Missouri must work to implement medical liability reforms to hold back rising medical liability insurance premiums that could jeopardize access to care. One important reform would be the implementation of additional liability protection for care mandated by the Emergency Medical Treatment and Labor Act, which is aimed at reducing the burden on emergency providers who serve high-risk patients, often with little or no knowledge of their medical histories. Given the loss of the medical liability cap, this reform would be an important step toward improving the state's liability climate, potentially encouraging more on-call specialists to provide services to the emergency department.
Missouri should work to discourage risky behaviors that can lead to preventable disease and injury. Distracted driving legislation and stronger enforcement of child safety belt and seatbelt laws could help reduce traffic fatalities. Passage of smoke-free legislation for restaurants, bars, and workplaces could help prevent secondhand smoke exposure and encourage current smokers to quit.
Despite high scores in Access to Emergency Care, Missouri falls behind with regard to financial barriers to care and has a shortage of primary care providers. In addition to low Medicaid reimbursement rates, it ranks among the 10 worst for the proportion of children with no health insurance (11.5%). Missouri should work to address these issues to ensure that the state's low-income and child populations can access the care that they need.