Nebraska earned solid marks for multiple indicators, including its lowest-in-the-nation average medical liability insurance premiums, but work is needed to improve preparedness for disasters and to ensure an adequate supply of key specialists.
Strengths. Nebraska’s performance in Access to Emergency Care reflects a number of positive factors, particularly regarding the supply of facilities and hospital capacity. The state ranks among the top 10 with regard to the rates of emergency departments (38.0 per 1 million people), staffed inpatient beds (500.9 per 100,000), and psychiatric care beds (39.5 per 100,000). The state also has an adequate supply of primary care providers, registered nurses, mental health providers, and pediatric specialty centers. Rates of uninsured residents are also comparatively low: 13.1 percent of adults and 10.1 percent of children lack insurance, compared to 17.2 and 11.7 percent, respectively, nationwide.
The state’s Quality and Patient Safety Environment benefits from funding for quality improvements within the EMS system and hospital-based infections and mandatory quality reporting requirements. The state has invested in both a stroke system of care and PCI network or STEMI system of care. Nebraska also has the fourth highest percentage of eligible patients receiving PCI within 90 minutes of hospital arrival (76 percent).
Nebraska also fared well with regard to numerous Public Health and Injury Prevention indicators. The state has relatively low rates of homicides and suicides (13.1 per 100,000 people) and infant mortality (5.6 deaths per 1,000 live births). Nebraska also has the fifth lowest percentage of traffic fatalities that are alcohol-related (33.0 percent), though the state has a relatively high rate of binge drinking among adults (18.1 percent versus 15.4 percent nationally). The childhood immunization rate (80.8 percent) is approximately equal to the national rate, while vaccination rates among older adults are slightly higher than the national rate for the annual influenza (73.3 versus 69.6 percent, respectively) and pneumococcal vaccines (68.3 versus 66.9 percent, respectively).
Regarding the Medical Liability Environment, Nebraska enjoys the lowest average medical liability insurance premium in the country for specialists ($21,810) and the second lowest premium for primary care physicians ($5,753). However, the average malpractice award in the state is still higher than the average across the states ($297,247 versus $285,218). Nebraska has a patient compensation fund and has eliminated joint and several liability, while also enacting mandatory pretrial screening panels whose findings are admissible as evidence, as well as a cap on damages.
Challenges. The state’s poorest performance is in Disaster Preparedness. Nebraska does not have written plans specifically for special needs patients or to supply medications for chronic conditions during a disaster. The state also lacks patient and victim tracking systems, as well as a real-time surveillance system for common emergency department presentations. The state ranks 27th for enrollment of physicians in the state-based Emergency System for Advance Registration of Volunteer Health Professionals program and lacks any nurses registered with the program. The state has failed to enact a policy that requires training for EMS and essential hospital personnel in disaster management and response to bio- and chemical terrorism.
While the state fared well overall with regard to Access to Emergency Care, Nebraska faces challenges that may pose barriers to accessing care throughout the state. The state ranks poorly for its per capita numbers of emergency physicians (46th), neurosurgeons (29th), plastic surgeons (37th), and orthopedists and hand surgeons (22nd). The state also appears to be lacking with regard to substance abuse treatment options or availability: 9.2 percent of Nebraska’s population is in need of but unable to obtain treatment for substance abuse.
Recommendations. Nebraska can build on disaster preparedness efforts by investing further in systems and activities to improve coordination, communication, and training to respond to catastrophic events. Further reforms could continue to improve the Medical Liability Environment, potentially helping to address the need to continue to recruit and retain medical specialists. Finally, Public Health And Injury Prevention might benefit from further policies or investments aimed at promoting healthy behaviors, such as seat belt use, healthy eating, and increased physical activity.