Despite having relatively good Quality and Patient Safety and Medical Liability Environments, South Carolina needs to address some significant public health concerns and the ability of patients to access the care they need.
Strengths. South Carolina has instituted a number of effective medical liability reforms over the years which contribute to the state’s success in this category. South Carolina is one of only six states that provide additional liability protections for EMTALA-mandated emergency care, and one of only four states that have implemented all three of the following expert witness rules: case certification, requiring witnesses to be of the same specialty as the defendant, and requiring or providing for witnesses to be licensed to practice medicine in the state.
While South Carolina does not excel with regard to Disaster Preparedness, the state has made noteworthy strides in this area, despite receiving relatively low levels of federal funding ($6.91 per capita). The state has written plans for special needs patients, as well as a written plan to supply dialysis for patients during a disaster. In addition, South Carolina has a state-based Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program and civil liability protections for health care workers during a disaster event.
Challenges. South Carolina scores poorly on a number of public health indicators. The state has the fourth highest infant mortality rate in the nation (9.4 per 1,000 live births), well above the national rate of 6.9 per 1,000 live births, and nearly 30 percent of South Carolina’s adult population is obese. The state also has a relatively high rate of traffic fatalities (24.0 per 100,000 people), 50.0 percent of which are alcohol-related. While South Carolina is successful in immunizing a relatively high percentage of children aged 19–35 months, the state falls well below the national rate with regard to vaccinating older adults. Fewer than 63 percent of adults aged 65 and older receive the influenza vaccine, while only 61.5 percent have ever received the pneumococcal vaccine.
A number of aspects of Access to Emergency Care in South Carolina may be negatively affecting the population’s health outcomes. The state, like many others, is facing a workforce shortage in many areas, including primary care, mental health, and specialty medicine. For instance, South Carolina needs an additional 123.0 full-time equivalent primary care providers to serve its population, as well as an additional 33.3 mental health providers. While the state’s Medicaid fee levels for office visits are 111.8 percent of the national average, South Carolina has seen a 21.0 percent decline in reimbursement rates since 2004.
Recommendations. South Carolina should work to address the numerous public health risk factors present, including obesity, the high infant mortality rate, and the low rates of vaccination among older adults. South Carolina might consider tackling these issues through social marketing campaigns, interventions, and improving access to medical care, especially with regard to minorities and the older population, who may face additional barriers to care. As part of the effort to reduce barriers to access, South Carolina should work to reverse the declining trend in Medicaid reimbursement rates for office visits and increase the number of physicians accepting Medicare (2.4 per 100 beneficiaries).
South Carolina could improve its Quality and Patient Safety Environment further by focusing on its emergency medical systems. A funded state EMS medical director could lend considerable expertise in this area.
While the state continues to have a good Medical Liability Environment, South Carolina must be vigilant in maintaining this environment that is critical in helping to provide on-call specialist care. Additional enhancements are possible, including lowering the cap on non-economic damages to $250,000, completely abolishing joint and several liability, and instituting mandatory pretrial screening panels.