Utah continues to support an outstanding Quality and Patient Safety Environment and has made notable improvements to its Medical Liability Environment. However, Access to Emergency Care is threatened by financial barriers, including poor rates of health insurance coverage and low Medicaid reimbursement levels.
Utah has among the best Quality and Patient Safety Environments in the nation, with numerous policies and practices in place to enhance emergency response systems. The state has a uniform system for providing pre-arrival instructions and state field trauma triage protocols based on Centers for Disease Control and Prevention guidelines. There are destination policies in place for stroke, ST-elevation myocardial infarction (STEMI), and trauma patients that allow emergency medical services teams to bypass local hospitals for medical specialty centers. Utah hospitals are second best in the nation for the time that it takes to transfer a chest pain patient to another facility (45 minutes).
Public Health and Injury Prevention in Utah surpass that of most of the nation, with solid marks for health risk factors. The state has the lowest proportion of adults who smoke (11.8%) and the third lowest percentage of adults engaging in binge drinking (12.0%). Utah has a low infant mortality rate (4.9 per 1,000 live births) and can boast among the lowest racial and ethnic health disparities in infant mortality and cardiovascular disease rates. The state also has relatively high levels of funding for injury prevention ($682.47 per 1,000 people) and has dedicated funding for injury prevention among children and the elderly.
Utah has also improved its Medical Liability Environment since the 2009 Report Card, largely due to passage of additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act, as well as an increase in insurers writing medical liability insurance premiums. The state has seen slight decreases in medical liability insurance premiums, although rates for specialists remain well above the national average. Utah also has a medical liability cap on non-economic damages and allows periodic payments of awards.
Utah's grade for Disaster Preparedness was affected by low rates of physicians and nurses registered in the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP; 15.4 and 143.2 per 1 million people, respectively). Data indicate a low bed surge capacity (412.9 beds per 1 million people) as reported to the U.S. Office of the Assistant Secretary for Preparedness and Response, although state law allows hospitals to surge internally to a higher level. The state also lacks a patient-tracking system during disasters.
Access to Emergency Care remains a major challenge in Utah, especially in relation to the adequacy of health insurance for children. A relatively large proportion of children in Utah are uninsured (10.7%), and more than one in five who do have insurance is underinsured, with parents reporting unreasonable out-of-pocket costs for accessing care (20.2%). Medicaid fee levels for office visits are also well below the national average (85.5%), despite a 12% increase since 2007. While the state has roughly average rates of many types of providers, there is a shortage of orthopedists and hand surgeons (8.5 per 100,000 people) and registered nurses (678.7 per 100,000 people).
Utah has the opportunity to implement statewide policies and procedures that would enhance its overall Disaster Preparedness. Outreach and education should be undertaken to increase the number of physicians and nurses who register with ESAR-VHP; this would significantly improve the state's ability to respond quickly and effectively during a disaster or mass casualty event. Utah could also improve in this category by exploring mutual aid agreements with behavioral health providers to provide care during a disaster.
The lack of access to adequate health insurance, especially for children, is a major concern for Utah. Utah policymakers and other stakeholders must take action to address this gap and ensure that this vulnerable population is able to receive needed care on time. Increasing childhood immunization rates would help improve the overall health of children by preventing the spread of life-threatening diseases.
Utah should build on previous successes in the Medical Liability Environment and implement rules that require all expert witnesses to be of the same specialty as the defendant and licensed to practice in the state.