Wisconsin's emergency medical system is robust, with above-average rankings for the Medical Liability Environment and Access to Emergency Care, along with low rates of injury. However, the state's Disaster Preparedness planning and policies related to the Quality and Patient Safety Environment are subpar.
Wisconsin's Medical Liability Environment has a number of reforms in place that help ensure adequate access to care. Wisconsin boasts the lowest per capita rate of malpractice award payments in the nation (0.7 per 100,000 people), and the amounts of the awards themselves are generally well below average. In addition, the average medical liability insurance premiums for both primary care physicians and specialists are the fourth lowest in the country ($5,880 and $22,017, respectively). Wisconsin has placed caps on medical liability payments for non-economic damages and implemented a patient compensation fund. Periodic payments, which can lessen the burden of excessive award payments, are also required by the state.
Wisconsin has improved in Public Health and Injury Prevention, rising from below average on the 2009 Report Card to 20th in the nation. The state now has the fifth highest rate of childhood immunizations (81.5%), and the sixth highest rate of pneumonia vaccination among older adults (74%). Wisconsin does have some areas of concern, such as the second highest rate of accidental fall-related deaths in the nation (17.1 per 100,000 people), though dedicated funding is available to address injury prevention for older adults and children. The state also has a high rate of binge drinking among adults (24.3%).
Wisconsin has slipped in the Disaster Preparedness rankings, largely by not keeping pace with other states. The state lacks some essential provisions that help ensure a quick disaster response and manage patient flow, including a statewide medical communication system with redundancy and a statewide patient tracking system. Wisconsin's planning processes do not include input from emergency physicians, and its Emergency Support Function 8 plan is not shared with essential hospital and emergency medical services personnel.
Wisconsin has some challenges in Access to Emergency Care, notably in access to behavioral health resources. The state has the second highest need for mental health care providers in the nation, with 3.4 additional full-time providers needed per 100,000 people to eliminate the shortage. More than 10% of the state's population has an unmet need for substance abuse treatment, the sixth highest in the country. These numbers, coupled with Wisconsin's high binge drinking numbers and aboveaverage rates of alcohol-related traffic injuries, indicate that this is a critical gap in the state's overall health care system.
There is some evidence that Wisconsin's denizens are not enjoying equal access to preventive care. Wisconsin has one of the highest cardiovascular disease disparity ratios in the country: The state's American Indian/Alaska Native population is almost three times more likely to suffer from this chronic condition as the race or ethnicity least likely to do so. Wisconsin's HIV disparity is also stark, with Black individuals being about 13 times more likely to receive an HIV diagnosis than White individuals. The state needs to ensure that disadvantaged populations are receiving preventive care and education and have access to adequate treatment services.
Overall, Wisconsin has a relatively strong emergency care system, but there are improvements that could be made. While the state has an average-sized health care workforce, its hospital capacity is lacking. Wisconsin has a below-average rate of staffed inpatient beds (264.6 per 100,000 people), and its low rate of intensive care unit beds (196.5 per 1 million people) is a contributor to its poor Disaster Preparedness score. An increase in hospital capacity could improve access to care in both every day and disaster situations.
Wisconsin has one of the country's lowest Medicaid reimbursement rates, at only 65.9% of the national average. Increasing this rate will help ensure that the state can recruit and retain physicians willing to treat this vulnerable population.
The state could enhance its liability environment and encourage specialists to provide critical on-call services to emergency patients by enacting special liability protections for Emergency Medical Treatment and Labor Act (EMTALA)-mandated emergency care.
Wisconsin could improve the policies and procedures in its Quality and Patient Safety Environment, particularly those that help first responders and emergency physicians treat vulnerable patients. The state currently does not have a uniform system for providing pre-arrival instructions, nor does it have triage and destination policies in place for stroke or ST-elevation myocardial infarction (STEMI) patients. Putting such policies in place would help ensure that these patients receive the time-sensitive and evidence-based care needed for a better prognosis.