NICK GRAHAM/STAFF
Photo: Nick Graham
Photo: Nick Graham

Ohioans living less healthy, spend more on health care

Ohio should prioritize early interventions for children, stable housing, better support for healthy aging and decreasing tobacco use as strategies to improve health in the state.

These were among a list of priority recommendations Health Policy Institute of Ohio gave in a new report, the 2019 Health Value Dashboard, that says Ohioans are living less healthy lives and spending more on health care than people in most other states.

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Ohio ranks 46 out of 50 states when it comes to health value, according to the nonpartisan Health Policy Institute of Ohio, which does research for state policy makers and health care agencies.

Ohio’s poor ranking was driven by high rates of addiction and smoking, social inequality and too much money spent on expensive health care instead of invested in cheaper prevention and healthy lifestyle measures.

Ohio population health 
Out of every state and Washington D.C., Ohio ranked low on key health outcomes.  
MetricState ranking*
Drug overdose deaths50
Infant mortality44
Adult smoking44
Premature death43
Life expectancy42
Poor oral health42
Adult obesity41
Adult insufficient physical activity40
Cardiovascular disease mortality39
Source: 2019 Health Value Dashboard 
*Rank based on 1 being the best and 51 being the worst

“We spend a lot of money on downstream care, to treat health conditions, when we could be investing and focusing our efforts intentionally on the many factors that are at the root of those health conditions,” Amy Rohling McGee of Health Policy Institute of Ohio said.

More than one in five adults in Ohio smoke and that high rate also drives poor health. Tobacco use leads to other chronic illness and increases the risk of low birth weight and infant death.

Tobacco use is also expensive. About 15 percent of U.S. Medicaid costs trace back to cigarette smoking and 46 percent of working-age Ohio Medicaid enrollees smoked in 2017.

“We know Ohio’s high rate of adult smoking is one of the main factors driving poor health value in Ohio,” said Amy Bush Stevens, a researcher with Health Policy Institute of Ohio.

The report also recommends building up a better workforce of addiction and mental health care workers, and implementing evidenced based drug prevention and social-emotional learning programs in schools.

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Ohio’s health care landscape is also uneven and the report states that too make Ohioans are left behind and breaks down in detail disparities in specific health outcomes. Ohioans with disabilities or who are racial or ethnic minorities, have lower incomes or educational attainment, are sexual or gender minorities and those who live in rural or Appalachian counties, are all more likely to face multiple barriers to health.

Angela Dawson, executive director of the Ohio Commission on Minority Health, said the dashboard is an important tool because it points policy makers toward how to craft polices that solve health problems and it connects the dots between health inequities and their root causes.

“This dashboard really set the stage for addressing structural or institutional or what we call interpersonal or internalized racism,” she said.

The report recommends programs that intervene early and improve children’s lifelong health, which are also programs touted by Gov. Mike DeWine: evidence-based home visiting, expanded lead screening and abatement, and better access to early childhood education.

Ohioans could also save money if there was more support for healthy aging and prevention as a way to reduce spending on costly sick care later in life, according to researchers with Health Policy Institute of Ohio.

Ohio’s per person spending for older Medicaid enrollees is 1.4 times more than the U.S. rate, even though Ohio’s overall Medicaid spending per enrollee is relatively similar to other states.

Most people want to stay in their homes as long as possible, and when people receive supports for healthy aging and to remain in their home, that is cheaper than nursing home care, said Douglas McGarry, executive director of the Dayton Area Agency on Aging.

“It’s one of those rare occurrences where what people prefer is actually the lower cost options,” McGarry said.

Ohio health care spending 
Out of every state and Washington D.C., Ohio ranked low on key health outcomes.  
MetricState ranking*
Employer-sponsored plan spending, per enrollee28
Nursing home care spending, per capita41
Hospital care spending, per capita41
Total Medicare spending, per beneficiary39
Source: 2019 Health Value Dashboard 
*Rank based on 1 being the best and 51 being the worst

The report recommends prioritizing transit that invests in employment, housing and transportation, such as transit that connects low-income workers to jobs and education, safe and affordable housing for at-risk Ohioans, and strengthening the state earned income tax credit.

Dayton-based CareSource, which covers over half of Ohio’s Medicaid enrollees, has been working on piloting and scaling programs to help their members with employment and housing, which also have health benefits.

The insurer is early into a joint housing pilot in Columbus aimed at keeping babies healthy through stable housing for moms. CareSource also has a JobConnect program that started in 2015 and so far worked with 2,500 members with job and life coaching to work with the member on things like housing, child care and other barriers.

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Besides getting help with employment, the members also use the emergency department 18 percent less and CareSource measured a 29 percent drop in inpatient spending with those members, said Karin VanZant, CareSource vice president of integrated community partnerships.

“So not only are folks becoming more stable across the board, we are seeing their health outcomes becoming more stable and improving over their time working with a life coach,” she said.

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