A recent article about the quality of healthcare in Utah caught my attention (see: Why Does Utah Rank So High in Health Care?). The article describes in detail why Utah ranks so high in both the quality of care combined with the low cost of such care. Below is an excerpt from it:
Utah holds a unique distinction among U.S. states: It has the healthiest population and the lowest per-capita health care costs, according to some measures....Its per-capita costs are just over half those of equally healthy Massachusetts ($5,013 vs. $9,278)....Experts haven’t quite uncovered the secret to Utah’s success — but the state’s people, systems, dollars, and data certainly matter. Utah’s advantage in health starts with demographics. Its population is the youngest in the union by several years, with an average age just under 30, according to U.S. Census figures....It’s also a relatively well-educated state, ranking 7th in percentage of high school graduates and 17th in percentage of residents with at least a bachelor’s degree. Both youth and high educational levels correlate with better population health.....There’s much higher use of home health and hospice.....Utah posts impressively low numbers on smoking, preventable hospitalizations, and percentage of children living in poverty. But it has challenges: a high rate of drug-related deaths...; a shortage of primary care physicians (ranked 44th); and...the highest rate of mental illness in the United States. A preponderance of Mormons explains some of Utah’s overall edge on health....60% to 70% of the state’s 3 million people identify as Mormon, even if they don’t attend church regularly, and most of them follow the church’s dietary and behavioral restrictions, which include no tobacco, alcohol, or recreational drugs. The faith also encourages large families and strong social networks, both of which provide support when people get sick....When Utahans get sick enough to be hospitalized, they are treated in the least aggressive hospitals of any state....And hospitalized Medicare patients in Utah went home sooner: an average of 0.83 inpatient days per Medicare enrollee, versus 1.42 nationally. However, when it comes to surgery, Utah’s utilization is actually higher: Dartmouth’s analysis shows that Utah hospitals had higher-than-average surgical discharges for Medicare patients: 85.5 per thousand enrollees, compared with 80.4 nationally.
The positive correlation between education and health has always fascinated me and I have frequently blogged about it (see: Correlation of Sociodemographic Status with Personal Engagement in Cancer Screening Programs; Fewer Hospital Admissions for Heart Failure Among Better Educated Patients). As noted above, Utah resident are relatively well educated, younger, and also lead healthier lives than those in other states because of their usual avoidance of alcohol and tobacco products. It's quite clear also that stronger family and social networks allow patients in the state to be discharged from the hospital sooner. However, what interested me most in the article was that healthcare delivery in Utah tends to less "aggressive." Here's a quote from the article about this particular factor:
Dartmouth Atlas of Healthcare’s Hospital Care Intensity index, which defines “aggressive” hospital care on the basis of two variables: how many days patients spend in the hospital, and how often they see a physician while they’re there. Even the most aggressive hospital in Utah, Intermountain-owned LDS hospital in Salt Lake City, is only in the 14th percentile.
Why would healthcare delivery be less aggressive in Uta not including the rate of surgery which is higher? One can only speculate about this factor. My best guess is that the healthcare delivery style is related to the culture of Utah which is closely linked to Mormonism. Perhaps because the people enjoy better health than is the norm in the country there is no perceived need to consult often with a physician when hospitalized or spend many days in the hospital as is common in other parts of the country.