Meractus report: Health care in West Virginia has room for improvement

By Karen Kidd | Dec 22, 2016

FAIRFAX, Va. – Although there is some not-so-bad news for West Virginia's health care ranking in a report recently released by the Mercatus Center at George Mason University, the predicted direction is predominantly up, according to one of the report's authors.

"If West Virginia wished to make its health care system more open and accessible, there are plenty of areas for improvement," Robert Graboyes, a Mercatus senior research fellow, said during an email interview with The West Virginia Record.


Overall rankings map  

West Virginia ranks No. 44 in provider regulation due to certificate of needs laws, which restrict hospital competition, and is related to prescription drugs laws, Graboyes said.

"In the area of pharmaceutical access, the state ranks No. 50, due to its highly restrictive environment with respect to use of experimental and other controversial drugs," he said. "Our data also show that West Virginia could also improve its rankings by lightening the taxation and medical liability burdens on health care providers."

Graboyes wrote the report with Darcy N. Byran, a health sciences associate clinical professor at University of California Riverside, and Jared Rhoads, a research project manager at The Dartmouth Institute for Health Policy.

Their report, "The Healthcare Openness and Access Project (HOAP)," measures how open and accessible each state’s health care system is to patient and provider preferences. The overall HOAP index is the average of 10 categories, referred to as sub-indexes, each of which is in turn an average of multiple indicators.

Although the Mecatus Center report doesn't place West Virginia at the bottom of its state rankings, the state does have far fewer states placing behind it than ahead, according to the report's overall profile for the state. West Virginia is 44th in the nation for how much flexibility patients and providers have in shaping health care, according to the report.

Among other rankings, West Virginia is 31st in state insurer flexibility to determine the pricing of health insurance policies, 17th in how physicians are constrained by the threat of malpractice, 17th in occupational regulation; and 50th in medical professionals' ease of access to licensure.

"The indicators that determine the corporate, insurance, and direct primary care sub-indexes come from entirely different areas of state law and regulation," Graboyes said. "So their numbers can differ widely."

The corporate sub-index depends on the flexibility the state affords medical enterprises in structuring their businesses as they see fit, Graboyes said.

"Can a company hire a doctor to serve its employees?" he said. "Can someone other than a doctor hold a financial interest in a medical practice? Can a doctor split fees with a business partner who is not a doctor? On these issues, West Virginia offers little flexibility, and hence ranks No. 35 among the states."

West Virginia does a bit better in the insurance sub-index, which measures the flexibility insurers have in designing and pricing insurance policies, Graboyes said. "Here West Virginia does better, ranking No.17 among the states," he said. "The state allows insurers the maximum discretion, as defined under the Affordable Care Act, to differentiate their pricing by age, geography and tobacco usage. The state is heavy, however, on rate review requirements and quite heavy on the number of services each insurer is required to cover. 

"Finally, I'll note that West Virginia ranks No. 25 in openness to tele-medicine. Given the state's rural nature and demographics, tele-medicine could go a long way in improving the health of the population."

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