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The Florida state flag flies.

(The Center Square) – Florida’s health care system is among the nation’s worst in access, affordability, avoidable use, consistent pediatric care and overall costs, especially for the privately insured, according to a recently published analysis by The Commonwealth Fund.

The Commonwealth Fund’s annual Scorecard on State Health System Performance ranked Florida 41st overall in grading health care in 50 states and the District of Columbia.

The analysis measured 49 data indicators in five categories: access and affordability, prevention and treatment, avoidable hospital use and costs, healthy lives, and income disparity and racial disparity.

The top-scoring states were Hawaii, Massachusetts, Minnesota, Iowa and Connecticut. The bottom five were Mississippi, Oklahoma, Nevada, Missouri and West Virginia.

Florida ranked 48th for access and affordability, 47th for avoidable use and cost, 41st for income disparity, 41st for per capita public health spending ($19 a person, 51 of percent the national median) and last in the percentage of children without a medical home, meaning without a personal doctor or nurse or "a usual source for sick and well care.”

The annual scorecard is based on 2018 data, which means issues identified in the analysis by the New York-based health care advocacy nonprofit likely have been exacerbated by the COVID-19 pandemic, The Commonwealth Fund President Dr. David Blumenthal said last week when introducing the report.

“There’s no doubt the pandemic has exacerbated these weaknesses in our health care system,” he said.

The analysis’ Florida breakdown showed the state improved in 2018 from previous rankings in 17 indicators – most notably in prevention and treatment indicators, where Florida climbed from 44th to 33rd – dropped in 12 and had no change in 14.

More than 35 million people in the U.S. as of this month are estimated to be uninsured by The Commonwealth Fund.

About 19 percent – or about 2.5 million of Florida’s 13 million adults between the ages of 19-64 – were uninsured in 2018, when Florida had the nation’s 48th-highest percentage of uninsured adults.

Among reasons cited in Florida’s 48th ranking for access and affordability is a 2019 U.S. Centers for Disease and Prevention Control (CDC) report that found 8.3 percent of respondents in Florida skipped needed medical care at least once in the previous 12 months because of cost, up from 4.8 percent in 2018.

The CDC survey also found 9.7 percent of Florida respondents did not take medications as prescribed because of cost.

Accessibility to health care is limited by accelerating costs and privately insured individuals essentially are paying the brunt of the bill nationwide and, particularly, in Florida, The Commonwealth Foundation reported.

“Prices paid by commercial insurers are higher than Medicare rates for similar services,” the analysis stated, placing Florida 41st in the nation in comparing prices paid by commercial employer-sponsored plans for inpatient hospital services to Medicare payment rates for similar services.

Commercial insurers paid between 140 percent of Medicare prices in Hawaii, for instance, and 274 percent in Oregon – the nation’s highest rate. Private insurers generally paid about 240 percent the Medicaid rate for similar services in Florida, accord to the study.

“High prices have consequences,” The Commonwealth Fund stated. “When health providers charge private insurers higher prices, insurers pass along those higher costs to employers by increasing premiums. Ultimately, employees bear the burden through higher premium contributions, deductibles, out-of-pocket medical costs and reduced wages. States where providers charge the highest prices also tended to have the highest average premium costs in terms of both employer and employee contributions.”