Arkansas is ranked last in the country for its overall emergency care environment. The state faces a wide range of significant challenges including an insufficient supply of physicians, numerous public health concerns, and inadequacies in the areas of trauma care, disaster preparedness, and quality initiatives.
Strengths. Arkansas’ Medical Liability Environment is in relatively good shape due to the enactment of a few important medical liability reforms. The state enjoys average medical liability insurance premiums that are among the lowest in the country; premiums for primary care physicians and specialists are less than half the average across the states ($7,632 and $32,637, respectively).
Despite the state’s poor score in Access to Emergency Care, Arkansas has some resources and facilities available to serve its population. For instance, only 7.4 percent of the population has an unmet need for substance abuse treatment. The state also ranked seventh for its relatively high rate of psychiatric care beds (45.3 per 100,000 people).
Challenges. Arkansas faces considerable challenges regarding Access to Emergency Care due to a severe workforce shortage. The state ranks among the worst five states in the nation in per capita access to emergency physicians, plastic surgeons, and orthopedists and hand surgeons. Arkansas is the only state in the nation with no Level I or II trauma centers and only 12.6 percent of the state’s population lives within 60 minutes of a Level I or II trauma center in a neighboring state. Compounding the shortages of emergency care services and specialists is the fact that many people in Arkansas have no health insurance coverage. More than 22.1 percent of adults are uninsured, compared to 17.2 percent nationally.
Both Disaster Preparedness and the Quality and Patient Safety Environment pose significant problems for Arkansas. These grades point to the need to enhance the state’s infrastructure and capacity on a number of levels. Arkansas has neither a patient nor victim tracking system nor a statewide medical communication system with one layer of redundancy. The state also lacks a real-time syndromic surveillance system. Similarly, the state’s Quality and Patient Safety Environment is compromised by the low percentage of hospitals using electronic health records or computerized practitioner order entry systems, as well as the lack of a mandatory quality reporting requirement.
Arkansas has the third lowest seat belt use rate in the country. The state also has the second highest rate of unintentional burn-related fatalities (2.7 per 100,000 people). The levels of cigarette smoking, infant mortality, traffic fatalities, fatal occupational injuries, and deaths from firearms are above average as well, contributing to the state’s poor grade in Public Health and Injury Prevention.
Recommendations. The high proportion of uninsured adults and the severe shortage of specialists, physicians, nurses, and facilities in the state may be contributing to problems such as hospital crowding, emergency department patient boarding, and ambulance diversion, all of which have been reported as serious concerns by emergency physicians in the state. Arkansas policymakers should act immediately to address these issues to ensure that timely and adequate care is available to the entire population. As the only state without a Level I or II trauma center, Arkansas needs to invest in trauma care and develop a statewide trauma system. Additional medical liability reforms such as caps on non-economic damages and special liability protection for EMTALA-mandated emergency care should also be considered to help recruit and retain physicians and encourage specialists to provide on-call emergency care.
While the state continues to have higher than average rates of obesity, Arkansas has made active efforts to reverse the trend with outreach, education, and surveillance initiatives, particularly among school-age children. The state should continue these efforts in full force and apply these lessons to address the relatively high rates of fatal injury and infant mortality in the state.
The multitude of low marks in Arkansas suggests a critical need for wide-scale investments and improvements in the state’s public health, disaster preparedness, and emergency care systems. The application of information technologies and automated systems could be used to improve coordination, tracking, and communications across numerous areas of disaster planning and quality control.