With a relatively large health care workforce and low rates of uninsured residents, Maine is second in the nation in terms of Access to Emergency Care, but high grades in this and other categories are tempered by poor marks in Disaster Preparedness and a lack of medical liability reforms.
Strengths. Maine ranks fourth in the nation in emergency physicians per capita and fifth for board-certified emergency physicians. The state also has a relatively healthy supply of registered nurses, orthopedists and hand surgeons, mental health professionals, and primary care physicians. Only 10.1 percent of adults and 6.4 percent of children in Maine have no health insurance, compared to 17.2 and 11.7 percent, respectively, nationwide. The state also has the second highest rate of adults covered by Medicaid (14.9 percent) and ranks eighth for the proportion of physicians accepting Medicare. The state has 39.0 psychiatric care beds per 100,000 people, compared to an average of 29.9 per 100,000 across the states.
The Quality and Patient Safety Environment in Maine benefits from a number of positive factors, including a funded state EMS medical director position, a uniform system for providing pre-arrival instructions, mandatory quality reporting requirements, statewide Enhanced 911 capability, and a relatively high rate of emergency medicine residents. Perhaps reflective of the state’s investment in systems and infrastructure, Maine has the seventh highest proportion of patients presenting with acute myocardial infarction being treated with PCI within 90 minutes of arrival (74 percent).
Contributing to the state’s grade in Public Health and Injury Prevention, Maine has among the highest per capita rates of injury prevention funding in the nation. Deaths from occupational injuries are lower than in most states, and Maine has relatively low rates of unintentional firearm-related fatalities and homicides and suicides. The traffic fatality rate is lower than in the average state (14.2 versus 16.2 per 100,000 people). Maine has enacted legislation regarding seat belt and child safety seat use, including primary seat belt law enforcement, but the state has failed to enact a universal motorcycle helmet law covering all riders. Despite traffic safety efforts, the rate of front occupant seat belt use is lower than the national rate (79.8 versus 82 percent).
Challenges. The state’s grade in Disaster Preparedness includes some positive indicators but they are offset by numerous negative ones. For example, the state has in place medical strike teams or medical assistance teams, but it lacks the ability to verify the credentials of volunteer health professionals and assign them to one of four levels in a state-based Emergency System for Advance Registration of Volunteer Health Professionals program. While Maine has systems in place for “just-in-time” training, as well as patient and victim tracking, the state does not have an all-hazards medical response plan or a written plan for the coordination of the State Emergency Operations Center or local emergency management agencies to provide security to hospitals in the event of disaster. Hospital capacity is also an issue: the state lacks any verified burn centers and has relatively low rates of burn unit beds and ICU beds (3.0 and 275.3 per 1 million people, respectively).
The state receives a low rank for its Medical Liability Environment due to a paucity of medical liability reforms. Maine has not enacted additional liability protection for EMTALA-mandated emergency care or expert witness rules requiring the witness to be of the same specialty as the defendant or to be licensed in the state. The state has also failed to enact joint and several liability reform.
Recommendations. Maine must continue to build disaster response capacity through formal written plans and greater preparation to deploy volunteer health professionals during a disaster event. The state also needs to address specialist shortages with regard to neurosurgeons; ear, nose, and throat specialists; and plastic surgeons. The implementation of additional liability reforms and protections, along with increasing Medicaid reimbursement rates, are two strategies the state could use to attract more specialists. The state should also further strengthen its commitment to Public Health and Injury Prevention by requiring all motorcycle riders to wear helmets.