Relationships between black race, lower income, higher rates of
uninsurance, and poorer health outcomes have been examined in a
number of studies.13 In this study, state uninsured rates are strongly
related to black race and poverty and are not statistically significant in
the multivariate analysis of the relationship with amenable mortality
after controlling for poverty and race. Yet, persistent lack of access to
affordable care undermines health and puts children and adults at risk
of complications that could have been prevented.14 Reducing, ideally
eliminating, the percentage of the population that is uninsured is thus
central to comprehensive health reform and could yield a societal
payback in many ways. Efforts to improve performance and over time
reduce death rates from conditions amenable to health care also will
require a comprehensive approach. For example, the close association
of per cent black population with Medicare hospital readmission
rates (R2ผ0.43) and readmission rates among short-stay nursing
home residents (R2ผ0.63) may indicate that the states with a high
proportion of black residents have weaker care systems and lower
quality hospital and transitional care. Efforts to reduce readmissions
ideally involve changes and improvements at all levels of the care
process following the patient’s journey – including factors leading to the
initial admission, care delivered while hospitalized, care and information
flow during transitions, and follow-up care. This spans care
provided in ambulatory, hospital, rehabilitation, and nursing home
settings.