Las Vegas health care ranks 268 out of 306, with 30 percent uninsured

If the Las Vegas area had about the same percentage of insured adults as Boston, then 272,090 more men and women in Southern Nevada would be covered by health insurance, making them more likely to receive health care when needed, a new national health report reveals.

The report, issued today by the Commonwealth Fund, found that all three of the local health care regions in Massachusetts studied by researchers -- Boston, Springfield and Worcester -- led the nation with only about 5 percent uninsured, compared with nearly 30 percent uninsured in Las Vegas.

"Access to health care is the foundation and hallmark of a high performance health system," the report said. "The foremost factor in determining whether people can pay for and access the care delivery system when needed is having insurance that covers essential care."

Researchers, using the latest statistics available, studied 306 local areas in access, prevention and treatment, potentially avoidable hospital use and cost, and healthy lives, ranking the three Massachusetts cities among the top 35 in the country in overall health system performance while Las Vegas ranked 268 and Reno 200.

Only 69.7 percent of Las Vegans have a usual source of care, far below the national median of 82.4 percent, according to the report.

Las Vegas also did poorly on "potentially preventable mortality," with 117.7 deaths per 100,000 population compared with the national median of 91.3.

The Las Vegas suicide rate of 25.7 per 100,000 population is about 70 percent higher than the national median.

If Las Vegas improved its performance to the level of the top 1 percent of local health regions, then nearly 112,000 more adults age 50 and older would receive recommended preventive care, such as colon cancer screenings, mammograms and flu shots at appropriate ages, researchers found.

There was good news in the report. Only 9.9 percent of Southern Nevadans ages 18 to 64 have lost six or more teeth because of infection, tooth decay or gum disease compared with the national median of 10.1 percent. And only 26.5 percent of Las Vegans are considered obese, 3 percentage points below the national rate.

Authors of the research -- done on behalf of the nonprofit Commonwealth Fund, whose mission is promoting better health care access and improved health care to all Americans ­­-- concluded in the "Scorecard on Local Health System Performance" report that "where one lives has a major impact on the ability to access health care and the quality of care received."

"People in the United States, regardless of where they live, deserve the same opportunities to lead long, healthy and productive lives," the report said.

The report noted that Massachusetts is the only state where health insurance is required of citizens, a legacy left by former Gov. Mitt Romney, now a Republican candidate for president.

Romney has been a vocal critic of President Barack Obama's Patient Protection and Affordable Care Act passed by Congress in 2010, though the insurance requirement in the legislation was modeled on the Massachusetts law.

Romney has argued that the Massachusetts law had bipartisan support, while the Obama plan received no Republican backing. He also has said that the state law was an answer to a state problem and that problems in states should be left to the states to solve.

While both Dr. Howard Baron, president of the Clark County Medical Society, and Dr. Mitchell Forman, dean of the Touro College of Osteopathic Medicine in Henderson, agree that insurance is critical to good medical care, they stress that the problems in Southern Nevada go far beyond that.

"We simply don't have enough physicians," Baron said.

In 2007, the last year with firm statistics, Nevada had 218 physicians per 100,000 residents, ranking 48th among states in the number of physicians per capita.

"Even with insurance, it's hard to see a doctor," said Forman, adding there is a three- to four-month wait for patients to get into his rheumatology practice.

Not only do medical schools in Nevada need to turn out physicians who then decide to practice in the state, but recruitment of physicians from other states must pick up, Baron said.

"It's difficult because some people still perceive this as a sin city where you can't raise a family," he said.

Forman provided insight into why some cities, including St. Paul, Minn.; Dubuque, Iowa; and San Luis Obispo, Calif.; were able to finish ahead of Boston, Worcester and Springfield in overall health system performance despite the fact that the three Massachusetts cities had the fewest uninsured.

"One of the biggest problems they had in Massachusetts after the legislation passed requiring health insurance for everyone is that there was nowhere near enough primary care doctors to take care of the people," he said.

Forman said the nation will face the same problem should the Patient Protection and Affordable Care Act survive scrutiny by the U.S. Supreme Court.

"Clearly, insurance can open doors to access, but when you suddenly give 35 million more people insurance, you have to make sure they have somewhere to go," he said.