New Jersey’s healthcare system now ranks 20th nationwide, an improvement over the past year. But it continues to face challenges when it comes to the cost of care — a factor that may have driven down access for adults in recent years, according to a new national report.

The Commonwealth Fund’s 2019 rankings of state healthcare performance, which the nonprofit research organization publicly unveiled today, showed the Garden State does fairly well when it comes to supporting healthy lives. It boasts some of the lowest mortality rates for suicide or alcohol use — ranking third and fourth nationwide, respectively. And it places fifth in the U.S. for its low percentage of adult smokers.

However, the report found New Jersey is still plagued by a high rate of drug overdoses — 30 per 100,000 people versus a U.S. average of 21.7 — and is one of more than two dozen states that saw these deaths soar by more than 100 percent since 2005. The findings also indicate several neighboring states, including Delaware and Pennsylvania, now exhibit among the highest overdose rates in the U.S.

“There certainly are regional patterns,” said David Radley, a Commonwealth senior scientist and study co-author, but no states have been able to reduce mortality associated with suicide, alcohol, or drugs. “We want people within state government to be able to compare with their neighbors.”

“There are policy tools the federal government and states can use to address these problems,” Radley added, noting efforts to reduce access to addictive prescription drugs.

Downturn in opioid RXs

In New Jersey, various policies have contributed to a 40 percent decline in opioid prescriptions since 2014, according to the state’s prescription-monitoring system. Still, more than 3,000 people died of drug-related issues in 2018, twice the number recorded two years earlier, in part because of the growing use of a deadly mixing agent, fentanyl, that is far more powerful than heroin alone.

The authors of the 2019 report from the Commonwealth Fund — the seventh produced since 2005 — examined federal data related to nearly 50 indicators to assess each state’s level of healthcare access and affordability, prevention and treatment capacity, and efforts to avoid costly and unnecessary procedures, promote healthy lives, and reduce disparities. The results are used to compare states against each other and to national averages for each factor.

Overall, Commonwealth found Hawaii to be No. 1 in its healthcare system, followed by Massachusetts and Minnesota. Texas, Oklahoma, and Mississippi ranked as the bottom three states, respectively. Neighboring New York placed 14th, Connecticut came in fifth, while Pennsylvania ranked 21st and Delaware was listed at 27th nationwide.

New Jersey, which came in 25th in the 2018 report card, does very well when it comes to providing nursing-home patients with antipsychotic medications, as needed, and avoiding deaths among patients hospitalized in the past month. It also succeeds in keeping infant mortality rates low — although there is significant racial disparity — and avoiding hospitalizations among adults.

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But the Garden State’s overall ranking is depressed by a drop in childhood vaccine coverage, high rates of childhood obesity, and hospitals with below-average patient experience ratings. In addition, it has struggled to keep up with the mental health needs of children, and not enough are getting proper care, according to Commonwealth.

Climbing costs of care

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New Jersey is one of many states that drove down its uninsured rate by expanding Medicaid under the Affordable Care Act — which provided coverage to more than 800,000 additional residents here — but these advances may now be offset by the rising costs of care, the report found. “The gains made in people’s coverage and access to healthcare following enactment of the (ACA) have stalled and even eroded in some states,” said Sara Collins, a Commonwealth vice president and co-author of the study.The Commonwealth notes New Jersey is one of a dozen states where the share of adults that skipped treatment, because of cost, climbed 2 percentage points or more between 2016 and 2017; Delaware, Rhode Island, and Maine are also in this group. New Jersey also ranks sixth nationwide in terms of Medicare spending per enrollee.

According to an analysis commissioned by the New Jersey Health Care Quality Institute, spending here rose 18 percent between 2012 and 2016 alone, outpacing the national increase of 15 percent for those years; the Garden State also had the fifth highest per-person spending nationwide in 2016.

In addition to the latest report, Commonwealth unveiled a new online data center that allows visitors to its website to compare and contrast nationwide results and create customized tables, maps, and graphs that focus on specific populations or issues.