Most areas of Arkansas moved up in rank in a report rating measures of healthy behavior, access to medical care and efficient use of health services in 306 regions of the country.
But the nine "hospital referral regions" that include parts of Arkansas still ranked toward the bottom of the report, released last week by the Commonwealth Fund, a private foundation based in New York City that focuses on independent research on health care issues.
The Little Rock region, which includes much of the central and southern parts of the state, moved up from No. 249 in 2012 to No. 211 in last week's report.
The Texarkana region, which includes the southwestern corner of the state as well as parts of Texas and Oklahoma, had the lowest ranking in the state: 300th out of the 306 regions in the country.
But that was an improvement from 2012, when the Commonwealth Fund released its first local health system performance score card. That year, the Texarkana region had the country's third-lowest ranking.
The Springdale region, which includes Northwest Arkansas as well as parts of Missouri and Oklahoma, improved in rank from 199 to 194, the highest in the state.
The Jonesboro region in northeastern Arkansas moved down three spots, from 293 to 296.
The Fort Smith region, which includes parts of western Arkansas and eastern Oklahoma, moved up from 271 to 240.
The rankings are based on 36 measures, including the percentage of adults who lack health insurance, hospital readmission rates, and rates of obesity and smoking.
The regions represent health care markets with at least one hospital where complex surgeries are performed.
Most of the measures were from 2014, the first year expanded coverage options became available under the federal 2010 Patient Protection and Affordable Care Act.
In Arkansas and 26 other states, that included expanding Medicaid eligibility to adults with incomes of up to 138 percent of the federal poverty level. Currently, that's $16,394 for an individual or $33,534 for a family of four.
An additional five states, Pennsylvania, Indiana, Alaska, Montana and Louisiana, expanded Medicaid after the end of 2014, according to the Kaiser Family Foundation of Menlo Park, Calif.
Namvar Zohoori, deputy chief science officer at the Arkansas Department of Health, credited the state's Medicaid expansion with helping improve the health rankings of regions in the state.
At the same time, the Affordable Care Act and Arkansas' own health care payment overhaul "brought a lot more attention to the quality of care provided by hospitals and medical providers, all of which have probably contributed to better performance and outcomes," Zohoori said in an email.
Among the nation's hospital referral regions, the Jonesboro region had the biggest drop in the percentage of adults who lacked insurance, with the number falling from 28 percent in 2012 to 16 percent in 2014.
The portion of the population lacking health insurance in the Little Rock, Fort Smith and Texarkana regions fell 6 percentage points in each area: to 17 percent in the Little Rock region, 22 percent in the Forth Smith region and 23 percent in the Texarkana region.
The Springdale region's uninsured percentage fell 5 points, to 19 percent, according to the report.
Craig Wilson, director of health policy at the Arkansas Center for Health improvement, said he expects that the expansion of health coverage has increased the ability of Arkansans to see doctors and get preventive health screenings, which could improve the state's rankings in future reports.
"Getting an insurance card doesn't necessarily mean an individual is going to be able to access appropriate care immediately," Wilson said. But, he said, "with some education, we expect those things to improve over time."
Nationally, Honolulu had the country's best overall ranking, followed by St. Paul, Minn., and San Mateo County, Calif.
Two Mississippi regions ranked at the bottom, with Hattiesburg at No. 306 and Oxford at 305. Monroe, La., had the third-lowest ranking.
The Memphis region, which includes eastern Arkansas and parts of Tennessee, Mississippi, Kentucky and Missouri, improved from 283 to 278.
The St. Louis region, which extends into part of Clay County, ranked 190, down from 180 in 2012.
The Shreveport region, which includes part of Columbia County, improved from 297 to 289.
Arkansas Surgeon General Greg Bledsoe said such health rankings "always remind me that we have a long way to go to get as healthy as we want the state to be."
He said he's been encouraging businesses to adopt strategies, such as offering nutritious food to employees and rewarding healthful behavior, outlined in the Healthy Active Arkansas plan, which was endorsed by Gov. Asa Hutchinson in October.
"I think we're on the right track, but certainly it's an uphill challenge," he said.
Metro on 07/17/2016