Chattanooga ranks in the bottom third of communities nationwide in a health system scorecard looking at medical access, costs, quality and outcomes, but scores better than other areas of Tennessee.

The Commonwealth Fund released its first-ever community assessment Tuesday, evaluating 306 communities divided into health-referral regions that are based on where most residents in that region go for major health care and surgeries.

The assessment found a wide disparity within states and from one community to the next, according to Karen Davis, president of the Commonwealth Fund, a New York City-based private foundation that promotes a high-performance health care system.

"Where you live in this country largely determines for better or worse the kind of health care you will receive," Davis said during a news conference Tuesday. "We know that local communities can and must do better to assure all Americans have the opportunity to live long and healthy lives.

"By highlighting communities, providers and health systems that are finding ways to address these challenges in our health care system and achieve high performance, the local scorecard can be used as a tool for policymakers and health care leaders to promote innovation and target resources efficiently."

The Northeast and Midwest ranked best in the scorecard, while the Southeast ranked worst.

The Chattanooga area, which includes 700,000 people, ranked better than the Nashville and Knoxville areas but worse than the Atlanta area.

The assessment looked at 43 indicators divided into four main categories. Chattanooga ranked in the top one-third in prevention and treatment but worse in healthy lives.

For example, Chattanooga ranked among the best in the country in preventing complications in surgical patients and caring for pneumonia patients. But it was among the worst in having preventable deaths, avoidable emergency room visits, low birth weights and obese residents.

Billions of dollars could be saved and millions of people could receive insurance if areas that ranked worst would improve until they ranked best, the assessment found.

The Commonwealth Fund has released scorecard information at the national and state levels, but this is the first time such detail has been gathered at the community level, according to Cathy Schoen, one of the researchers who compiled the scorecard.

"What we've done is gone below the state averages to the local communities," Schoen said. "What we are hoping this will allow communities to do is say, 'Where are we doing relatively well and where are we doing not as well?' and focus on what needs to change."

Some of the outcomes to the ranking were expected -- areas with better access to health care had better treatment and prevention numbers. High-poverty communities also had poorer access to health care and often had worse overall outcomes.

Schoen said what researchers found most surprising was the wide differences in ranking, with some areas in the country having three or four times more preventable deaths or much higher costs. Variations beneath the state level were particularly surprising, suggesting that states should look at implementing more uniform policies, she said.

Secondly, it was surprising that some very affluent levels didn't do as well as others, she said.

Researchers hope to dig deeper to find out why some of the variations exist.

"Where we see positive deviations, can we dig a little bit more and ask why?" she said. "But we are hoping state leaders and community leaders also will start to do this work. It is going to take very local and strategic action to make a difference."

Follow the latest Chattanooga news on Facebook.