2014’s States with the Best & Worst Health ROI

by Richie Bernardo

WH-Best-Badges-150x150Under the Hippocratic oath, physicians and other health care professionals vow to improve the quality of life. But for whom, exactly? For a country that spends $2.9 trillion a year on health care — twice as much per capita as other industrialized nations — one would think the United States is home to the healthiest humans on the planet. And yet, the reverse is true: Americans have shorter lives, higher infant mortality rates and more cases of chronic diseases than populations of other wealthy countries.

To add insult to injury, someone’s pockets are getting deeper, and it’s definitely not the patient’s. Looks as if Hippocrates left out the clause on offering the best treatment to patients without ruining their finances. In 2013, the average annual health insurance premium for an individual had a price tag of $5,884 while families paid an average of $16,351 for group coverage. To put that in perspective, single coverage has increased by 74 percent and family coverage by 80 percent since 2003. It’s no surprise that millions of Americans consider forgoing medical attention a better option than draining their savings.

As the U.S. undergoes the most sweeping health insurance expansion since Medicaid and Medicare, health care expenditures and standards continue to dominate the discussion regarding policy. And only recently have researchers been able to gauge the number of uninsured Americans after the implementation of the Affordable Care Act. To examine the quality of American health care relative to its cost, WalletHub used data from 47 states to construct a health-related return on investment (ROI) metric. In doing so, WalletHub can educate Americans on the level of care they can expect for the price they must pay in their states.

Main Findings

 

Overall Rank

State

America's Health Ranking

Death Rate Ranking

Health Care Costs Ranking

1 Minnesota 3 2 1
2 Utah 6 15 3
3 Kansas 27 29 2
T-4 Hawaii 1 7 9
T-4 Iowa 18 17 6
6 Illinois 30 22 6
7 Nebraska 11 13 13
8 Arizona 28 21 11
9 Maryland 24 18 12
10 Idaho 12 19 16
11 Oregon 13 16 20
12 Oklahoma 44 48 3
13 Michigan 34 32 10
14 Colorado 8 10 28
15 South Dakota 22 26 19
16 North Dakota 9 20 26
17 Texas 36 27 14
18 Connecticut 7 5 38
19 California 21 1 33
20 Massachusetts 4 3 42
21 Virginia 26 25 24
22 Washington 14 6 37
23 New Hampshire 5 7 44
24 Florida 33 22 23
25 Tennessee 42 43 8
26 New Jersey 10 9 43
27 North Carolina 35 33 16
28 New York 15 4 45
29 Wisconsin 20 14 39
30 Pennsylvania 29 28 25
31 Missouri 39 41 15
32 Georgia 38 39 18
33 New Mexico 32 33 26
34 Montana 23 37 34
35 Wyoming 17 35 46
36 Delaware 31 30 39
37 Alaska 25 31 47
38 Nevada 37 36 32
T-39 Alabama 47 49 5
T-39 Ohio 40 38 30
41 Kentucky 45 43 20
42 South Carolina 43 42 31
43 Indiana 41 40 41
44 West Virginia 46 45 36
45 Arkansas 49 45 29
46 Louisiana 48 47 22
47 Mississippi 50 50 34
N/A Maine 16 24 N/A
N/A Rhode Island 19 12 N/A
N/A Vermont 2 11 N/A
Blue-vs-Red-Image-400x371

Ask the Experts

As we’ve determined in this study, expensive health costs are no guarantee of superior care. With that in mind, we’ve asked a panel of experts in various fields for advice on cost-cutting measures and local program implementation. Click on the experts’ profiles to read their bios and responses to the following key questions:

  1. Is it possible to buy a nutritious meal at the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?
  2. What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?
  3. How effective could overtaxing fast food be at encouraging Americans to make healthier meal choices?
  4. How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?
  5. According to a recent study conducted by the University of Arizona College of Medicine-Phoenix, more than half of all cardiac arrest victims survived in cities with strong training programs and quick EMS response times. In light of that fact, what key changes should local governments implement to duplicate the findings of the study?
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  • Heather Eicher-Miller Assistant Professor of Nutrition Science, Purdue University
  • Susan Massad Professor of Foods and Nutrition, Framingham State University
  • Melissa Fuster Assistant Professor of Nutrition, Food Studies and Public Health, New York University
  • Melinda Johnson Clinical Assistant Professor of Nutrition and Health Promotion, College of Health Solutions, Arizona State University
  • Laura Bellows Assistant Professor of Health and Human Sciences, Colorado State University
  • Kristin Madison Professor of Law and Health Sciences, Northeastern University
  • Jamie Cooper Assistant Professor of Nutritional Sciences, Texas Tech University
  • Tatiana Andreyeva Director of Economic Initiatives at the Rudd Center for Food Policy & Obesity, Yale University
  • Keith Joiner Professor of Medicine, Economics, and Health Promotions Science, Eller College of Management, University of Arizona
  • Luba Ketsler Senior Lecturer of Economics, The University of Texas at Dallas
  • Ellen Magenheim Professor and Chair of the Department of Economics, Swarthmore College
  • Diane Dewar Associate Professor of Health Policy, Management and Behavior, SUNY University at Albany
  • Melissa Davis Gutschall Assistant Professor in Nutrition and Foods, Appalachian State University

Heather Eicher-Miller

Assistant Professor of Nutrition Science, Purdue University
Heather Eicher-Miller
Is it possible to buy a nutritious meal with the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

"Healthier foods", or foods with more and greater amounts of the nutrients encouraged for all Americans and less of the nutrients recommended to decrease, are outlined in USDA's Dietary Guidelines for Americans. Choosing healthier foods for less money than one would typically spend on a fast food meal is certainly possible but the location where the food is purchased, the amount of the food that is purchased, and preparation time are all factors that contribute to the health and cost equation.

For example, selecting skim milk is a healthy alternative to soda. Although prices may vary by region, milk becomes even more of a cost savings per serving when it is purchased by the gallon and when one considers the nutrients per dollar spent for a gallon of milk, the value is much greater than that of soda. Replacing French fries with a baked potato offers nutrients such as vitamin B6, potassium, copper, vitamin C, and others, without contributing saturated fat and sodium, both nutrients recommended for all Americans to decrease in the Dietary Guidelines for Americans. Potatoes may be purchased in bulk for a fraction of the price of a similar amount of French fries. The purchase of other fruits and vegetables, when considering nutrients per dollar and the number of serving sizes that are actually purchased, in comparison to the serving size purchased in a fast food venue, will most often be a much better value compared with fast food choices.

Finally, purchasing a package of frozen chicken drumsticks, reduced fat beef or pork, or fish at a grocery store and preparing these foods by baking them with minimal fat and sodium added, will be a savings when considering both the nutrients per serving and cost per serving when compared with the equivalent serving size of a similar protein source at a fast food restaurant.

Susan Massad

Professor of Foods and Nutrition, Framingham State University
Susan Massad
What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

a. Commit to 30 minutes a day of steady aerobic (cardiorespiratory) exercise at least 5 days a week – longer if possible. The American Heart Association recommends 150 minutes a week – that would translate to 30 minutes a day, 5 days a week. This can include brisk walking, jogging, swimming, or using an exercise machine that involves using all of the large muscle groups, for a steady 30 minutes (exercise bike, treadmill, elliptical machine, stair-master, etc.). Outdoor activities like bike-riding, cross-country skiing, or playing tennis, soccer, or basketball are also great options, but keep in mind that these activities involve “intermittent” bouts of cardiorespiratory activity. Skiing and bicycling involve gliding so that the activity is not steadily aerobic, and the sports – soccer, basketball, and tennis, involve a lot of “stops and starts” so to get the same cardiorespiratory benefit, these would need to be done for approximately 60 minutes.

b. Refrain from smoking

c. Include at least 5 servings a day from the vegetable and fruit category

d. Try to maintain a normal weight. A Body MassIndex between 18.5-24.9 is considered healthy. If you are very muscular, then a little higher, like 25-26, is healthy.

How effective could overtaxing fast-food be at encouraging Americans to make healthier meal choices?

I think that this would be a great start. Ideally, healthier foods would be less expensive, and the foods that are high in saturated (animal) fat, salt, sugar, would be more expensive. Right now, we have this in reverse. Here are a few comparisons:

• ½ gallon of 100% orange juice costs $3.79 while a 2 liter bottle of Coca Cola is $1.67

• 1 pound fresh broccoli costs $1.99, (organic: $2.99) while a can of green beans costs 1.39

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

They are effective when the messages that they promote are easy to adopt. Getting exercise is easier if there is a gym, public tennis or basketball court, recreation center, or workplace that allows exercise breaks and provides some type of fitness facility.

Eating healthy is best achieved when there is low-cost, nutritious food available – via farmer’s markets, lower cost grocery chains, and institutional food service facilities (e.g. at schools, employee cafeterias) that offer healthier meal choices.

According to a recent study conducted by the University of Arizona College of Medicine-Phoenix, more than half of all cardiac arrest victims survived in cities with strong training programs and quick EMS response times. In light of that fact, what key changes should local governments implement to duplicate the findings of the study?

Make EMS training programs low-cost and more available to the public, so that more people are trained. This would be a great career option for many young people who are “hands on” learners and are interested in the health professions. Needless to say, if this training was more widespread, it would be a great public health service.

Melissa Fuster

Assistant Professor of Nutrition, Food Studies and Public Health, New York University
Melissa Fuster
Is it possible to buy a nutritious meal with the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

When talking about healthy eating, people often have the perception that is expensive and difficult. Yet, even if still difficult, it is possible to eat healthy while spending roughly the same amount of money you would at fast food establishments. Several nutrition education resources have been developed to show us how to “eat healthy on a budget”, including the USDA MyPlate page, among many others widely publicized online, in magazines and in community education brochures. These tips require us to plan ahead, check store discounts and coupons, go to the grocery store after eating and with a list, buy in bulk, preserve foods, cook at home, etc. All of this definitely takes more time and energy than going to any fast food restaurant nearby. They also require access to fresh, healthy foods and, above all, motivation. This last one is the tougher one to deal with, even among those of us with the access and time to eat healthy. Changing eating habits is difficult – on any budget.

How effective could overtaxing fast-food be at encouraging Americans to make healthier meal choices?

Economic disincentives, such as taxing “bad” and “unhealthy” foods, are often discussed as a way to encourage people to make healthier meal choices, following the logic of cigarette taxes. However, “fast”/unhealthy foods and cigarettes are not equal. “Fast foods” can include a variety of different foods and drinks, including the "healthy" options being offered at many of these establishments. In addition, how would you define these “fast food” establishments? Would you extend the tax beyond franchises, to small food establishments, such as the local taqueria or burger joint? The effectiveness of such tax measure depends greatly on these implementation considerations, as well as the level of taxation applied to the fast-food (and resulting price) vis a vis the cost of the desired “healthier meal” options.

Such decision requires a comprehensive study of consumer food spending habits and preferences. However, potential effectiveness aside, we also need to consider who will be more affected by this measure. A "fast-food" tax is regressive, affecting mostly those at lower income brackets, who are at a greater disadvantage to access healthier options in the first place. An option to overtaxing fast-foods and other “unhealthy” foods would be to subsidize or lower the cost of healthier food options. This can take the form of, for example, the Double up Food Buck programs for SNAP recipients, among other similar efforts.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

Personally, I am skeptical about these campaigns as I feel that most of us know the benefits of a healthy lifestyle and the consequences of unhealthy and risky behavior. But, again, behavior change is no piece of cake. Therefore, awareness campaigns need to go hand in hand with inter-sectorial interventions making healthy lifestyle choices the easy ones, such as investments in public spaces to encourage everyday walking, for example. That being said, awareness campaigns may provide the final push some may need for behavior change. Therefore, their effectiveness is dependent on individual and community level considerations.

Melinda Johnson

Clinical Assistant Professor of Nutrition and Health Promotion, College of Health Solutions, Arizona State University
Melinda Johnson
Is it possible to buy a nutritious meal with the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

Yes, but healthy eating takes a bit of planning (and this is true even when you aren't working with a limited budget); you need to have the food ingredients on hand and have a plan for what you want to eat. You also need to plan a bit of food prep into your day. However, this does not have to be as long as people think - to go to a fast food restaurant, you have to drive there, wait in line to order, and then perhaps take it home to eat it. In that same time, you could open a bag of pre-cut greens, toss in some kidney beans and other ingredients, and have a healthy salad.

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

I can only speak from the nutrition side of it - I'm sure you might get a different answer from a MD or other health professional. Eating the right amount of calories to maintain weight, getting exercise, getting enough sleep, not smoking, avoiding excessive alcohol, salt, and fried foods can all make a big difference on this one.

How effective could overtaxing fast-food be at encouraging Americans to make healthier meal choices?

We simply do not know. If people turn away from consuming fast food, the question still remains as to what they will choose to eat? We can't automatically assume they will switch to home cooked meals that have plenty of fresh produce and whole grains. One potential benefit of higher taxes on fast food might be in the way those taxes are "earmarked" - if they go into nutrition and cooking programs, for example, we might be able to help people make healthier choices.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

Some campaigns have shown success, while others have shown no effect at all. Campaigns that involve key stakeholders and work to make environmental change at the same time seem to be helpful.

Good campaigns will provide targeted messages that people can actually do (such as: walk 10000 steps every day instead of "get more exercise”); the campaign will also provide assistance to make this change - perhaps by working with the town government to spruce up walking paths or provide rebates for pedometers.

Laura Bellows

Assistant Professor of Health and Human Sciences, Colorado State University
Laura Bellows
Is it possible to buy a nutritious meal with the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

Eating healthfully on a budget is definitely doable but it will take some thought and preparation. Foods that are less processed and have limited packaging tend to be more economical as do generic versus brand names. Look for bulk items or larger package sizes, as the cost per unit tends to be lower. However, be sure that you can eat (or freeze) it all to decrease waste. Go shopping with list so that you buy what you need and avoid falling into marketing traps at the store. Lastly, look for what’s on sale and build your shopping list off of that to get the most bang for your buck.

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

The leading causes of chronic diseases, such as obesity, heart disease and diabetes, are lifestyle behaviors. This includes diet and physical activity. This isn’t a new or sexy message but it is the reality. Eating a healthy diet the majority of the time can have a strong impact on your waistline, and thus decrease disease risk. In my opinion, there are no bad foods, just bad quantities. It’s ok to splurge, just don’t do it all of the time. As for activity, getting 30 minutes a day, whether all at once or in smaller increments, can improve health and give you more energy.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

Awareness campaigns provide good reminders to all of us about what we should be doing. I haven’t met anyone who doesn’t know that we shouldn’t eat more fruits and vegetables. The challenge is really in getting us to do it. So, accessibility and environmental nudges may have a stronger impact. Making healthy foods the easy choice is where we need to focus rather than just telling people what they should be doing.

Kristin Madison

Professor of Law and Health Sciences, Northeastern University
Kristin Madison
How effective could overtaxing fast-food be at encouraging Americans to make healthier meal choices?

When prices go up, people often buy less. This is true for prices for individual foods, just as it is for many other kinds of goods and services. How much less depends both on how much prices rise and what kinds of foods are involved. Research suggests that large taxes can significantly reduce consumption of sugar-sweetened beverages, for example, but that effects on consumption of fast food are likely to be smaller. More research is needed on whether specific types of food taxes ultimately improve health. If high taxes lead you to eat less of an unhealthy food, do you eat less food overall, do you replace unhealthy food with healthy food, or do you just eat a different unhealthy food?

Jamie Cooper

Assistant Professor of Nutritional Sciences, Texas Tech University
Jamie Cooper
Is it possible to buy a nutritious meal at the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

This is a challenge because in general, it does usually cost a little bit more to eat healthy. However, you can still eat healthy if you are on a budget. With regard to fast food, any sub or sandwich shop that offers some healthy options is usually comparable in cost to most unhealthy fast food restaurants. Of course, if you are on a budget, the best thing to do is cook at home because it's always more expensive to dine out than it is to buy your food at the grocery store and prepare it. For example, the cost of one value meal at a fast food restaurant is the same as several healthy meals if you buy and prepare your food at home.

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

Americans spend a huge amount of money on health care each year. It appears that the best thing people can do is on the "prevention" side of things. This means living a healthy lifestyle so you minimize your risk of illness and chronic disease. In order to live a healthy lifestyle, several key factors come in to play. These include daily exercise, eating healthy, reducing stress levels, and getting enough sleep, to name a few. Just one of these factors is important, but all of these combined have a much larger impact on overall health.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

There will always be some people that benefit from these types of campaigns, but I'm also guessing that the impact is not nearly as large as we would like it to be.

According to a recent study conducted by the University of Arizona College of Medicine-Phoenix, more than half of all cardiac arrest victims survived in cities with strong training programs and quick EMS response times. In light of that fact, what key changes should local governments implement to duplicate the findings of the study?

I am not familiar with this study. However, if those results are accurate, then this would be very important for local governments to try to implement things in order to save lives. Of course, the cost of implementing the training as well as several other factors would obviously play into this, so it's probably not as easy and waving a magic wand and having this implemented in all local governments.

Tatiana Andreyeva

Director of Economic Initiatives at the Rudd Center for Food Policy & Obesity, Yale University
Tatiana Andreyeva
Is it possible to buy a nutritious meal at the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

Cooking simple quick meals from scratch.

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

1) have good health insurance so their out of pocket expenditures are minimized;

2) don’t smoke;

3) be active every day and avoid too much sugar and too much red meat in the diet.

How effective could overtaxing fast food be at encouraging Americans to make healthier meal choices?

Taxes would be effective in reducing purchases if they were significant, like say 20-30%. A tax of 5% is not going to change anything.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

I don’t believe they’re generally effective, unless combined with laws or/and taxes. Look at tobacco as an example of successful policy. We needed awareness campaigns, restrictions like no smoking in public places, and high taxes to have an effect on smoking rates.

Keith Joiner

Professor of Medicine, Economics, and Health Promotions Science, Eller College of Management, University of Arizona
Keith Joiner
Is it possible to buy a nutritious meal at the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

The answer is clearly yes, and there is lots of information available on how to do this. Rather than my just reiterating what is on various online sites, probably best for me to pass.

Here is another perspective: From a purely economic standpoint, when considering caloric content, many of the McDonalds sandwiches are tremendous values. The problem is less McDonald’s per se, than the fact that people lead unhealthy lives (sedentary, overweight, smoking, etc.) and fast foods are just another component of that unhealthy lifestyle.

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

There are a range of perspectives on this question, depending upon whether one is talking short term or long term, individual’s risk tolerance, social situation, etc.

Having said this, increasingly, the most important measure is to comparison shop for prices. Until recently, it has been nearly impossible to get information on prices from hospitals, providers and more. That is changing rapidly, with online sites that allow price comparisons, and a push by many federal and state agencies to mandate price transparency. Because prices for the same procedure or intervention can vary by as much as 4-5 fold in the same city or geographic region (the poster child for this is colonoscopy), this is an enormously important advance.

How effective could overtaxing fast food be at encouraging Americans to make healthier meal choices?

My general sense is that all this would do is shift purchases to inexpensive, prepared foods which are (in terms of caloric value, fat content, salt, etc.) worse than many of the foods in fast-food restaurants. The reason is that many consumers do not feel they have the time to deal with unprocessed foods. This is directly related to the first question, about eating healthy foods on a budget. The sites that outline how to do this are largely focused on time-saving approaches.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

I would argue that the most effective campaigns at this juncture are through employer wellness programs, because they typically build incentives (and in some cases penalties) into the campaign. Some employers are actually refusing to hire smokers or obese individuals, which takes it one step further.

More general social marketing messages are becoming more prevalent, but again from a “behavioral economics” perspective, are less effective than programs with carrots and sticks.

Luba Ketsler

Senior Lecturer of Economics, The University of Texas at Dallas
Luba Ketsler
Is it possible to buy a nutritious meal at the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

Fast food restaurants now offer healthy choices on their menu. However, they are relatively expensive compared to their standard burgers and nuggets -- where their input costs are very low and their producer surplus is extremely high. Eating healthy at a fast food restaurant can be comparable (in price) to eating healthy at home. It's not necessary to purchase at Whole Foods -- similar, healthy food can be found at any grocery store for much less. I think the main issue is not just monetary -- it's the time associated with going food shopping and preparing a healthy meal.

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

I think that saying exercising and eating right is too easy of an explanation. It has to be an entire life-style change. We live in a society where instant gratification is a very high priority. We want fast, easy results to a very difficult problem. The solution is going to be a cultural and generational change. Education in the younger generation is key -- the problem is that our education system is deteriorating. Funding at schools is being cut -- including breakfast at schools and nurses at schools. In some impoverished areas, the breakfast that children receive at schools is their primary meal. If they are not eating right, they are not learning and comprehending well during the remainder of the day.

In impoverished areas, a school nurse may be the only access that a child has to medical attention. If the school does not have a registered nurse on staff, studies have shown that this impacts the child's health, which in turn hurts their ability to learn and function properly.

It is the poor that are the least healthy -- the poorest are the most obese. It is the fast food that they are eating -- the families do not have the time, money, and proper education. It is a vicious cycle.

How effective could overtaxing fast food be at encouraging Americans to make healthier meal choices?

Probably not effective at all. Just like sales tax is regressive tax, so is this.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

I think it is effective. I think the more people understand and are made more aware, the more likely they will try to make better choices. This extends to my earlier comments about the importance of education.

Ellen Magenheim

Professor and Chair of the Department of Economics, Swarthmore College
Ellen Magenheim
Is it possible to buy a nutritious meal at the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

It is possible but challenging. People often say that it's possible to do this but I think they often forget that what this requires, in addition to the cash you would spend on a fast food meal, is time: time to shop, time to prepare the food, and time to clean up. For people who are already very time constrained because of their work and family obligations, this can sometimes be a big challenge. In order to accomplish this objective, I think it's important to rely on relatively inexpensive healthy foods (e.g., beans if chicken is too costly, frozen fruit if fresh is too expensive) and to plan meals ahead (e.g., cook a big pot of beans that can be used for several meals). And it's also important to educate yourself about which foods are healthy and about different ways to prepare them.

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

It is important to know what health care you are eligible to receive: under the ACA, for example, many types of preventive care are readily available and individuals should take advantage of the opportunity to get this care. In states which have implemented the Medicaid expansion, many more people are eligible for Medicaid coverage and individuals should seek assistance to see if they are eligible.

Get a flu shot: it helps keep you healthy and helps keep your family, friends, and coworkers healthy.

Get dental care: unfortunately, when people face constrained resources they let their dental care slip and also it is less common for people to have dental insurance than health insurance. The longer run effects of ignoring dental health can be serious.

Live a healthy lifestyle: exercise, eat healthily, don't smoke and don't drink alcohol excessively. It is important for people to make even small changes in the right direction - if you can't get the "recommended daily dose" of exercise every day, do what you can, when you can. It's better than being overwhelmed by setting impossible goals.

How effective could overtaxing fast food be at encouraging Americans to make healthier meal choices?

The answer depends on how high the taxes are and whether substitutes for fast food (or at least unhealthy fast food) are available. It is reasonable to assume that higher prices will lead to lower purchases but it is likely they would be more effective if there were good substitutes available - e.g., if extra-large orders of French fries were taxed while an attractive fresh salad were available (and possibly subsidized).

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

The evidence on this is mixed and behavioral economists have been researching other ways to encourage individuals to incorporate healthy behavior into their lives: e.g., incentivizing individuals to exercise or eat healthily or get a flu vaccine or helping individuals follow through on their intentions to get preventive tests done. A key tenet of behavioral economics is that if you want someone to change their behavior you need to make it easy to do so: there has been success with rearranging school cafeterias to make the healthier options more accessible, for example. Information alone may not be enough to shift people toward healthier lifestyles.

Diane Dewar

Associate Professor of Health Policy, Management and Behavior, SUNY University at Albany
Diane Dewar
Is it possible to buy a nutritious meal at the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

While most choices are not healthy here are a few tips on fast food in general:

1. Do not go on impulse. Check out the menu from home

2. Drop the sugary drinks - go with water or milk for more nutrition

3. if you go for a sandwich, take a small sandwich choice, not a super-sized option

4. If you want a meal, go for the happy meal or children's choice

5. Avoid fatty foods in salads and otherwise. Try the grilled options

A few tips in general on how to eat healthy is to buy:

1. Cheap proteins (beans and other lean proteins)

2. Buy in bulk

3. Buy frozen vegetables and fruit not in season or go to farmers markets when available

4. Do not buy on impulse

5. Stay away from processed drinks - make your own iced tea or drink water

6. Buy store brand foods

7. Use supplements if eating less - multivitamins

8. Clip coupons when available

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

Prevention is key here. Use health care budgets for wellness visits, annual exams, vaccines, etc. to maintain health and go to a primary care doctor at early signs of illness. Try to avoid urgent or emergency care venues, since they are not coordinated care and the out of pocket costs are very high relative to regularly scheduled appointments with a primary care provider. Other ways to save money and improve health are the following:

1. Join a gym or exercise club

2. Buy generic or mail order drugs

3. Only choose providers that are in network for lower co-pays

4. Seek out lower cost after hour care sources

5. For tax breaks set up an MSA or flex spending account

6. In general, negotiate fees

How effective could overtaxing fast food be at encouraging Americans to make healthier meal choices?

I personally think that this will not have a big impact on lower SES households since many of these households do not have easy access to healthier food choices or well stocked grocery stores. If there are no good alternatives to cheap and filling food, then fast food will still be the primary choice.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

Awareness campaigns can be very helpful, but only for people that have a variety of food choices.

Melissa Davis Gutschall

Assistant Professor in Nutrition and Foods, Appalachian State University
Melissa Davis Gutschall
Is it possible to buy a nutritious meal at the same price as a fast-food meal? If so, what tips can you offer to people who want to eat healthy but are on a tight budget?

Absolutely, some of the most nutrient dense foods are really not that expensive and less is often more, because they will be more satisfying. Time and money are cited as the two largest barriers to health behavior changes, but if health is a priority, anyone can do it with a little planning ahead. Planning is key, and it may take a little extra prep time on the weekends or packing a lunch each night, but I believe if you do that, it can definitely be as cost and time effective as eating out, especially when you factor in the trip to McDonald's, waiting in line, etc. I think it can actually save time, and this is from personal experience.

I've come from childhood obesity to what I consider optimal health, and now feed a family of 4 on a budget based on these very principles. If you consider the long-term health benefits vs. rising health care costs, the answer also becomes much clearer. I guarantee you will save money if you prepare your own food, and even if it isn't the "healthiest" it has to be a step in the right direction. The cost of many fruits and vegetables, whole grains, and even organic options are now becoming more reasonable as well. I've noticed as the cost of all food rises, there has been a narrowing margin between the cost of unhealthier convenience foods and more nutrient dense options.

It all comes down to "nutrient density". Which foods give you the most nutrients for your dollar? Of course, another option for handling the cost, although more time consuming, is to grow some of your own food. This is less costly and boosts both physical and mental well-being.

And, don't forget, drinking water is free! If that isn't convincing enough, what would be so wrong with spending a little more on food and a little less on other things so we can enjoy a healthier quality of life?

What are the most important measures (e.g., opening a health saving account, exercising, etc.) that Americans can take to minimize health-related expenditures?

Get back to the basics - eat like your grandparents or great grandparents ate. Cooking our own food is becoming a dying art. Exercise regularly, even if you don't already. You have to start somewhere. Build activity into your day. There are no negatives to exercise. It helps every body system and can prevent several common ailments, reduce stress, but especially head off chronic diseases. As I said before, these two activities will take some time to implement, but can be made a regular part of your daily routine if you make them a priority.

How effective could overtaxing fast food be at encouraging Americans to make healthier meal choices?

I'm not sure. It obviously hasn't stopped all people from smoking cigarettes, but if it does decrease the cost differential between fast-food and other options, perhaps people will start choosing the other options. There will always be those who cannot live without their fast food, but maybe it will be consumed less often.

How effective are awareness campaigns at educating Americans about the benefits of a healthy lifestyle?

I think they may be starting to make a difference, in that the rates of obesity are leveling off, but we definitely aren't there yet. Individuals also have to make the choice to lead a healthier life in order to be optimally motivated. In my opinion, people do have a general sense of what is healthy or not so healthy, it is overcoming the individual barriers to making those behavior changes and maintaining them. What's in it for them? Unfortunately, health and feeling good are not the best internal motivators for all.

Methodology

To highlight the ROI for health care services in 47 of the U.S. states, we looked into three key metrics, including death rates, America’s Health Rankings® and average individual health insurance premiums. Maine, Rhode Island and Vermont were excluded from the analysis due to data limitations.

To calculate the ROI for health care expenditures, WalletHub used the following formula:

  • Health ROI = Quality of Health Ranking/Health Care Costs Ranking

Each variable can be broken down as follows:

  • To determine the Health Care Costs Ranking, we used the average individual health insurance premiums as a proxy.
  • To determine the Quality of Health Ranking, we used America’s Health Rankings® and death rate rankings.

More specifically, we assessed quality based on observed death rates on the following age groups: less than 1-year-old, 1 to 4 years old, 5 to 14, 15 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, 65 to 74, 75 to 84, and 85 and older. All age groups were weighted equally. We also used America’s Health Rankings®, one of the most reliable sources tracking the health of Americans on the state level. America’s Health Rankings® measures health using 27 metrics that range from smoking and obesity to sedentary lifestyle and diabetes.

 

Source: Data used to create these rankings is courtesy of the Centers for Disease Control and Prevention, America’s Health Rankings® and eHealthInsurance.

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Richie Bernardo is a financial writer at WalletHub. He graduated with a Bachelor of Journalism and a minor in business from the University of Missouri-Columbia. Previously, Richie was a journalism…
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