Best & Worst States for Children’s Health Care

During the coronavirus pandemic, it’s more important now than ever to safeguard the health of America’s children. While children are less likely than adults to experience serious symptoms from COVID-19, they are still able to contract the disease and spread it to others, and may be less apt to practice good hygiene than adults. Most children also don’t have the opportunity to get vaccinated yet, as the current vaccines are only available to people over age 16.

Luckily, around 95% of children aged 0 to 18 have health insurance to protect them if they do get sick. The bad news is that the high coverage rate hasn’t translated to lower health costs for parents, and the average family premium rose 4% in 2020 alone. Some families can find relief through Medicaid or through the Children’s Health Insurance Program (CHIP). However, many people who don’t qualify for government assistance will still struggle, especially in the difficult economic situation caused by COVID-19.

It’s a different story in every state, though. WalletHub therefore compared the 50 states and the District of Columbia across 35 key indicators of cost, quality and access to children’s health care. Our data set ranges from share of children aged 0 to 17 in excellent or very good health to pediatricians and family doctors per capita.

Main Findings

Best States for Children’s Health

Note: With the exception of “Total Score,” all of the columns in the table above depict the relative rank of that state, where a rank of 1 represents the best conditions for that metric category.

Ask the Experts

There are steps that parents, health-care organizations and the government can take to ensure the best health for children in the U.S. For insight and advice, we asked a panel of experts to share their thoughts on the following key questions:

1. Is there evidence that children’s hospitals produce better health outcomes for children?
2. What are the most important steps parents can take to help their children grow up healthy?
3. Do you believe children are prescribed too much medication in the US today?
4. Do you think the government should mandate all children have health-insurance coverage?
5. In evaluating the best states for children’s health care, what are the top five indicators?
6. How has the coronavirus pandemic impacted the utilization of preventive and primary care among children?

Methodology

In order to determine the best and worst states for children’s health care, WalletHub compared the 50 states and the District of Columbia across three key dimensions: 1) Kids’ Health & Access to Health Care, 2) Kids’ Nutrition, Physical Activity & Obesity and 3) Kids’ Oral Health.

We evaluated these categories using 35 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with 100 representing the best health care for children.

We then determined each state and the District’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

Kids’ Health & Access to Health Care – Total Points: 55

• Share of Children Aged 0 to 17 in Excellent/Very Good Health: Double Weight (~5.79 Points)
• Share of Children Aged 3 to 17 Suffering from Depression: Full Weight (~2.89 Points)
• Infant-Death Rate: Full Weight (~2.89 Points)
  Note: “Infant” includes children who are less than 1 year old.
• Child-Death Rate: Full Weight (~2.89 Points)
  Note: “Child” includes children aged 1 to 14.
• Share of Children 19 to 35 Months Old with All Recommended Vaccines: Full Weight (~2.89 Points)
  Note: Recommended vaccines include the following: DTaP vaccine; polio vaccine; measles, mumps and rubella (MMR) vaccine; Haemophilus influenzae type b (Hib) vaccine; varicella (chicken pox) vaccine; hepatitis B (HepB) vaccine; and pneumococcal conjugate vaccine (PCV).
• Share of Uninsured Children Aged 0 to 18: Double Weight (~5.79 Points)
• Share of Children Aged 0 to 17 with Unaffordable Medical Bills: Full Weight (~2.89 Points)
  Note: This metric measures the percentage of children aged 0 to 17 whose families had problems paying or were unable to pay their child’s medical bills.
• Pediatricians & Family Doctors per Capita: Full Weight (~2.89 Points)
• Cost of Doctor’s Visit: Full Weight (~2.89 Points)
• Out-of-Pocket Cost for Children’s Health Care: Full Weight (~2.89 Points)
• Number of Children’s Hospitals per Total Number of Children: Full Weight (~2.89 Points)
• COVID-19 Positive Tests in the Past Week per Capita: Triple Weight (~8.68 Points)
• COVID-19 Death Rate in the Past Week per Capita: Triple Weight (~8.68 Points)

Kids’ Nutrition, Physical Activity & Obesity – Total Points: 40

• Healthy-Food Access: Full Weight (~2.86 Points)
  Note: This metric measures the share of low income population that is more than 1 mile (urban areas) or more than 10 miles (rural areas) from the nearest supermarket, supercenter, or large grocery store.
• Sugar-Sweetened Beverage Consumption Among Children Aged 14 to 18: Full Weight (~2.86 Points)
• Share of Children Aged 14 to 18 Who Consume Fruits/Vegetables Less than Once Daily: Full Weight (~2.86 Points)
• Fast-Food Restaurants per Capita: Full Weight (~2.86 Points)
• Dietitians & Nutritionists per Capita: Full Weight (~2.86 Points)
• Share of Children Aged 6 to 17 Who Exercise at Least 60 Minutes per Day: Full Weight (~2.86 Points)
• Share of Overweight Children Aged 10 to 17: Double Weight (~5.71 Points)
• Share of Obese Children Aged 10 to 17: Double Weight (~5.71 Points)
• Presence of Healthy Eating and Physical Activity Policies in Schools: Full Weight (~2.86 Points)
  Note: This binary metric considers the presence or absence of Early Childhood Education (ECE) programs required to have healthy eating policies and Physical Education requirements for elementary, middle and high school.
• Schools Meeting Nutrition Standards: Full Weight (~2.86 Points)
  Note: This metric measures 1) the share of eligible school districts adopting the Community Eligibility Provision Take-Up, 2) the share of certified school food authorities and 3) the share of children in the School Lunch Program that are also in the School Breakfast Program.
• Presence of Obesity-Related State Initiatives: Full Weight (~2.86 Points)
  Note: This metric considers the presence of absence of obesity-related state initiatives such as menu-labeling laws and soda taxes.
• Share of Children Aged 1 to 17 Who Live Near a Recreation Area: Full Weight (~2.86 Points)
  Note: This metric measures the share of children aged 1 to 17 who live near a park/playground and recreation/community center.

Kids’ Oral Health – Total Points: 5

• Share of Children Aged 1 to 17 with Excellent/Very Good Teeth: Double Weight (~0.83 Points)
• Share of Children Aged 0 to 17 with Recent Medical & Dental Checkups: Double Weight (~0.83 Points)
• Share of Population Lacking Access to Fluoridated Water: Full Weight (~0.42 Points)
• Presence of State Oral Health Plan: Full Weight (~0.42 Points)
  Note: This metric considers the presence or absence of state oral health plans. According to the Centers for Disease Control and Prevention, “A state oral health plan is a roadmap for accomplishing the goals and objectives that have been developed in collaboration with partners and stakeholders, including the state oral health coalition, and members from the public health, dental and medical communities. A comprehensive state oral health plan should be used to direct skilled personnel and funding decisions to reduce the prevalence of oral disease.”
• Presence of School-Based Dental-Sealant Programs: Full Weight (~0.42 Points)
  Note: This binary metric considers the presence or absence of school-based dental sealant programs. According to the Centers for Disease Control and Prevention, “School-based sealant programs provide pit and fissure sealants to children in a school setting. These programs generally target vulnerable populations that may be at greater risk for developing decay and less likely to receive preventive care.”
• Dental Treatment Costs: Full Weight (~0.42 Points)
  Note: “Dental Treatment” includes children’s braces, cleanings, crowns, root canals and tooth extractions.
• Free or Low-Cost Dental Clinics per Capita: Full Weight (~0.42 Points)
• Presence of State Mandate for Dental-Health Screening: Full Weight (~0.42 Points)
  Note: This binary metric considers the presence or absence of a mandatory dental-health screening or certification of a dental-health assessment as a condition of school entry.
• Share of Dentists Participating in Medicaid for Child Dental Services: Full Weight (~0.42 Points)
• Dentists per Capita: Full Weight (~0.42 Points)

 
Sources: Data used to create this ranking were collected from U.S. Census Bureau, Bureau of Labor Statistics, Child and Adolescent Health Measurement Initiative, Centers for Disease Control and Prevention, Council for Community and Economic Research, U.S. Department of Agriculture, American Dental Association, Trust for America's Health, Free Dental Care, The Annie E. Casey Foundation, Healthy Grid and U.S. News & World Report.

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