2019’s Best & Worst States for Health Care

According to the CDC, 87.6 percent of the population has a regular place to go for medical care. But the cost and service quality of that care can vary widely from state to state. The overall health of the population, more advanced medical equipment and a general lack of awareness regarding the best types of treatment, for instance, can all affect costs. Today, the average American spends more than $10,000 per year on personal health care, according to the most recent estimates from the Centers for Medicare & Medicaid Services. That’s about 17.9 percent of the U.S. GDP.

But higher costs don’t necessarily translate to better results. According to a study by the Kaiser Family Foundation, the U.S. lags behind several other wealthy nations on several measures, such as health coverage, life expectancy and disease burden, which measures longevity and quality of life. However, the U.S. has improved in giving more healthcare access for people in worse health, and healthcare cost growth has slowed somewhat.

Conditions aren’t uniform across the U.S., though. To determine where Americans receive the best and worst health care, WalletHub compared the 50 states and the District of Columbia across 43 measures of cost, accessibility and outcome. Read on for our findings, expert insight on the future of American health care and a full description of our methodology.

Main Findings

 

States with Best Health Care Systems

Overall Rank (1 = Best)	State	Total Score	‘Cost’ Rank	‘Access’ Rank	‘Outcomes’ Rank
1	Minnesota	63.79	2	4	9
2	Massachusetts	62.33	35	2	1
3	Rhode Island	62.12	11	5	6
4	District of Columbia	61.38	1	3	26
5	Vermont	60.13	5	34	4
6	New Hampshire	59.80	40	8	2
7	Hawaii	59.64	8	36	5
8	Maine	58.44	38	1	13
9	North Dakota	58.21	3	9	22
10	Iowa	57.27	15	17	14
11	Colorado	56.77	47	12	3
12	Maryland	56.71	4	21	23
13	Connecticut	56.44	44	11	7
14	Kansas	56.05	7	16	27
15	Pennsylvania	55.70	13	13	25
16	Wisconsin	55.46	45	6	10
17	Montana	55.44	21	19	18
18	South Dakota	55.15	17	15	24
19	Utah	55.12	32	41	8
20	Michigan	55.09	6	18	30
21	Virginia	54.63	25	35	12
22	Nebraska	53.64	43	10	17
23	New Jersey	53.39	14	30	28
24	New York	52.26	29	24	29
25	Ohio	52.22	10	22	37
26	Illinois	52.20	24	23	32
27	Wyoming	52.14	36	37	16
28	Idaho	52.02	30	43	19
29	Delaware	51.79	42	27	21
30	California	51.19	39	42	20
31	New Mexico	50.95	19	31	36
32	Washington	49.85	48	44	11
33	Oregon	49.43	49	29	15
34	Indiana	49.29	9	38	40
35	Kentucky	49.11	16	14	47
36	Tennessee	48.05	18	32	42
37	Missouri	47.50	31	25	41
38	Nevada	47.37	22	47	39
39	Florida	47.37	34	46	35
40	West Virginia	47.35	41	7	45
41	Arizona	46.74	37	48	34
42	Alabama	46.59	12	45	46
43	Texas	45.94	28	51	38
44	Louisiana	44.50	33	20	49
45	Oklahoma	44.47	26	39	48
46	Georgia	44.45	23	49	44
47	Arkansas	43.48	20	33	50
48	South Carolina	42.96	46	40	43
49	Mississippi	42.76	27	28	51
50	North Carolina	42.63	50	50	33
51	Alaska	42.21	51	26	31

 

Ask the Experts

As Americans anticipate changes to their health care in both the short and long terms, we asked a panel of experts to weigh in with their thoughts on the following key questions:

1. Major insurers, including Blue Cross, Aetna and Humana, have pulled out of many state-run insurance exchanges, leaving residents of some counties with few, if any, options for coverage. What effects will this have for the market in the future?
2. How has the recently enacted health-care reform reshaped state health care systems? How has it impacted businesses and the provision of employer-sponsored plans?
3. What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?
4. What are the most important steps Americans can take to minimize health-related expenditures?
5. What is your opinion on Medicare-for-All?

Methodology

In order to determine the best and worst states for health care, WalletHub compared the 50 states and the District of Columbia across three key dimensions: 1) Cost, 2) Access and 3) Outcomes.

We evaluated those dimensions using 43 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the best health care at the most reasonable cost.

Finally, we 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.

Cost – Total Points: 33.33

• Cost of Medical Visit: Full Weight (~5.56 Points)
• Average Hospital Expenses per Inpatient Day at Community Hospitals: Full Weight (~5.56 Points)
  Note: Includes all operating and non-operating expenses for registered US community hospitals, defined as nonfederal short-term general and other special hospitals whose facilities and services are available to the public.
• Cost of Dental Visit: Full Weight (~5.56 Points)
• Average Monthly Insurance Premium: Full Weight (~5.56 Points)
• Share of High Out-of-Pocket Medical Spending: Full Weight (~5.56 Points)
  Note: This metric measures the share of the population aged 64 years and younger with high out-of-pocket medical spending relative to their annual income.
• Share of Adults with No Doctor Visits Due to Cost: Full Weight (~5.56 Points)

Access – Total Points: 33.33

• Quality of Public Hospital System: Full Weight (~1.45 Points)
  Note: This metric is based on the Centers for Medicare & Medicaid Services’ ranking of public hospital systems.
• Hospital Beds per Capita: Full Weight (~1.45 Points)
• Average Response Time from EMS Notification to EMS Arrival (minutes): Full Weight (~1.45 Points)
• Average Emergency-Room Wait Time: Full Weight (~1.45 Points)
• Transfer Time: Full Weight (~1.45 Points)
  Note: This metric refers to the additional time spent waiting before being taken to a room.
• Physicians per Capita: Full Weight (~1.45 Points)
• Geriatricians per Population Aged 65 Years & Older: Full Weight (~1.45 Points)
• Nurse Practitioners per Capita: Full Weight (~1.45 Points)
• Physician Assistants per Capita: Full Weight (~1.45 Points)
• EMTs & Paramedics per Capita: Full Weight (~1.45 Points)
  Note: “EMTs” refer to emergency medical technicians.
• Urgent-Care Centers per Capita: Full Weight (~1.45 Points)
  Note: “Urgent-Care Centers” include those certified by the Urgent Care Association of America (UCAOA).
• Retail Clinics per Capita: Full Weight (~1.45 Points)
• Medicare Certified Rural Health Clinics per Rural Population: Full Weight (~1.45 Points)
  Note: Medicare Certified Rural Health Clinics (RHCs): RHCs provide primary care and preventive services in rural, underserved areas. They can be public, non-profit, or for-profit facilities, must be staffed at least 50% of the time with Nurse Practitioners, PAs, or Certified Nurse Midwives, and must meet certain other facility and quality requirements.
• Dentists per Capita: Full Weight (~1.45 Points)
• Share of Medical Residents Retained: Full Weight (~1.45 Points)
• Medicare Acceptance Rate Among Physicians: Full Weight (~1.45 Points)
• Medicaid Acceptance Rate Among Physicians: Full Weight (~1.45 Points)
• Share of Insured Adults: Full Weight (~1.45 Points)
  Note: “Adults” include the population aged 19 to 64 years.
• Share of Insured Children: Full Weight (~1.45 Points)
  Note: “Children” include the population aged 0 to 18 years.
• Share of Adults with No Personal Doctor: Full Weight (~1.45 Points)
• Status of State ACA Innovation Waivers: Full Weight (~1.45 Points)
  Note: This metric measures if a state has either released draft, enacted a legislation or has had an Innovation waiver approved by federal government.
• Presence of Telehealth: Full Weight (~1.45 Points)
  Note: “Telehealth,” as defined by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, is the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
• Patient Encounters in Community Health Centers per Capita: Full Weight (~1.45 Points)
  Note: “Community Health Centers” refer to Federally Qualified Health Centers (FQHCs), which the U.S. Department of Health and Human Services defines as “all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits.”

Outcomes – Total Points: 33.33

• Infant Mortality Rate: Full Weight (~2.22 Points)
• Child Mortality Rate: Full Weight (~2.22 Points)
• Maternal Mortality Rate: Full Weight (~2.22 Points)
• Share of Patients Readmitted to Hospitals: Full Weight (~2.22 Points)
  Note: This metric measures the percentage of patients readmitted within 30 days following discharge from a hospital.
• Share of Hospitalized Patients Discharged Without Instructions for Home Recovery: Full Weight (~2.22 Points)
• Share of Hospital Patients Who Did Not Receive Patient-Centered Care: Full Weight (~2.22 Points)
• Life Expectancy: Double Weight (~4.44 Points)
• Cancer Incidence Rate: Full Weight (~2.22 Points)
• Heart Disease Rate: Full Weight (~2.22 Points)
• Share of Adults with Type 2 Diabetes: Full Weight (~2.22 Points)
• Share of At-Risk Adults with No Routine Doctor Visit in Past Two Years: Full Weight (~2.22 Points)
• Share of Adults with No Dental Visit in Past Year: Full Weight (~2.22 Points)
• Share of Children with Medical & Dental Preventive-Care Visits in Past Year: Full Weight (~2.22 Points)
  Note: “Children” include the population aged 0 to 17 years.
• Share of Non-Immunized Children: Full Weight (~2.22 Points)
  Note: “Children” include the population aged 19 to 35 months.

Videos for News Use:

• YouTube (for web embedding National)
• YouTube (for web embedding Minnesota)
• Raw files (for editing into clips)

 

Sources: Data used to create this ranking were collected from the U.S. Census Bureau, Bureau of Labor Statistics, Council for Community and Economic Research, The Commonwealth Fund, Institute for Health Metrics and Evaluation, Trust for America's Health and Robert Wood Johnson Foundation, U.S. Department of Agriculture, Child and Adolescent Health Measurement Initiative, United Health Foundation, Centers for Medicare & Medicaid Services, Health Resources & Services Administration, ProPublica, Association of American Medical Colleges, Centers for Disease Control and Prevention, American Telemedicine Association, Urgent Care Association of America, Convenient Care Association, Kaiser Family Foundation, Trustees of Dartmouth College, American Geriatrics Society and National Highway Traffic Safety Administration.

Image: Andrei_R / Shutterstock.com

Community Discussion

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Dorothy Knightly @dotknightly

August 9, 2019

Yes, NH is the Leader in Deaths! NH Healthcare SUCKS! I'd hate to see what you call bad healthcare!

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None Nonner @emorganbusiness

August 6, 2019

Wisconsin and Minnesota compete (or try to) in many areas of life quality. Though the states are adjacent, why is the Cost factor so much higher in WI than MN? I've heard--anecdotally--that Wisconsin's health care costs are higher than average, and this study appears to prove that--in spades!

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