Best & Worst States for Health Care

Americans need affordable, quality health care more than ever this year as we face the COVID-19 pandemic. State healthcare systems need to care for and quarantine those who contract the virus while making sure not to neglect the regular health care needs of their residents. The pandemic has already disrupted medical care in so many ways, from postponing elective surgeries to moving many doctor visits entirely online.

Finding good health care at the right price point should be a priority for all Americans during the current health crisis. However, even without any extra costs that might arise from the coronavirus pandemic, the average American spends more than $11,000 per year on personal health care, according to the most recent estimates from the Centers for Medicare & Medicaid Services. That’s a daunting statistic considering that so many Americans are out of work or making less money than usual this year.

In addition, while health care in the U.S. is expensive, higher medical 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 44 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

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. What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?
2. What are the most important steps Americans can take to minimize health-related expenditures?
3. What is your opinion on Medicare-for-All?
4. What measures can local authorities take to better support hospitals and healthcare providers as the pandemic progresses?

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 44 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 U.S. 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 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

• WalletHub “States with the Best Health Infrastructure for Coronavirus” Score: Triple Weight (~3.85 Points)
  Note: This metric is based on WalletHub’s “States with the Best Health Infrastructure for Coronavirus” ranking.
• Quality of Public Hospital System: Full Weight (~1.28 Points)
  Note: This metric is based on the Centers for Medicare & Medicaid Services’ ranking of public hospital systems.
• Hospital Beds per Capita: Full Weight (~1.28 Points)
• Average Response Time from EMS Notification to EMS Arrival (minutes): Full Weight (~1.28 Points)
• Average Emergency-Room Wait Time: Full Weight (~1.28 Points)
• Time Before Admission: Full Weight (~1.28 Points)
  Note: This metric refers to the average time, in hours, patients spend in the emergency room before being admitted to the hospital.
• Physicians per Capita: Full Weight (~1.28 Points)
• Geriatricians per Population Aged 65 Years & Older: Full Weight (~1.28 Points)
• Nurse Practitioners per Capita: Full Weight (~1.28 Points)
• Physician Assistants per Capita: Full Weight (~1.28 Points)
• EMTs & Paramedics per Capita: Full Weight (~1.28 Points)
  Note: “EMTs” refer to emergency medical technicians.
• Urgent-Care Centers per Capita: Full Weight (~1.28 Points)
  Note: “Urgent-Care Centers” include those certified by the Urgent Care Association of America (UCAOA).
• Retail Clinics per Capita: Full Weight (~1.28 Points)
• Medicare Certified Rural Health Clinics per Rural Population: Full Weight (~1.28 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 (~1.28 Points)
• Share of Medical Residents Retained: Full Weight (~1.28 Points)
• Medicare Acceptance Rate Among Physicians: Full Weight (~1.28 Points)
• Medicaid Acceptance Rate Among Physicians: Full Weight (~1.28 Points)
• Share of Insured Adults: Full Weight (~1.28 Points)
  Note: “Adults” include the population aged 19 to 64.
• Share of Insured Children: Full Weight (~1.28 Points)
  Note: “Children” include the population aged 0 to 18.
• Share of Adults with No Personal Doctor: Full Weight (~1.28 Points)
• Status of State ACA Innovation Waivers: Full Weight (~1.28 Points)
  Note: This metric measures if a state has either released a draft, enacted a legislation or has had an Innovation waiver approved by federal government.
• Adoption of Telehealth Services: Full Weight (~1.28 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. This composite metric includes Patient Setting, Technology, Provider Types and Medicaid Coverage.
• Patient Encounters in Community Health Centers per Capita: Full Weight (~1.28 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)
• Stroke & 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.
• Share of Non-Immunized Children: Full Weight (~2.22 Points)
  Note: “Children” include the population aged 19 to 35 months.

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, National Highway Traffic Safety Administration and WalletHub research.

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