The Best and Worst States for Health Care

Although America’s uninsured rate has fallen to a historic low, cost and quality of health care seems to fluctuate from state to state.

According to US Centers for Medicare and Medicaid Services data, Americans shell out an average of $9523 for health expenditures annually—and this figure is expected to continue to rise. Compared with their counterparts in other wealthy nations, Americans pay the highest price for common prescription drugs and medical procedures.

With that in mind, WalletHub analysts recently compared all 50 states and the District of Columbia across 3 key dimension: health care costs, access, and outcomes. Within those dimensions were 29 key metrics—including average monthly insurance premium, number of physicians per capita, and percentage of adults and children with health insurance coverage—

to determine which states offer the most cost-effective and highest-quality care.

Based on those metrics, the states with the worst health care are:

51. Alaska

50. Louisiana

49. Mississippi

48. Nevada

47. Arkansas

46. Georgia

45. West Virginia

44. Oklahoma

43. South Carolina

42. Alabama

In contrast, these are the states with the best health care:

1. Minnesota

2. Maryland

3. South Dakota

4. Iowa

5. Utah

6. Kansas

7. Hawaii

8. Vermont

9. District of Columbia

10. Nebraska

Other Key Findings

• The states with the highest percentage of adults with health insurance are Massachusetts, the District of Columbia, and Hawaii, while the states with the lowest percentage of adults with health insurance are Georgia, New Mexico, and Nevada.
• Minnesota has the lowest average monthly insurance premium ($234) which is 2.4 times lower than in Alaska, where the premium is highest ($567).
• The District of Columbia has the highest number of hospital beds per 1000 residents (6.97), which is 3.4 times higher than in Oregon, which has the lowest (2.05). It also has the highest number of physicians per 100,000 residents (849.3), which is 4.6 times higher than in Mississippi, which has the lowest (184.7).
• California has the highest retention rate for medical residents (69.8%), which is 4.5 times higher than in the District of Columbia, where the rate is lowest (15.4%). It also has the lowest number of infant mortalities per 1000 births (4.30), which is 2 times lower than in Alabama, where the number is highest (8.68).
• Colorado has the lowest percentage of adults who have had a stroke (1.7%) which is 2.7 times lower than in Arkansas, which has the highest (4.6%).
• Kentucky and West Virginia share the lowest percentage of at-risk adults without a routine doctor visit in the past 2 years (10.3%), which is 1.7 times lower than in Vermont, where the number is highest (17.7%).
• Massachusetts has the lowest percentage of adults without a dental visit in the past year (25.3%), which is 1.8 lower than in West Virginia, which has the highest (45.1%).

Methodology

Data used to create these rankings were collected from the US Census Bureau, Bureau of Labor Statistics, Council for Community and Economic Research, eHealthInsurance, Urban Institute, 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, Amnesty International USA, Trustees of Dartmouth College, and Social Science Research Council.

Each of the following metrics was graded on a 100-point scale, with 100 representing the best health care:

Health Care Costs — Total Points: 33.33

• Cost of Medical Visit: Full Weight (~8.33 Points)
• Cost of Dental Visit: Full Weight (~8.33 Points)
• Average Monthly Insurance Premium: Full Weight (~8.33 Points)
• Out-of-Pocket Medical Spending: Full Weight (~8.33 Points) Note: This metric measures the percentage of individuals younger than age 65 with high out-of-pocket medical spending relative to their annual income.

Health Care Access — Total Points: 33.33

• Public Hospital System Ranking: Full Weight (~2.08 Points)
• Number of Hospital Beds per Capita: Full Weight (~2.08 Points)
• Average Emergency-Room Wait Time: Full Weight (~2.08 Points)
• Number of Physicians per Capita: Full Weight (~2.08 Points)
• Number of Nurse Practitioners per Capita: Full Weight (~2.08 Points)
• Number of Physician Assistants per Capita: Full Weight (~2.08 Points)
• Number of Dentists per Capita: Full Weight (~2.08 Points)
• Percentage of Medical Residents Retained: Full Weight (~2.08 Points)
• Physician Medicare Acceptance Rates: Full Weight (~2.08 Points)
• Physician Medicaid Acceptance Rates: Full Weight (~2.08 Points)
• Adult Health-Insurance Coverage: Full Weight (~2.08 Points) Note: This metric measures the percentage of adults aged 18 to 64 with health insurance coverage.
• Youth Health-Insurance Coverage: Full Weight (~2.08 Points) Note: This metric measures the percentage of adults aged 18 to 64 with health insurance coverage.
• Telehealth: Full Weight (~2.08 Points) Note: This metric indicates the presence of telehealth in the state.
• Number of UCAOA-Certified* Urgent-Care Centers per Capita: Full Weight (~2.08 Points) Note: UCAOA stands for Urgent Care Association of America.
• Number of Retail Clinics per Capita: Full Weight (~2.08 Points)
• Number of Patient Encounters per Capita in Federally Qualified Community Health Centers*: Full Weight (~2.08 Points) Note: “Federally Qualified Health Centers,” or FQHCs, are defined by the U.S. Department of Health and Human Services 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.”

Health Outcomes — Total Points: 33.33

• Infant Mortality Rate: Full Weight (~3.33 Points)
• Child Mortality Rate: Full Weight (~3.33 Points)
• Maternal Mortality Rate: Full Weight (~3.33 Points)
• Patient Hospital-Readmittance Rate: Full Weight (~3.33 Points) Note: This metric measures the percentage of patients readmitted within 30 days following discharge from a hospital.
• Life Expectancy at Birth: Double Weight (~6.67 Points)
• Cancer Rate: Full Weight (~3.33 Points)
• Heart-Disease Rate: Full Weight (~3.33 Points)
• Percentage of At-Risk Adults Without a Routine Doctor Visit in the Past Two Years: Full Weight (~3.33 Points)
• Percentage of Adults Without a Dental Visit in the Past Year: Full Weight (~3.33 Points)