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MoneyGeek Analysis:

The Best & Worst States for Health Care

Last Updated: 8/11/2022
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Access to health care services and the affordability of health insurance are crucial to overall health but vary widely across the United States. MoneyGeek analyzed a host of statistics, from health outcomes — such as preventable deaths and rates of certain diseases or risk factors — to health access and cost — such as how many people are uninsured and have affordable health insurance options available — to find the best and worst states for health care in the U.S.

Summary Findings:
  • Hawaii is the top state for health care in the U.S. It has the best health outcomes in the country, with low preventable death (47 per 100,000 people), diabetes mortality and obesity rates. However, the state ranks fairly low for accessibility (No. 31).
  • Iowa is the second-best state for health care. Iowans benefit from relatively easy access to health care and relatively low costs. The state ranks No. 7 for affordability.
  • West Virginia has the worst health care in the nation. Though West Virginia ranks No. 6 for accessibility, it has the worst health outcomes of any state, with the highest rate of preventable deaths (126 preventable deaths among 100,000 residents) and diabetes mortalities. It also has the highest average private health insurance premiums ($8,546 per year) in the U.S.
  • New Mexico has the nation’s lowest overall health care costs but ranks No. 48 for accessibility. The state has been slow to alleviate staffing needs to address primary care provider shortages.
  • Vermont is the most expensive state for health care. The state has the third-highest annual private health care premiums in the country (averaging $7,886) and government spending on per capita health care costs at nearly $6,000. Vermont spends more than 13% of its total gross domestic product (GDP) on health care, while the national average is around 9%.
  • Maryland has the lowest annual private health insurance premiums of any state ($4,052, on average). The national average annual cost across all states in the U.S. is $5,752.
  • Massachusetts ranks No. 8 for overall health care. However, the state also has the highest rate of government health care spending in the U.S. at $7,813 per person. That’s nearly $3,000 more than the national average and nearly 11% of the state’s GDP.

States With the Best (& Worst) Health Care

Best US States for Health Care

The states with the best health care in the United States are those where people are generally healthier, have access to health care services and are less likely to be uninsured. The best states for health care are found all across the country, from Hawaii to Rhode Island. That said, 4 of the top 10 states on our list are located in the Northeast.

States that fare worse on our health care rankings tend to have higher costs for less access and higher rates of medical conditions like diabetes and obesity. The worst states for health care are concentrated regionally, with 8 of the 10 clustered in the South and Southeast.

The Top 10 States for Health Care

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  • State
    Overall Score
  • 1.
    Hawaii
    99.0
  • 2.
    Iowa
    95.4
  • 3.
    Colorado
    91.6
  • 4.
    Minnesota
    91.1
  • 5.
    Rhode Island
    85.6
  • 6.
    Maryland
    82.9
  • 7.
    New Hampshire
    82.1
  • 8.
    Massachusetts
    81.3
  • 9.
    Utah
    81.0
  • 10.
    Washington
    80.8

The 10 Worst States for Health Care

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  • State
    Overall Score
  • 1.
    West Virginia
    1.0
  • 2.
    Mississippi
    33.4
  • 3.
    Alaska
    33.7
  • 4.
    Tennessee
    38.3
  • 5.
    Louisiana
    44.7
  • 6.
    Oklahoma
    45.6
  • 7.
    New Mexico
    47.2
  • 8.
    Kentucky
    48.9
  • 9.
    Missouri
    49.9
  • 10.
    Arizona & Maine (Tie)
    52.7

Additional Findings: Outcome, Cost & Access Data Rankings

To evaluate health care in the United States, MoneyGeek looked at three categories of data that together create a comprehensive view of the overall quality of health care in each location. Those categories include:

  • Health outcomes, including indicators such as rates of disease and risk factors like obesity and smoking, preventable deaths and infant mortality. These measures help answer the question: How healthy are the people who live here?

  • Cost, including factors like how much the state spends on health care and the average cost of private health insurance. These measures help answer the question: How expensive is health care in this state?

  • Access, including data on the number of primary care providers and hospital beds available, how many people are uninsured and how many people needed care but had difficulty getting it. These indicators help answer the question: How easy is it to get the health care you need in this state?

Within these three categories, we broke down the best and the worst states across a wide range of health care outcome, cost and access data points. Below is a brief summary of those findings, along with the top best and worst states for each data point.

Deep Blue States Across the US Have the Healthiest Residents


hawaii
Best States for Health Outcomes:
1. Hawaii
2. Vermont
3. California
4. Massachusetts
5. New York
westVirginia
Worst States for Health Outcomes:
1. West Virginia
2. Mississippi
3. Louisiana
4. Tennessee
5. Kentucky

Southern States Have Highest Diabetes Mortality Rates


hawaii
States With Fewest Diabetes Mortalities per 100,000 Residents:
1. Hawaii: 17.0
2. Massachusetts: 17.2
3. Connecticut: 17.5
4. Vermont: 17.5
5. Colorado: 18.0
westVirginia
States With Most Diabetes Mortalities per 100,000 Residents:
50. West Virginia: 41.3
49. Mississippi: 41.0
48. Arkansas: 33.8
47. Louisiana: 33.1
46. Oklahoma: 32.8

West Virginia’s Preventable Death Rate Is Nearly 3x Texas’s


texas
States With the Lowest Rates of Preventable Deaths per 100,000 Residents:
1. Texas: 44.0
2. Utah: 45.0
3. New York: 45.3
4. Hawaii: 46.5
5. Nebraska: 46.6
westVirginia
States With the Highest Rates of Preventable Deaths per 100,000 Residents:
50. West Virginia: 125.6
49. Tennessee: 88.7
48. Kentucky: 88.2
47. New Mexico: 88.0
46. Maine: 85.1

Overall Affordability Is Best in the Southwest, Worst in the Northeast


newMexico
States With Most Affordable Health Care
1. New Mexico
2. Colorado
3. Maryland
4. Utah
5. South Carolina
vermont
States With Least Affordable Health Care:
50. Vermont
49. West Virginia
48. New York
47. Massachusetts
46. New Jersey

Health Insurance Is Nearly 2x as Expensive in Worst States for Costs


maryland
States With Lowest Average Cost of Private Health Insurance:
1. Maryland: $4,052
2. New Mexico: $4,063
3. Minnesota: $4,109
4. Michigan: $4,335
5. Colorado: $4,368
westVirginia
States With Highest Average Cost of Private Health Insurance:
50. West Virginia: $8,546
49. New York: $8,501
48. Vermont: $7,886
47. Wyoming: $7,646
46. New Jersey: $7,000

Access to Care Varies Widely Across Regions


rhodeIsland
Best States for Access to Care:
1. Rhode Island
2. Iowa
3. Ohio
4. North Dakota
5. Massachusetts
alaska
Worst States for Access to Care:
1. Alaska
2. Texas
3. New Mexico
4. Nevada
5. Georgia

Northeast States Have Lowest Uninsured Rates; Southern States, Highest


massachusetts
States With Lowest Uninsured Population Rate:
1. Massachusetts: 3.0%
2. Rhode Island: 4.1%
3. Hawaii: 4.2%
4. Vermont: 4.5%
5. Minnesota: 4.9%
texas
States With Highest Uninsured Population Rate:
50. Texas: 18.4%
49. Oklahoma: 14.3%
48. Georgia: 13.4%
47. Florida: 13.2%
46. Mississippi: 13.0%

Northeast States Have 2x the Primary Care Providers of Western States


rhodeIsland
States With the Most Primary Care Providers per 100,000 Residents:
1. Rhode Island: 255.1
2. Massachusetts: 227.7
3. New York: 207.4
4. Connecticut: 197.8
5. Pennsylvania: 197.0
utah
States With the Fewest Primary Care Providers per 100,000 Residents:
50. Utah: 98.7
49. Idaho: 99.2
48. Nevada: 101.6
47. Texas: 109.0
46. Montana: 110.3

Expert Insights

Geographic variation in health care costs, access and outcomes is well documented. Some differences are due to local-level conditions and social determinants of health, or non-medical factors that affect health like advantage, isolation and opportunity. The drivers of variation are not predetermined and can be influenced through policy and practice.

MoneyGeek consulted health industry experts to understand some of the potential choices states can make — or are making — to affect their local health care systems for better and worse.

  1. States vary widely on quality, cost and access measures. To what do you attribute geographic variation in health outcomes and access?
  2. What could or should states with worse health outcomes and access do to improve health care for their residents?
  3. Are there principles or best practices for optimizing health spending to optimize outcomes (at the state level or otherwise)?
  4. Is there anything else you’d like to add about the general phenomenon of geographic variation in health care outcomes, access and cost?
Jay Bhatt
Jay Bhatt

Executive Director, Deloitte Center for Health Solutions

Cyrena Gawuga
Cyrena Gawuga

Director of Research, Preparedness & Treatment Equity Coalition

Rima Cohen
Rima Cohen

Special Advisor, Centers for Medicare & Medicaid Services

Full Data Set

The data points presented are defined as follows:

Rank: Based on the “Final Score” ranging from 1-100

Final Score: Cumulative total of Outcome, Cost, and Access scores

  1. Outcome Factor Rank: Based on cumulative scores across the following factors:
    • Infant mortality rate: The number of infant deaths per 1,000 live births
    • Preventable death rate: Deaths that can be avoided through effective preventative health care and interventions per 100,000 residents
    • Diabetes mortality rate: Deaths attributed to diabetes per 100,000 residents
    • Obesity: Percentage of population considered obese
    • Smoking rate: Percentage of adults who reported smoking
    • Life expectancy: The average number of years a person can expect to live
    • Suicide rates: Suicide deaths among persons age 12 and over per 100,000 residents
    • New HIV cases per 100,000 residents over the age of 13
    • Opioid-related hospital stay rate: Inpatient hospital stays involving opioid-related diagnoses per 100,000 residents
  2. Cost Factor Rank: Based on cumulative scores across the following factors:
    • Health care spending as a percentage of state GDP: Government spending on health care and social assistance out of total state GDP
    • State government spending on health care and social assistance per resident
    • Average annual private health insurance premium costs
  3. Access Factor Rank: Based on cumulative score across the following factors:
    • Number of hospital beds per 1,000 residents
    • Number of primary care providers per 100,000 residents
    • Primary care provider shortage areas (HPSAs) by state: Designations that identify areas of the U.S. experiencing health care professional shortages
    • Percentage of population with access to any insurance versus just health insurance
    • Ease of access to care at the doctor’s office or clinic using Medicare
    • Ease of access to care at a specialist using Medicare
State
Rank
Final Score
Outcome Factor Rank (1st = Best)
Cost Factor Rank (1st = Lowest)
Access Factor Rank (1st = Best)

Alaska

48

33.7

32

45

50

Texas

26

61.2

20

8

49

New Mexico

44

47.2

44

1

48

Nevada

28

60.5

22

12

47

Georgia

34

55.5

27

16

46

Arizona

41

52.7

31

22

45

Oklahoma

45

45.6

40

13

44

Idaho

24

65.8

19

20

43

California

12

80.6

3

30

42

Florida

39

52.9

29

32

41

Wyoming

31

58.0

23

29

40

Utah

9

81.0

11

4

39

Washington

10

80.8

9

6

38

Colorado

3

91.6

7

2

37

North Carolina

35

54.8

38

15

36

Oregon

19

73.1

13

27

35

Montana

27

61.1

24

33

34

Mississippi

49

33.4

49

14

33

Missouri

42

49.9

37

38

32

Hawaii

1

99.0

1

18

31

South Carolina

29

58.8

41

5

30

Delaware

30

58.5

28

40

29

Alabama

38

53.0

43

17

28

Virginia

15

78.8

18

10

27

Connecticut

17

75.5

8

42

26

New Jersey

16

75.9

6

46

25

Maine

40

52.7

36

43

24

Arkansas

32

56.1

42

11

23

Indiana

36

54.6

39

28

22

South Dakota

37

54.0

35

44

21

Maryland

6

82.9

21

3

20

Tennessee

47

38.3

47

41

19

New York

22

71.9

5

48

18

Nebraska

18

75.5

14

37

17

Illinois

11

80.8

17

21

16

Michigan

21

72.6

34

9

15

Kansas

23

67.2

33

25

14

Louisiana

46

44.7

48

26

13

New Hampshire

7

82.1

12

35

12

Pennsylvania

25

65.2

30

39

11

Kentucky

43

48.9

46

24

10

Wisconsin

20

73.0

26

31

9

Minnesota

4

91.1

10

23

8

Vermont

14

79.0

2

50

7

West Virginia

50

1.0

50

49

6

Massachusetts

8

81.3

4

47

5

North Dakota

13

79.9

25

19

4

Ohio

33

55.8

45

34

3

Iowa

2

95.4

15

7

2

Rhode Island

5

85.6

16

36

1

Methodology

To explore and rank health care quality by state, MoneyGeek analyzed three core categories — health outcomes, cost and access to care — using health care data from the Kaiser Family Foundation, the Centers for Disease Control and HealthData.gov. We assigned weights to each factor within these core categories to measure health care quality.

MoneyGeek used the following metrics in our analysis:

  • Preventable death rate: Full weight
  • Infant mortality rate: Full weight
  • Life expectancy: Half weight
  • Diabetes mortalities per 100,000 people: Half weight
  • Obesity as a percentage of the population: Half weight
  • Hospital inpatient stays involving opioid-related diagnoses per 100,00 people: Quarter weight
  • Smoking rate among adults: Quarter weight
  • Suicide deaths among persons ages 12 and older per 100,000 people: Quarter weight
  • New HIV cases among persons ages 13 and older per 100,000 people: Quarter weight
  • Annual health insurance costs: Full weight
  • Health care spending as a percentage of state GDP: Half weight
  • Health care spending as a share of GDP per resident: Half weight
  • Percentage of population with health insurance: Full weight
  • Number of hospital beds per 100,000 people: Half weight
  • Adults who had a doctor's office or clinic visit in the last 12 months and needed care, tests, or treatment who sometimes or never found it easy to get the care, tests, or treatment, Medicare fee-for-service: Quarter weight
  • Adults who needed to see a specialist in the last 6 or 12 months who sometimes or never found it easy to see a specialist, Medicare fee-for-service: Quarter weight
  • Primary care health professional shortage areas: % of need met to remove shortage designation: Quarter weight
  • Number of primary care providers per 100,000 population: Quarter weight

If you have any questions about our findings or methodology, please reach out to Melody Kasulis via email at melody@moneygeek.com.

About the Author


expert-profile

Deb Gordon is author of The Health Care Consumer’s Manifesto (Praeger 2020), a book about shopping for health care, based on consumer research she conducted as a senior fellow in the Harvard Kennedy School’s Mossavar-Rahmani Center for Business and Government between 2017 and 2019. Her research and writing have been published in JAMA Network Open, the Harvard Business Review blog, USA Today, RealClear Politics, TheHill, and Managed Care Magazine. Deb previously held health care executive roles in health insurance and health care technology services. Deb is an Aspen Institute Health Innovators Fellow, and an Eisenhower Fellow, for which she traveled to Australia, New Zealand, and Singapore to explore the role of consumers in high-performing health systems. She was a 2011 Boston Business Journal 40-under-40 honoree, and a volunteer in MIT’s Delta V start-up accelerator, the Fierce Healthcare Innovation Awards, and in various mentorship programs. She earned a BA in bioethics from Brown University, and an MBA with distinction from Harvard Business School.


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