DG
ByDeb Gordon
Edited byMegan Hull
Quality Verified
Updated: March 28, 2024
Advertising & Editorial Disclosure
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 low-cost health insurance options available — to find the best and worst states for health care in 2023.
KEY 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 (630 per 100,000 people), diabetes mortality and obesity rates. However, the state ranks fairly low for accessibility (No. 30).
Rhode Island is the second-best state for health care. Its residents enjoy convenient access to medical services, securing the No. 2 spot for accessibility.
West Virginia has the worst health care in the nation. Though West Virginia ranks No. 3 for accessibility, it has the worst health outcomes of any state, with the highest rate of preventable deaths (1,229 deaths per 100,000 residents) and diabetes mortalities. It also has the second-highest average private health insurance premiums ($11,472 per year) in the U.S.
Utah has the nation’s lowest overall health care costs but ranks No. 39 for accessibility. The state has the second-fewest primary care providers for every 100,000 residents.
New York is the most expensive state for health care. The state has the highest annual private health care premiums in the country (averaging almost $18,400), and government spending on health care is $7,820 per capita.
Virginia has the lowest annual private health insurance premiums of any state ($5,172, on average). The national average annual cost across all states in the U.S. is $7,549.
Massachusetts ranks No. 4 for overall health care. However, the state also has the highest rate of government health care spending in the U.S. at $9,320 per person. That’s nearly $3,600 more than the national average and nearly 12% of the state’s GDP.
States With the Best (and Worst) 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, six 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 eight of the 10 clustered in the South and Southeast.
The Top 10 States for Health Care
State | Score | Region | |
|---|---|---|---|
1. | Hawaii | 73.0 | West |
2. | Rhode Island | 68.0 | Northeast |
3. | Iowa | 67.7 | Midwest |
4. | Massachusetts | 67.4 | Northeast |
5. | Minnesota | 67.0 | Midwest |
6. | New Hampshire | 66.9 | Northeast |
7. | Colorado | 66.8 | West |
8. | Vermont | 66.6 | Northeast |
9. | Connecticut | 64.5 | Northeast |
10. | New Jersey | 63.6 | Northeast |
The 10 Worst States for Health Care
State | Score | Region | |
|---|---|---|---|
1. | West Virginia | 35.4 | South |
2. | Mississippi | 42.1 | South |
3. | Alaska | 44.2 | West |
4. | Louisiana | 44.4 | South |
5. | Oklahoma | 44.6 | South |
6. | New Mexico | 45.2 | West |
7. | Tennessee | 45.6 | South |
8. | Arkansas | 46.6 | South |
9. | Kentucky | 47.4 | South |
10. | Alabama | 48.0 | South |
Additional Findings: Outcome, Cost and 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 summary of those findings, along with the best and worst states for each data point.
Deep Blue States Across the US Have the Healthiest Residents
1. Hawaii
2. Vermont
3. Massachusetts
4. California
5. New Jersey
1. West Virginia
2. Mississippi
3. Louisiana
4. Kentucky
5. Arkansas
Southern States Have Highest Diabetes Mortality Rates
1. Connecticut: 15.9
2. Massachusetts: 17.3
3. New Jersey: 17.6
4. Hawaii: 17.7
5. Vermont: 17.9
1. West Virginia: 47.6
2. Mississippi: 42.1
3. Arkansas: 39.3
4. Louisiana: 35.7
5. Oklahoma: 35.1
West Virginia’s Preventable Death Rate Is Nearly Double Hawaii’s
1. Hawaii: 630
2. New York: 713
3. Massachusetts: 721
4. Connecticut: 725
5. New Jersey: 731
1. West Virginia: 1,229
2. Mississippi: 1,205
3. Kentucky: 1,140
4. Alabama: 1,134
5. Tennessee: 1,121
Overall Affordability Is Worst in the Northeast
1. Utah
2. Virginia
3. Colorado
4. Mississippi
5. Georgia
1. New York
2. Vermont
3. West Virginia
4. South Dakota
5. Massachusetts
States with Costliest Health Insurance Are Twice as Expensive as the 5 Cheapest States
1. Virginia: $5,172
2. Minnesota: $5,220
3. Maryland: $5,256
4. Kentucky: $5,316
5. Idaho: $5,424
1. New York: $18,396
2. West Virginia: $11,472
3. Alaska: $10,584
4. Wyoming: $10,500
5. Vermont: $10,236
Access to Care Varies Widely Across Regions
1. Iowa
2. Rhode Island
3. West Virginia
4. Ohio
5. Massachusetts
1. Nevada
2. Texas
3. New Mexico
4. Alaska
5. Arizona
Northeastern States Have the Lowest Uninsured Rates; Southern States Have the Highest
1. Massachusetts: 2.5%
2. Vermont: 3.6%
3. Hawaii: 3.9%
4. Rhode Island: 4.4%
5. Minnesota: 4.5%
1. Texas: 18.0%
2. Oklahoma: 13.8%
3. Georgia: 12.6%
4. Wyoming: 12.1%
5 Florida: 12.1%
Northeast States Have Double the Primary Care Providers of Western States
1. Rhode Island: 258.5
2. Massachusetts: 233.4
3. New York: 226.1
4. Connecticut: 210.3
5. Pennsylvania: 203.5
1. Idaho: 97.9
2. Utah: 98.8
3. Nevada: 104.9
4. Montana: 108.5
5. Texas: 111.8
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.
- States vary widely on quality, cost and access measures. To what do you attribute geographic variation in health outcomes and access?
- What could or should states with worse health outcomes and access do to improve health care for their residents?
- Are there principles or best practices for optimizing health spending to optimize outcomes (at the state level or otherwise)?
- Is there anything else you’d like to add about the general phenomenon of geographic variation in health care outcomes, access and cost?
Chunhuei Chi, Sc.D., MPHProfessor of Health Management and Policy, Professor in Global Health at Oregon State University
Raymond March, Ph.D.Assistant Professor of Economics at North Dakota State University
Reena Kelly, Ph.D., MHAAssistant Professor, Department of Population Health & Leadership, School of Health Sciences at the University of New Haven
Allie Peckham, MSW, Ph.D.Assistant Professor at Arizona State University
Tinglong Dai, Ph.D.Bernard T. Ferrari, Professor of Business at the Johns Hopkins Carey Business School
Tracey Brigman, Ed.D., M.S., RDN, LDClinical Associate Professor and Director at FACS Education Program at the University of Georgia
Rima CohenSpecial Advisor, Centers for Medicare & Medicaid Services
Cyrena GawugaDirector of Research, Preparedness & Treatment Equity Coalition
Jay BhattExecutive Director, Deloitte Center for Health Solutions
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
- 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
- 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
- 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 | FinalScore | Outcome Factor Rank (1st = Best) | Cost Factor Rank (1st = Lowest) | Access Factor Rank (1st = Best) |
|---|---|---|---|---|---|
Hawaii | 1 | 73.0 | 1 | 18 | 30 |
Rhode Island | 2 | 68.0 | 10 | 40 | 2 |
Iowa | 3 | 67.7 | 15 | 13 | 1 |
Massachusetts | 4 | 67.4 | 3 | 46 | 5 |
Minnesota | 5 | 67.0 | 11 | 35 | 6 |
New Hampshire | 6 | 66.9 | 9 | 30 | 11 |
Colorado | 7 | 66.8 | 8 | 3 | 33 |
Vermont | 8 | 66.6 | 2 | 49 | 13 |
Connecticut | 9 | 64.5 | 6 | 44 | 16 |
New Jersey | 10 | 63.6 | 5 | 41 | 31 |
California | 11 | 63.5 | 4 | 22 | 43 |
Washington | 12 | 62.7 | 12 | 11 | 41 |
Virginia | 13 | 62.5 | 22 | 2 | 26 |
Utah | 14 | 61.5 | 14 | 1 | 39 |
Wisconsin | 15 | 61.3 | 16 | 37 | 10 |
Illinois | 16 | 60.9 | 18 | 25 | 21 |
Nebraska | 17 | 60.4 | 17 | 34 | 18 |
North Dakota | 18 | 60.4 | 19 | 33 | 12 |
Oregon | 19 | 59.9 | 13 | 27 | 34 |
Maryland | 20 | 57.8 | 23 | 15 | 35 |
Delaware | 21 | 57.6 | 21 | 29 | 29 |
Idaho | 22 | 57.4 | 20 | 9 | 42 |
Pennsylvania | 23 | 57.3 | 25 | 43 | 8 |
Michigan | 24 | 57.3 | 35 | 19 | 9 |
Kansas | 25 | 57.0 | 32 | 23 | 15 |
New York | 26 | 55.9 | 7 | 50 | 17 |
Maine | 27 | 55.4 | 26 | 42 | 24 |
Wyoming | 28 | 53.5 | 30 | 12 | 44 |
Montana | 29 | 53.3 | 24 | 39 | 37 |
Florida | 30 | 52.6 | 29 | 28 | 40 |
Ohio | 31 | 52.4 | 42 | 31 | 4 |
South Carolina | 32 | 52.4 | 40 | 6 | 32 |
Indiana | 33 | 51.8 | 41 | 24 | 19 |
Missouri | 34 | 51.0 | 37 | 36 | 27 |
Nevada | 35 | 50.5 | 28 | 8 | 50 |
North Carolina | 36 | 50.2 | 38 | 20 | 36 |
Georgia | 37 | 50.1 | 36 | 5 | 45 |
South Dakota | 38 | 50.1 | 34 | 47 | 23 |
Texas | 39 | 49.9 | 31 | 7 | 49 |
Arizona | 40 | 49.9 | 27 | 32 | 46 |
Alabama | 41 | 48.0 | 45 | 10 | 22 |
Kentucky | 42 | 47.4 | 47 | 21 | 7 |
Arkansas | 43 | 46.6 | 46 | 16 | 20 |
Tennessee | 44 | 45.6 | 43 | 38 | 25 |
New Mexico | 45 | 45.2 | 39 | 17 | 48 |
Oklahoma | 46 | 44.6 | 44 | 14 | 38 |
Louisiana | 47 | 44.4 | 48 | 26 | 14 |
Alaska | 48 | 44.2 | 33 | 45 | 47 |
Mississippi | 49 | 42.1 | 49 | 4 | 28 |
West Virginia | 50 | 35.4 | 50 | 48 | 3 |
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 six 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
About Deb Gordon
Deb Gordon is the co-founder and CEO of Umbra Health Advocacy, and 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 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.
sources
- Dartmouth Atlas Project. "The Dartmouth Atlas of Health Care." Accessed June 29, 2022.
- JAMA Network Open. "Quantification of Neighborhood-Level Social Determinants of Health in the Continental United States." Accessed June 29, 2022.
