CMHC Pulse Blog

Although CDC statistics reveal improvement in health care access, with 87.6% of the American population reporting having a usual place to visit for medical care, the U.S. still lags behind many comparable nations in the state of its health care system. 

According to most recent estimates from the Centers for Medicare and Medicaid Services, the average American spends over $10,000 annually on personal health care, while nearly 5% of the population failed to obtain needed medical care due to high costs.

 Many factors can influence the cost of health care, including population health, medical equipment, education and treatment strategies, however, the high costs of American health care do not necessarily deliver better outcomes. According to a recent Kaiser Family Foundation study, the United States fails to measure up to other wealthy nations in terms of life expectancy, disease burden, health coverage, and many other vital metrics. Perhaps one of the most telling statistics, the U.S. ranking in deaths amenable to health care reveals a rate of 88.7 – the lowest among comparable countries.

 To determine the highest and lowest performing states in health care <> and elucidate areas which need improvement, the personal finance website WalletHub compared 50 states and the District of Columbia across three key values: cost, accessibility, and outcomes. After analyzing 43 relevant metrics and weighing average scores across all measurements, investigators calculated a final overall score for each state, revealing Minnesota as the state with the best health care system and Alaska as the state with the lowest overall score.

 Top 5 States with the Best Health Care Systems

 Each state ranking was determined by a weighted average of scores across all relevant metrics. While the states below may not have the highest rank for each category, the cumulative marks reflect the overall position of their health care system compared to the other states and district. 

  1. Minnesota

Overall Score: 63.79

Cost Rank: 2

Access Rank: 4

Outcomes Rank: 9

According to WalletHub’s findings, Minnesota has the leading health care system in the nation, with an overall score of 63.79 out of a maximum 100 points. It ranked high across all three variables, and placed second in cost with the second lowest average monthly insurance premium.  Minnesota also scored high in accessibility, with the third highest physician Medicare-acceptance rate and fifth highest percentage of insured adults aged 19-65 in the nation.

  1. Massachusetts 62.33

Cost Rank: 35

Access Rank: 2

Outcomes Rank: 1

Massachusetts follows closely behind with an overall score of 62.33. Despite having the lowest average monthly insurance premium, its low cost rank reveals high health care expenditure in the state. With the second highest amount of physicians per capita and fifth highest number of dentists per capita, Massachusetts is the second leading state in accessible health care; it also has the highest percentages of insured adults and children nationwide. In addition, the state has the lowest infant mortality rate among many other vital factors, making it the number one in terms of health outcomes.

  1. Rhode Island 62.12

Cost Rank: 11

Access Rank:5

Outcomes Rank: 6

Third on the list is Rhode Island, with an overall score of 62.12 out of 100 points. With the third lowest average monthly insurance premium, it ranks 11th on the cost list right after Ohio and Indiana. Rhode Island also ranks third in the number of physicians per capita, contributing to its place in the top five most accessible health care systems. Rhode Island has the lowest percentage of at-risk adults with no routine doctor visits in the past two years across the nation.

  1. District of Columbia 61.38

Cost Rank:1

Access Rank:3

Outcomes Rank: 26

With 61.38 points, the District of Columbia ranks fourth on the list despite having the most affordable health care system. Equally high scores in access metrics contribute to its third place in the accessibility ranking. The district has the most physicians and hospital beds per capita, the second most dentists per capita, as well as the second and third highest percentages of insured adults and children, respectively. Despite its success across cost and access measures, the District of Columbia placed 26th in terms of health outcomes, in part due to high infant mortality rates. 

  1. Vermont 60.13

Cost Rank: 5

Access Rank: 34

Outcomes Rank: 4

 With the fifth best health care system in the nation, Vermont scored an overall 60.13 points out of 100. The state qualified for the top five in both cost and outcomes ranking however, its access rank was significantly lower at 34 despite high percentages of insured adults and children statewide.

5 States with the Worst Health Care Systems

According to WalletHub’s calculations, the following states had some of the lowest scores across key metrics and the lowest composite scores out of the 50 states and one district.

  1. Arkansas 43.48

Cost Rank:20

Access Rank: 33

Outcomes Rank: 50


Arkansas ranked 47th out of the 51 territories, with an overall score of 43.48. Despite having the third highest amount of beds per capita, the state ranked 33rd in accessibility and 20th in cost.

Its low position both overall and in terms of health outcomes is in part due to Arkansas having the second highest infant mortality and heart disease rates in the nation.

  1. South Carolina 42.96

Cost Rank: 46

Access Rank: 40

Outcomes Rank: 43

Close to the bottom of the list, South Carolina was ranked 48th out of 51 territories with a composite score of 42.96. Similarly, the state scored low across all three key metrics: 46th in cost, 40th in accessibility, and 43rd in health outcomes rank.

  1. Mississippi 42.76

Cost Rank: 27

Access Rank: 28

Outcomes Rank: 51

 The state with the third lowest performing health care system is Mississippi, with an overall score of 42.76. Ranked 28th on the accessibility list, the state not only has both the fourth lowest number of physicians and dentists per capita, but it also has a low percentage of insured adults. Most notably, Mississippi has the worst health outcomes of all of the territories, including the highest infant mortality rate, the fourth highest heart disease rate, and the second highest percentage of adults without a dental visit in the past year.

  1. North Carolina 42.63

Cost Rank: 50

Access Rank: 50

Outcomes Rank: 33

 Second to last is North Carolina with a total score of 42.63 out of 100. It ranked equally low in cost and accessibility ratings – in 50th place for both – and 33rd in terms of health outcomes.

  1. Alaska 42.21

Cost Rank: 51

Access Rank: 26

Outcomes Rank: 31

 WalletHub reports Alaska as the state with the worst health care system with a total score of 42.21 out of 100. Ranking 51st in terms of cost, Alaska has the nation’s highest health care costs; Alaskan residents may spend up to an additional $3,000 on top of national average expenditure. While the state may have a limited number of providers, it also has the second highest percentage of medical residents retained – which may contribute to its average accessibility score. With the second highest percentage of at-risk adults without a routine doctor visit in the past two years, Alaska comes in 31st place in health outcome rankings.

 Despite some success in improving the accessibility and cost of most state health care systems, the United States still greatly lags behind its equally wealthy and developed counterpart nations. As this recent report reveals, continued efforts are necessary to help bridge the divide between the best and worst state health care systems – and make quality health care accessible to all.

 To view the complete ranking of best and worst states for health care according to WalletHub’s findings and find out how your state stacks up, click here <>.


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