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August 4, 2020

The best (and worst) states for health care, according to WalletHub

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    WalletHub on Monday released its 2020 list of the Best & Worst States for Health Care, ranking Massachusetts as No. 1.

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    For the report, WalletHub used 44 measures to assess every state and the District of Columbia on health care access, cost, and outcomes. WalletHub rated the three categories equally, though some categories included more metrics than others. For example, the:

    • Access category includes metrics on hospital beds per capita, urgent care centers per capita, and average ED wait time;

    • Cost category includes metrics on cost of a medical visit, average monthly insurance premium, and share of adults who did not see the doctor because of affordability issues; and

    • Outcomes category includes metrics on infant mortality rate, share of patients who did not receive patient-centered care, cancer rate, and share of at-risk adults with no routine doctor visit in the last two years.

    The access category also included a new measure this year: states with the best health infrastructure for handling the novel coronavirus. WalletHub pulled states' scores for that measure from its "States with the Best Health Infrastructure for Coronavirus" rankings, which WalletHub released in May. For those rankings, WalletHub evaluated states based on public health emergency preparedness, public hospital system quality, availability of emergency centers and services, public health care spending, and other metrics.

    For WalletHub's Best & Worst States for Health Care rankings, the best health infrastructure for coronavirus measure was weighted three times the weight of the other measures within the access category.

    WalletHub graded each metric on a 100-point scale and calculated a weighted average for each state. Having a higher score represented having better care at a reasonable price, according to WalletHub.


    According to WalletHub, after Massachusetts, which scored 63.47 out of 100, the places with the best health care systems for 2020 were:

    1. Minnesota, which scored 63.11;
    2. Rhode Island, which scored 62.22;
    3. The District of Columbia, which scored 60.72;
    4. North Dakota, which scored 60.70; and
    5. Vermont, which scored 59.49.

    By contrast, the states at the bottom of the rankings were:

    1. Georgia, which scored 43.76;
    2. Louisiana, which scored 43.82;
    3. Alabama, which scored 43.84;
    4. North Carolina, which scored 44.32; and
    5. Mississippi, which scored 44.36.

    WalletHub also ranked states and the District of Columbia individually on the three categories, with:

    • The District of Columbia ranking first for cost and Alaska ranking last;
    • The District of Columbia ranking first for access and Georgia ranking last; and
    • Massachusetts ranking first for outcomes and Mississippi ranking last.

    In addition, WalletHub highlighted the highest- and lowest-performing states on certain metrics. For instance:

    • Average monthly insurance premiums were lowest in Massachusetts and tied for highest in Iowa, Vermont, West Virginia, and Wyoming;
    • The District of Columbia had the most hospital beds per capita, while Utah had the fewest; and
    • The infant mortality rate was lowest in New Hampshire and highest in Mississippi.

    Questions for the experts

    WalletHub spoke with six health care experts and asked them four "key questions" for Americans to consider as they "anticipate changes to their health care in both the short and long terms":

    1. What advice they have for people trying to find the correct balance between insurance premium costs and the level of coverage they receive;

    2. What are the vital things Americans can do to minimize their health-related expenditures;

    3. What are the experts' opinions on Medicare-for-All proposals; and

    4. What steps can local officials take to better support hospitals and providers amid America's coronavirus epidemic.

    On minimizing health-related expenditures, many of the experts who spoke with WalletHub emphasized the importance of preventive care and living healthy.

    Diane Howard, an associate professor in the department of health systems management at Rush University, said, "Americans have to take responsibility for our health to control health-related expenditures, particularly health that is in each individual's control. These are things everyone knows—eat correctly, exercise, limit stress, get regular check-ups, and know your health care numbers (cholesterol, blood pressure, weight)."

    John Huppertz, associate professor and director of health care management at Clarkson University's Reh School of Business, said in addition to focusing on healthy behaviors, consumers should "learn how to access the most appropriate level of care for the problem they have." For example, Huppertz said, people shouldn't "go to the [ED] for something that can be treated by [their] primary care provider or at urgent care." He noted that "a high percentage of cases seen in the [ED] could be handled in less acute settings."

    When it comes to finding the right balance between health insurance premium costs and coverage levels, Naomi Zewde, an assistant professor at City University of New York's School of Public Health, said, "It is not the ideal trade-off for anyone to make." She explained, "The narrower network might be the least-bad trade-off, though. If you can minimize your deductible and co[payments], which means you won't be deterred from seeking care when you end up needing it and maintain an affordable monthly premium, the least bad trade-off might be to only have a limited number of doctors and hospitals that accept your insurance."

    On Medicare-for-All proposals, which largely would transition the country to a single-payer health system, the experts largely were split over whether they supported such proposals, though many highlighted some of the complexities that could make it difficult for such a system to succeed in the United States.

    And when it comes to what local officials can do to better support hospitals and providers through the coronavirus epidemic, Atul Gupta, assistant professor of health care management at the University of Pennsylvania's Wharton School, said, implementing measures to curb the virus' spread, such as social distancing requirements; increasing access to coronavirus testing, ensuring quick results, and sharing those results with employers; and "well-executed contact tracing and isolation/quarantining to prevent spread" could help. "I think local authorities are already doing some or all of these things, though some are doing it better than others and unfortunately all are learning on the job," he said (McCann, WalletHub's "2020's Best & Worst States for Health Care," 8/3; McCann, WalletHub's "States with the Best Health Infrastructure for Coronavirus," 5/26).

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