And The Best State For Health Care Is ...

Hawaii leads and Oklahoma lags on a new state scorecard about health system performance.

The scorecard is the first of its kind from the Commonwealth Fund, a private foundation focused on health care.

The Commonwealth Fund rated states based on 32 indicators, including access,
quality, cost, insurance, preventive care, potentially avoidable hospital visits, and premature death (death before age 75).

The top five states in order are Hawaii, Iowa, New Hampshire, Vermont, and Maine.

The bottom five states are Nevada, Arkansas, Texas, Mississippi, and Oklahoma.

Wide Range

The top-rated states scored two to three times higher than the lowest-ranked
states.

"Where you live really matters in terms of your experience with the American health care system," Commonwealth Fund President Karen Davis told
reporters at a news conference.

"The wide variation and gaps between leading and lagging states add up
to substantial human and economic cost for the nation," says Cathy Schoen,
the Commonwealth Fund's senior vice president for research and evaluation.

Schoen says that if all states equaled the top-rated states, there would be 90,000 fewer premature deaths before age 75 from conditions such as diabetes, infection, respiratory disease, and treatable cancers. In addition, 22 million more adults and children would be insured, cutting U.S. uninsured rates in half.

Room for Improvement

Every state has room for improvement — even those leading the scorecard —
notes Schoen, who worked on the scorecard with other experts.

"Each of the top states has some indicators in the bottom half of the
state distribution," Schoen says. In other words, though those states may
rank highly overall, they're not acing every category in the scorecard.

Insurance tracked with the states' ratings.

"In general, states that did well in the overall rankings had the lowest
rates of uninsured in the nation, and states that did poorly had the highest
rates of uninsured in the nation," Schoen says.

But high ratings didn't always mean high costs.

"Indeed, some states have high quality and lower cost," Schoen says.
She adds that "high costs tend to track higher rates of potentially
preventable hospital use and 30-day re-admission rates, indicating a need for a focus on prevention and primary care and care coordination."

State Rankings

Here is the list of how the states and Washington, D.C., ranked overall.
States with the same ranking are listed together.

1. Hawaii


2. Iowa


3. New Hampshire, Vermont


4. Maine


5. Rhode Island


6. Connecticut


7. Massachusetts


8. Wisconsin


9. South Dakota


10. Minnesota


11. Nebraska


12. North Dakota


13. Delaware


14. Pennsylvania


15. Michigan


16. Montana, Washington


17. Maryland


18. Kansas


19. Wyoming


20. Colorado, New York


21. Ohio, Utah


22. Alaska, Arizona, New Jersey


23. Virginia


24. Idaho, North Carolina


25. Washington, D.C.


26. South Carolina


27. Oregon


28. New Mexico


29. Illinois


30. Missouri


31. Indiana


32. California


33. Tennessee


34. Alabama


35. Georgia


36. Florida


37. West Virginia


38. Kentucky


39. Louisiana, Nevada


40. Arkansas


41. Texas


42. Mississippi, Oklahoma