States With the Best Healthcare Systems Based on Access, Outcomes, and Cost

Access to healthcare is improving in the United States with more people covered under the Affordable Care Act. However, the drop in the rate of uninsured in America has focused attention on another issue: how greatly cost and quality vary across the country.

Donald M. Berwick, MD, MPP, president emeritus and senior fellow at the Institute for Healthcare Improvement, and guest editor of The American Journal of Managed Care’s supplement on the Aligning Forces for Quality initiative, recently discussed how even though America spends more on healthcare than other developed nations, we aren’t getting better results.

“In fact, we're ranked pretty low in outcomes and longevity in the satisfaction of our public with its healthcare,” he said. “So we're spending too much in America, I'm pretty convinced.”

WalletHub recently analyzed the impact of the America’s geography on healthcare quality and costs and ranked the states based on which had the best state healthcare systems. The analysis compared the 50 states and the District of Columbia across 3 dimensions: healthcare costs, access, and outcomes. The 3 metrics were all weighted equally and graded on a 100-point scale, with 100 representing the best healthcare.

Here are the states with the best healthcare.

10. Nebraska

Score: 60.95

Nebraska slipped into the top 10 because it ranks highly for access to care (number 5 in the country). Older patients will appreciate knowing that the state has the fourth highest acceptance rate of Medicare.

However, other than access to care, Nebraska fell just slightly better than average on healthcare costs (20) and health outcomes (21).

9. District of Columbia

Score: 61.56

The District of Columbia’s high rank is proof that statistics and numbers sometimes don’t tell the full story. While the nation’s capital ranked second for healthcare costs, and first for access, it was among the worst for health outcomes (ranked 42).

The District of Columbia has the most hospital beds per capita and the most physicians per capita. It also has some of the best coverage rates with the second-highest percentages of adults between the ages of 18 and 64 and children between the ages of 0 and 17 who have health insurance. It was second only to Massachusetts in both categories. However, after age 64, being covered may not be of any help: the District of Columbia has the second-lowest rate of physicians who accept Medicare.

8. Vermont

Score: 62.44

Cost of healthcare in Vermont isn’t anything to brag about: the state ranked 25th in the country. However, it was 13th for access and fifth for outcomes, despite falling in the bottom 5 for fewest hospital beds per capita.

The state also had one of the lowest rates of heart disease, but had one of the highest percentages of its at-risk adults not having a routine doctor visit in the past 2 years. Resident did better when it came to their teeth, though: Vermont tied for fourth for having a low percentage of adults without a dental visit in the past year.

7. Hawaii

Score: 62.71

Hawaii has the worst access to healthcare in the entire country, but people who can get access aren’t disappointed: Hawaii has ranked first for health outcomes. Despite having such poor access to care, the state’s costs are on the low end, ranking 15th in the country.

Like the District of Columbia, Medicare patients may have trouble getting seen as Hawaii has the lowest physician acceptance rate for Medicare.

6. Kansas

Score: 63.16

Healthcare costs got Kansas into the top 10. It ranked third overall for healthcare costs, and it has the third lowest average monthly insurance premium. However, it ranked 14th for access to healthcare, and was just better than average for health outcomes (ranked 23).

The state didn’t fall into the top or bottom for any of the health categories that WalletPop analyzed.

5. Utah

Score: 63.85

Despite being in the bottom half of the ranking for access to healthcare (ranked 32), Utah did well in the other 2 rankings: 8th for healthcare costs and 6th health outcomes.

Utah can claim that it has the fourth lowest cancer rate and the fourth lowest heart disease rate. No other state in the top 10 ranked among the top 5 for lowest cancer rate and lowest heart disease rate.

However, access is a big issue. The state ranked in the bottom for the fewest beds per capita, and had one of the highest percentage of at-risk adults not having a routine doctor visit in past 2 years.

4. Iowa

Score: 63.89

Access to care is an issue for Iowans. The state ranked 24th for the healthcare access ranking. However, beyond that, Iowa came in at 11 for health outcomes, and has one of the lowest healthcare costs in the country (ranked 5).

3. South Dakota

Score: 63.98

Access to care is the greatest thing going for South Dakota. It has one of the lowest percentages of at-risk adults going without a routine doctor visit in the past 2 years. In addition, it has one of the highest rates of physicians accepting Medicare. In addition, the state ranked in the top 5 for most dentists and most hospital beds per capita.

As for healthcare costs, South Dakota ranked 18th and it ranked slightly better (13) for health outcomes.

2. Maryland

Score: 64.36

Although it ranked below average for health outcomes (29), Maryland ranked first for healthcare costs. In addition, the state was ranked as having among the most physicians per capita. However, it only ranked 19th for healthcare access.

1. Minnesota

Score: 67.37

There is a reason why Minnesota came in first (and by a decent margin, based on scores). The state has one of the lowest rates of heart disease and one of the lowest percentages of adults going without a dental visit in the past year. For healthcare outcomes, Minnesota ranked 3rd.

In addition, the state has one of the lowest average monthly insurance premiums and ranked 11th for healthcare costs. Finally, it landed at number 6 for access to healthcare with one of the highest rates of physicians who accept Medicare and one of the highest percentages of adults between the ages of 18 and 64 being insured.