The Best and Worst Healthcare in the US

The Commonwealth Fund conducts an annual assessment on the quality of healthcare available to Americans living in each of the 50 states.

The metrics on which the report is based are the following:

  • Access and Affordability (8 indicators): includes rates of insurance coverage for children and adults, as well as individuals’ out-of-pocket expenses for health insurance and medical care, cost-related barriers to receiving care, rates of medical debt, and receipt of dental visits.
  • Prevention and Treatment (14 indicators): includes measures of receipt of preventive care and needed mental health care, as well as measures of quality in ambulatory, hospital, postacute, and long-term care settings.
  • Avoidable Hospital Use and Cost (14 indicators; including several measures reported separately for distinct age groups): includes indicators of hospital and emergency department use that might be reduced with timely and effective care and follow-up care, estimates of per-person spending among Medicare beneficiaries and working-age adults with employer-sponsored insurance, and the share of Medicare and employer-sponsored insurance spending directed toward primary care.
  • Healthy Lives (13 indicators): includes measures of premature death, health status, health risk behaviors and factors (including smoking and obesity), tooth loss, and state public health funding.
  • COVID-19 (7 indicators): includes measures to reflect state progress in vaccinating residents, COVID-related hospitalization rates and health system stress, and COVID-related mortality through the end of March 2022.(1)

The Covid-related measures are new in this latest report.

In this context, let’s start with the negative — which states did the worst in providing healthcare to residents? This list may surprise a few, but not many:

  1. (Worst) Mississippi
  2. Oklahoma
  3. West Virginia
  4. Texas
  5. Missouri
  6. Alabama
  7. Georgia
  8. Arkansas

Texas boasted of the highest consistent occupancy rate of ICU beds during the pandemic — the longest string of days with occupancy exceeding 80%.

Which states did the best?

  1. Hawaii
  2. Massachusetts
  3. Connecticut
  4. Washington State
  5. Vermont
  6. Rhode Island
  7. Maryland
  8. New Hampshire

There’s a strong case to be made that if you care about healthcare and climate change, you want to consider seriously a move to New England. Every New England state except Maine is in the top list, and Maine isn’t too far behind.

Conversely, the South Central states come across like a healthcare mess. One could hypothesize that the noise about abortion rights in these states is to distract voters from the failures of their elected officials. For a wealthy industrial state like Texas to do this poorly — well, there are no excuses.




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