Posted by: Richie Bernardo

According to the CDC, 88.1 percent of the population has a regular place to go for medical care. But the cost and service quality of that care can vary widely from state to state. The overall health of the population, more advanced medical equipment and a general lack of awareness regarding the best types of treatment, for instance, can all affect costs. Today, the average American spends more than $10,000 per year on personal health care, according to the most recent estimates from the Centers for Medicare & Medicaid Services. That’s about 17.9 percent of the U.S. GDP.

But higher costs don’t necessarily translate to better results. According to a study by the Kaiser Family Foundation, the U.S. lags behind several other wealthy nations on several measures, such as health coverage, life expectancy and disease burden, which measures longevity and quality of life. However, the U.S. has improved in giving more healthcare access for people in worse health, and healthcare cost growth has slowed somewhat.

Conditions aren’t uniform across the U.S., though. To determine where Americans receive the best and worst health care, WalletHub compared the 50 states and the District of Columbia across 40 measures of cost, accessibility and outcome. Read on for our findings, expert insight on the future of American health care and a full description of our methodology.

1. Main Findings
2. Ask the Experts
3. Methodology
4. Resources

Main Findings

Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/23457/geochart-healthcare-access.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="https://ift.tt/2LYP4DC>  

States with Best Health Care Systems

Overall Rank (1 = Best)	State	Total Score	‘Cost’ Rank	‘Access’ Rank	‘Outcomes’ Rank
1	Vermont	66.31	3	23	1
2	Massachusetts	65.31	31	2	2
3	New Hampshire	64.03	24	4	4
4	Minnesota	63.35	11	8	8
5	Hawaii	63.08	5	35	5
6	Rhode Island	62.98	4	24	10
7	Colorado	62.69	23	15	3
8	District of Columbia	62.08	1	6	36
9	Iowa	61.94	6	19	14
10	Maryland	61.86	2	28	28
11	Connecticut	61.79	33	7	7
12	Maine	61.26	35	1	15
13	Kansas	60.20	10	9	21
14	South Dakota	59.52	34	3	16
15	Utah	59.48	25	34	6
16	Nebraska	59.35	27	14	12
17	New York	58.68	13	11	24
18	Pennsylvania	58.34	16	10	29
19	Ohio	58.18	7	18	34
20	Michigan	57.98	8	17	33
21	North Dakota	57.78	15	12	32
22	Virginia	56.93	21	29	17
23	Wisconsin	56.90	47	13	9
24	Illinois	56.79	20	16	31
25	Delaware	56.52	9	38	25
26	New Jersey	55.77	12	41	23
27	Oregon	54.47	28	40	18
28	Washington	54.29	38	42	11
29	California	54.15	17	45	19
30	New Mexico	53.52	19	27	37
31	Idaho	53.19	36	48	13
32	Montana	52.76	43	21	26
33	Wyoming	52.29	46	25	20
34	Kentucky	52.12	14	20	45
35	Indiana	52.02	18	36	40
36	Arizona	50.62	40	43	27
37	Missouri	49.92	29	22	43
38	Texas	49.00	26	51	35
39	West Virginia	48.37	45	5	47
40	Nevada	48.16	32	49	38
41	Tennessee	47.79	22	30	48
42	Florida	47.04	39	47	39
43	Georgia	46.51	30	50	42
44	South Carolina	46.14	49	32	41
45	Oklahoma	45.59	41	33	46
46	Alabama	44.03	44	44	44
47	North Carolina	43.98	50	46	30
48	Arkansas	43.22	37	31	50
49	Alaska	41.78	51	37	22
50	Mississippi	41.53	42	26	51
51	Louisiana	41.14	48	39	49

 

Ask the Experts

As Americans anticipate changes to their health care in both the short and long terms, we asked a panel of experts to weigh in with their thoughts on the following key questions:

1. Major insurers, including Blue Cross, Aetna and Humana, have pulled out of many state-run insurance exchanges, leaving residents of some counties with few, if any, options for coverage. What effects will this have for the market in the future?
2. How has the recently enacted health-care reform reshaped state health care systems? How has it impacted businesses and the provision of employer-sponsored plans?
3. What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?
4. What are the most important steps Americans can take to minimize health-related expenditures?
5. What are the most important metrics for evaluating state health care systems?

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• Angela Snyder Research Associate Professor, Department of Public Management & Policy, Director, Health Policy and Financing, Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University
• Arthur M. Mora Ph.D., Clinical Associate Professor and MHA Program Director, Tulane University School of Public Health and Tropical Medicine, Global Health Management and Policy
• Robert D. Lieberthal Ph.D., Assistant Professor, Department of Public Health, University of Tennessee Knoxville
• Richard C. Boothman Executive Director of Clinical Safety, UMHS, Chief Risk Officer, Michigan Medicine & an Adjunct Assistant Professor at University of Michigan Medical School, Department of Surgery
• Amol S. Navathe Assistant Professor of Medical Ethics and Health Policy, University of Pennsylvania
• Keith J. Mueller Gerhard Hartman Professor and Head, Department of Health Management and Policy, University of Iowa

Angela Snyder Research Associate Professor, Department of Public Management & Policy, Director, Health Policy and Financing, Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University

Major insurers including Blue Cross, Aetna and Humana have pulled out many state-run insurance exchanges, leaving residents of some counties with few, if any, options for coverage. What effects will this have for the market in the future?

Healthcare markets are local and depend on an adequate number of consumers and providers to make insurance markets viable. Insurers exiting markets is concerning, but the future of these markets depends on a combination of issues currently being addressed by policy-makers trying to stabilize these markets given the diversity of local contexts.

How has the recently enacted health-care reform reshaped state health care systems? How has it impacted businesses and the provision of employer-sponsored plans?

Health-care reform has pushed integration of public and private health care systems within states. All states have moved to a more coordinated system enabling consumers to find and enroll in health coverage. Additional delivery system integration is also occurring in Medicaid-expansion states. It has always been true that temporary workers or low wage workers, especially at small firms, are the least likely to have employer sponsored insurance. To the extent that such workers now have access to Medicaid in expansion states or market place plans in all states, this can improve the health status of these workers which benefits employers, especially those who don’t offer insurance. Some of the provisions in the ACA create incentives for firms to hire more contract and part time labor to avoid potential penalties for not offering coverage that are tied to firm size and apply only for full time workers. The SHOP exchanges can reduce the search costs for small employers who want to offer coverage for their employees. Over the long run, this should improve the efficiency of the small group market although I haven’t seen evidence about this yet. Many of the provisions in the ACA involve payment reform for the Medicare system. Payment reforms such as a greater emphasis on payments tied to quality and a focus on coordinated care are pushing the provider market to higher levels of integration and quality….which is helpful for all types of patients.

What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?

I’m not sure this is a tip to find the right balance between premiums and level of coverage, but I would remind individuals that they have more information about their own health needs over the next year than anyone else, so they should exploit this advantage when determining how much they are willing to pay for coverage given their budget constraints. I believe the Healthcare.gov website has an option to compare plans where you input your health conditions and it will help the consumer weigh the tradeoffs between higher premiums or higher cost sharing.

What are the most important steps Americans can take to minimize health-related expenditures?

Chronic diseases are huge cost drivers and many of them result from poor lifestyle choices, so all of the positive behaviors we already know about including healthy eating, moderate exercise, regular health check-ups, adequate sleep, and managing stress can go a long way in minimizing long-term health-related expenditures.

What are the most important metrics for evaluating state healthcare systems?

The metrics for evaluating state healthcare systems depend on your policy goals and how you choose to balance access to care, cost, and quality, but I would imagine metrics in each of these areas.

Arthur M. Mora Ph.D., Clinical Associate Professor and MHA Program Director, Tulane University School of Public Health and Tropical Medicine, Global Health Management and Policy

Major insurers including Blue Cross, Aetna and Humana have pulled out many state-run insurance exchanges, leaving residents of some counties with few, if any, options for coverage. What effects will this have for the market in the future?

The worst-case scenario feared by many, one in which a population was left without a health insurer participating in their county, was avoided. Each county in 2018 has at least one insurer participating in the exchange. But for the 26% of exchange enrollees living in an area that has only one participating insurer, this effectively results in no alternative “options”. Restricted choice is true elsewhere too. According to annual analyses of insurer participation in state exchanges conducted by Henry J. Kaiser Family Foundation, the average number of insurers in a state has fallen from 5 in 2014 to 3.5 in 2018. This has coincided with continued increases in premiums for many.

From a policy perspective, in 2017, the individual mandate was eliminated effectively creating zero penalties for individuals not enrolled in an Affordable Care Act (ACA) qualified plan. Additionally, the current administration signed an executive order aiming to expand the availability of association health plans- “skinny plans”. Unlike ACA qualified plans, association plans can deny coverage for pre-existing conditions, can impose annual or lifetime caps on benefits, and are not required to cover essential health benefits- maternity care, prescription drugs, mental health, substance abuse, or preventive care. These association health plans are likely to cost significantly less than ACA qualified plans, but at the risk of leaving many underinsured.

Therefore, the association plans will be most attractive to a younger, healthier population. This leaves a potentially older, sicker and more costly population covered by ACA qualified plans. In response, insurers participating in the state exchange will increase premiums in response resulting in another wave of “healthy” individuals to seek the less costly association plans- the so-called death spiral.

What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?

It is probably most important to think about each plan’s deductible - the amount that a beneficiary must spend before the insurer begins sharing in the expense. A recent phenomenon has been the proliferation of high deductible plans. It is quite common to find health plans that include $10,000 deductibles. While these plans may have lower monthly premiums, a beneficiary is required to pay fully out of pocket for health care expenditures (except those specifically excluded such as well visits) up to the deductible amount before the health plan starts contributing. While the monthly premium is important to consider, a medical condition or injury that results in an individual paying $10, 000 out of pocket before realizing any insurance benefits could be financially devastating.

As always, however, reflecting on your projected healthcare utilization is critical. If you anticipate upcoming healthcare utilization for a chronic disease or a likely procedure or a potential pregnancy, paying a higher monthly premium that is associated with a lower deductible may make sense.

What are the most important steps Americans can take to minimize health-related expenditures?

The best way to minimize healthcare expenditures is to fully avail oneself of the many recommended preventive services such as screenings, immunizations, and medicinal treatments offered with no out of pocket cost to the beneficiary. If you have such a plan, having a personal physician or other provider that is aligning your care with the recommended care for you is important to keeping you healthy. Furthermore, if medical issues are detected early, treatment plans could be more effective and less costly.

What are the most important metrics for evaluating state healthcare systems?

At some point, most of us will require medical care. Mortality rates, indicators of effective prenatal care, monitoring and reporting the percentage of the population with health insurance, readmission rates for hospitals, infection rates in intensive care units, the percentage of patients with chronic conditions receiving appropriate follow up care and recommended screenings, and so many others are all extremely important.

The challenge, however, is that medical care often intervenes at the point when an individual or a population is already sick. Medical care may be limited to simply abating the effects of disease. To effectively improve health, strategies that address social determinants of health such as poverty, education, institutional racism, access to nutritious foods, and others will have a greater impact than medical care on overall population health. The influences of these social determinants on health shared within communities, however, vary greatly between communities, even from one city block to the next. As many experts will tell you, your zip code is a better predictor of your health than your genetic code. Therefore, when assessing the health of a population, metrics aggregated at the state level are insufficient. Calculating an average ignores the extreme values, particularly the poor outcomes that we should be most concerned about.

Robert D. Lieberthal Ph.D., Assistant Professor, Department of Public Health, University of Tennessee Knoxville

Major insurers including Blue Cross, Aetna and Humana have pulled out many state-run insurance exchanges, leaving residents of some counties with few, if any, options for coverage. What effects will this have for the market in the future?

Many of the companies you mention have offered coverage and then stopped offering coverage in certain areas. Other new entrants have stepped in to fill the gap. Consumers should plan for the continuing need to shop for new health insurance plans, or new insurance companies, every year.

How has the recently enacted health-care reform reshaped state health care systems?

Health-care reform has mainly had the effect of standardizing health insurance markets across states. The federal government has taken more responsibility for health insurance regulation. State health care systems now have more responsibility for deciding how to utilize federal programs in order to suit the needs of their state’s residents.

How has it impacted businesses and the provision of employer-sponsored plans?

Health care reform has made government provided health insurance relatively more important and employer-sponsored plans relatively less important. Employer-sponsored plans still provide insurance for a significant proportion of the US population.

What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?

People should be looking to shop around for health insurance every year. They also should be getting ready to shop around for care because many insurance plans come with high deductibles. Consumers in these plans often can use health savings accounts (HSAs) to save up for care and also reduce the amount they pay in taxes. HSAs also are portable, and do not rely on a specific insurance company.

What are the most important steps Americans can take to minimize health-related expenditures?

Shopping around is key. There is a large variation in price for many health care services. “Smart shoppers” often can obtain lower costs without sacrificing quality.

What are the most important metrics for evaluating state healthcare systems?

Important metrics include whether the state government has applied for the Medicaid expansion offered in the Affordable Care Act (ACA). Other metrics include whether the state has applied for waivers from the federal government to experiment with the delivery of health care and health insurance.

Richard C. Boothman Executive Director of Clinical Safety, UMHS, Chief Risk Officer, Michigan Medicine & an Adjunct Assistant Professor at University of Michigan Medical School, Department of Surgery

I only see what most Americans completely miss: that we all pay for the uninsured and underinsured. No American hospital can refuse to care for patients who have emergencies regardless of their insured status or ability to pay. Our failure to offer coverage for every American in whatever form, (single payer, subsidized insurance) causes most uninsured people to miss any preventative health care or even urgent care, leading to extreme medical emergencies that are far more costly both from a medical cost perspective as well as a social perspective. Little of the cost of what is ultimately the most-expensive medical care actually gets reimbursed, what does get reimbursed comes at the government's (taxpayers') expense, and virtually none of the social costs are ever addressed. The current predicament is stupid financially, corrosive socially, and often-devastating individually. Regardless of political affiliation, we all need to pay attention to this and insist that it gets fixed, because it IS fixable and controllable if we stop playing ridiculous political games. This cycle and human drama plays out every single day in our emergency rooms. The cost to all of us is staggering and unnecessary.

Amol S. Navathe Assistant Professor of Medical Ethics and Health Policy, University of Pennsylvania

Major insurers including Blue Cross, Aetna and Humana have pulled out many state-run insurance exchanges, leaving residents of some counties with few, if any, options for coverage. What effects will this have for the market in the future?

This may de-stabilize the insurance market for individuals who do not receive insurance through their employer. The federal and state governments will need to make changes to exchanges, for example by changes in subsidies, to make participation more attractive, or pursue other options such as providing coverage directly otherwise the uninsurance rate is likely to increase substantially in those states.

How has the recently enacted health-care reform reshaped state health care systems? How has it impacted businesses and the provision of employer-sponsored plans?

Reform of health care delivery has been one of the major, yet perhaps hidden, successes of health reform. Health care organizations and clinicians are now engaged in a major cultural and operational shift where they think about maximizing the value of care outside of just their four walls. The potential here is tremendous and businesses and employers stand to gain a tremendous amount in healthier individuals and reduced health insurance premiums.

What are the most important steps Americans can take to minimize health-related expenditures?

Invest in your basic, preventative care and seek out thoughtful clinicians who can help you take care of any ongoing medical problems.

What are the most important metrics for evaluating state healthcare systems?

Population level metrics like Healthy People 2020 while also considering the relative cost of health insurance compared to other states.

Keith J. Mueller Gerhard Hartman Professor and Head, Department of Health Management and Policy, University of Iowa

Major insurers including Blue Cross, Aetna and Humana have pulled out many state-run insurance exchanges, leaving residents of some counties with few, if any, options for coverage. What effects will this have for the market in the future?

One effect is that in counties with fewer than three plans we expect the premiums to be higher (lack of competition), and perhaps the out-of-pocket cost sharing (deductibles and copayments) to be higher. As long as there is at least one plan offered in the county through the health insurance exchanges, meeting essential health benefit requirements, residents will have access to coverage. For those qualifying for federal subsidies it will continue to be affordable coverage.

How has the recently enacted health-care reform reshaped state health care systems? How has it impacted businesses and the provision of employer-sponsored plans?

If you mean the new policies regarding short term plans and alliance plans we do not know yet how they reshape systems. If you mean reform shaped by the PPACA, not much impact on employer-sponsored plans.

What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?

Be sure to read the details of the health insurance plan before purchasing. What may seem appealing because of low premiums have little value when driven by injury or illness help with paying for services is needed.

Methodology

In order to determine the best and worst states for health care, WalletHub compared the 50 states and the District of Columbia across three key dimensions: 1) Cost, 2) Access and 3) Outcomes.

We evaluated those dimensions using 40 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the best health care at the most reasonable cost.

Finally, we determined each state and the District’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

Cost – Total Points: 33.33

• Cost of Medical Visit: Full Weight (~6.67 Points)
• Cost of Dental Visit: Full Weight (~6.67 Points)
• Average Monthly Insurance Premium: Full Weight (~6.67 Points)
• Share of High Out-of-Pocket Medical Spending: Full Weight (~6.67 Points)Note: This metric measures the percentage of the population aged 64 and younger with high out-of-pocket medical spending relative to their annual income.
• Share of Adults with No Doctor Visits Due to Cost: Full Weight (~6.67 Points)

Access – Total Points: 33.33

• Quality of Public Hospital System: Full Weight (~1.59 Points)Note: This metric is based on the Centers for Medicare & Medicaid Services’ ranking of public hospital systems.
• Hospital Beds per Capita: Full Weight (~1.59 Points)
• Average Response Time from EMS Notification to EMS Arrival (minutes): Full Weight (~1.59 Points)
• Average Emergency-Room Wait Time: Full Weight (~1.59 Points)
• Transfer Time (Additional Time Spent Waiting Before Being Taken to Room): Full Weight (~1.59 Points)
• Physicians per Capita: Full Weight (~1.59 Points)
• Geriatricians per Population Aged 65 & Older: Full Weight (~1.59 Points)
• Nurse Practitioners per Capita: Full Weight (~1.59 Points)
• Physician Assistants per Capita: Full Weight (~1.59 Points)
• EMTs & Paramedics per Capita: Full Weight (~1.59 Points)Note: “EMTs” refer to emergency medical technicians.
• Urgent-Care Centers per Capita: Full Weight (~1.59 Points)Note: “Urgent-Care Centers” include those certified by the Urgent Care Association of America (UCAOA).
• Retail Clinics per Capita: Full Weight (~1.59 Points)
• Dentists per Capita: Full Weight (~1.59 Points)
• Share of Medical Residents Retained: Full Weight (~1.59 Points)
• Medicare Acceptance Rate Among Physicians: Full Weight (~1.59 Points)
• Medicaid Acceptance Rate Among Physicians: Full Weight (~1.59 Points)
• Share of Insured Adults: Full Weight (~1.59 Points)Note: “Adults” include the population aged 18 to 64.
• Share of Insured Children: Full Weight (~1.59 Points)Note: “Children” include the population aged 0 to 17.
• Share of Adults with No Personal Doctor: Full Weight (~1.59 Points)
• Presence of Telehealth: Full Weight (~1.59 Points)Note: “Telehealth,” as defined by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, is the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
• Patient Encounters in Community Health Centers per Capita: Full Weight (~1.59 Points)Note: “Community Health Centers” refer to Federally Qualified Health Centers (FQHCs), which the U.S. Department of Health and Human Services defines as “all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits.”

Outcomes – Total Points: 33.33

• Infant Mortality Rate: Full Weight (~2.22 Points)
• Child Mortality Rate: Full Weight (~2.22 Points)
• Maternal Mortality Rate: Full Weight (~2.22 Points)
• Share of Patients Readmitted to Hospitals: Full Weight (~2.22 Points)Note: This metric measures the percentage of patients readmitted within 30 days following discharge from a hospital.
• Share of Hospitalized Patients Discharged Without Instructions for Home Recovery: Full Weight (~2.22 Points)
• Share of Hospital Patients Who Did Not Receive Patient-Centered Care: Full Weight (~2.22 Points)
• Life Expectancy: Double Weight (~4.44 Points)
• Cancer Rate: Full Weight (~2.22 Points)
• Heart Disease Rate: Full Weight (~2.22 Points)
• Share of Adults with Type 2 Diabetes: Full Weight (~2.22 Points)
• Share of At-Risk Adults with No Routine Doctor Visit in Past Two Years: Full Weight (~2.22 Points)
• Share of Adults with No Dental Visit in Past Year: Full Weight (~2.22 Points)
• Share of Children with Medical & Dental Preventive-Care Visits in Past Year: Full Weight (~2.22 Points)Note: “Children” include the population aged 0 to 17.
• Share of Non-Immunized Children: Full Weight (~2.22 Points)Note: “Children” include the population aged 19 to 35 months.

Resources:

• Summary video with V/O
• Summary video without V/O

Sources: Data used to create this ranking were collected from the U.S. Census Bureau, Bureau of Labor Statistics, Council for Community and Economic Research, The Commonwealth Fund, Institute for Health Metrics and Evaluation, Trust for America's Health and Robert Wood Johnson Foundation, United Health Foundation, Centers for Medicare & Medicaid Services, Health Resources & Services Administration, ProPublica, Association of American Medical Colleges, Centers for Disease Control and Prevention, American Telemedicine Association, Urgent Care Association of America, Convenient Care Association, Kaiser Family Foundation, Trustees of Dartmouth College, American Geriatrics Society and National Highway Traffic Safety Administration.

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