WalletHub on Monday released its 2021 list of the "Best & Worst States for Health Care," ranking Massachusetts as No. 1.

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Methodology

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

• The cost category includes metrics on the cost of a medical visit, average monthly insurance premium, and share of adults who did not see the doctor because of affordability issues.
• The access category includes metrics on hospital beds per capita, urgent care centers per capita, adoption of telehealth services, and average ED wait time.
• The outcomes category includes metrics on infant mortality rate, share of patients who did not receive patient-centered care, cancer incidence rate, and share of at-risk adults with no routine doctor visit in the last two years.

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The access category also included three Covid-19 specific measures: each state's percentage of eligible residents vaccinated, Covid-19 death rate in the past week per capita, and positive Covid-19 tests in the past week per capita. According to WalletHub, each of those three measures was weighted twice as heavily as the other measures in 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.

Findings

According to WalletHub, after Massachusetts, which scored 67.73 out of 100, the states with the best health care systems for 2021 were:

1. Rhode Island, which scored 67.08;
2. Minnesota, which scored 66.39;
3. Hawaii, which scored 64.90;
4. Maryland, which scored 64.68, and;
5. Vermont, which scored 63.22.

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

1. Alabama, which scored 41.46;
2. Louisiana, which scored 44.64;
3. Arkansas, which scored 44.89;
4. Mississippi, which scored 45.50, and;
5. North Carolina, which scored 47.09.

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

• Maryland ranking first for cost and Alaska ranking last;
• Massachusetts ranking first for access and Wyoming ranking last; and
• Massachusetts ranking first for outcomes and Mississippi ranking last.

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

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

Questions for the experts

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

For example, when asked what Americans can do to minimize health-related expenditures, experts recommended minimizing risky behaviors (such as smoking) and investing in preventive health measures.

Ingrid Nembhard, associate professor of health care management at the University of Pennsylvania, told WalletHub, "That means doing any and everything possible to stay healthy. Yes, that means you must eat healthy and exercise." She also strongly recommended getting the Covid-19 vaccine.

And when asked what local officials can do to better support hospitals and providers through the coronavirus epidemic, the experts consulted by WalletHub said local authorities can support providers' decisions on Covid-19 safety and encourage vaccination.

"Local authorities should ensure disaster and disease outbreak plans are developed, updated, and rehearsed in case of an outbreak," Stephen Gambescia, a professor at Drexel University, said. "Such plans need to be made clear to the various levels of public authorities, i.e. local, county, state, and federal."

Angela Mattie, a professor at Quinnipiac University, echoed these remarks, citing her own experiences seeing home state of Connecticut build field hospitals and mobile vaccination clinics. "When there is a public health emergency[,] collaboration between the government and health care providers is vital to minimizing the impact of the disease," she said.

More broadly, when asked about the key issues facing health care in 2021, the featured experts touched on a range of topics—aside from continuing Covid-19 challenges—including hospital price transparency, controlling drug costs, increasing consumer medical costs, implementation of the No Surprises Act, patient safety, and population health. (McCann, "2021's Best & Worst States for Health Care," WalletHub, 8/2)