Methodology

For the report, researchers evaluated all 50 states and the District of Columbia across seven broad dimensions, including:

• Access and affordability
• Prevention and treatment
• Potentially avoidable hospital use and cost
• Healthy lives
• Reproductive care and women's health (new)
•  Income disparity
• Racial and health equity

Data for the report was collected from publicly available data sources, including government-sponsored surveys, registries, quality indicators, vital statistics, mortality data, and administrative data bases. The most currently available data was used when possible, with most data taken from 2021.

The best and worst states for health system performance

According to the report, Massachusetts achieved the best overall score for its health system performance, consistently ranking among the top states across all seven evaluated dimensions. Rounding out the top five were Hawaii, New Hampshire, Rhode Island, and Vermont.

In comparison, the worst ranking state for overall health system performance was Mississippi. The other states in the bottom five include Arkansas, Texas, Oklahoma, and West Virginia. 

Researchers also ranked the states in more specific areas, including:

Health outcomes and healthy behaviors

Overall, Hawaii and Massachusetts tied for the best state for health outcomes and healthy behaviors. In comparison, New Mexico, Arkansas, Kentucky, Mississippi, and West Virginia were all in the bottom five states. According to the report, these states all had premature mortality rates that were significantly higher than average.

Since 2020, the United States has seen a sharp increase in avoidable, premature deaths, largely due to the COVID-19 pandemic. Although all states experienced a large jump in avoidable deaths from 2019 and 2021, Arizona, Louisiana, Mississippi, New Mexico, and Texas had the most substantial increases. Each of these states experienced an over 35% increase in avoidable mortality rates during this time.

Healthcare access and affordability

The top five states for healthcare access and affordability are Massachusetts, Hawaii, Rhode Island, New Hampshire, and the District of Columbia. In addition, Massachusetts had the lowest rate of uninsured adults in the United States at 3.4%.

On the other end, Mississippi, Georgia, Wyoming, Oklahoma, and Texas were the bottom five states in this category. As of 2021, none of these states had expanded Medicaid eligibility under the Affordable Care Act. Texas also had the highest rate of uninsured adults in the United States in 2021 at 24.3%.

How the US can improve its healthcare system

To address health challenges and improve health outcomes for all Americans, the Commonwealth Fund made several recommendations for state and federal legislators and agencies, including:

For avoidable mortality and behavioral health

• Expanding the primary care workforce
• Integrating primary care and behavioral health
• Increasing behavioral health treatments for children and adolescents
• Increasing access to addiction care
• Expanding comprehensive harm reduction policies
• Creating community-based healthcare workforces that focus on team care

For insurance coverage and affordability of care

• Filling in the gaps of Medicaid coverage
• Permanently extending enhanced marketplace subsidies, which will expire in 2025
• Creating a longer period for continuous Medicaid eligibility
• Creating a way for people to auto-enroll in either Medicaid or subsidized marketplace coverage
• Lowering deductibles and out-of-pocket costs for marketplace plans
• Lowering healthcare cost growth
• Protecting consumers from the financial consequences of medical debt

(Wilson, Becker's Hospital CFO Report, 6/22; Radley et al., Commonwealth Fund, 6/22)

The past few years have been hard for health system strategic planners, and it's not getting any easier. To find out the top challenges and priorities for the coming year, we surveyed 57 leaders at member organizations. Read on to learn the six key findings from our research.