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Louise Chang, MD
June 13, 2007 -- Hawaii leads and Oklahoma lags on a new state scorecard
about health system performance.
The scorecard is the first of its kind from the Commonwealth Fund, a private
foundation focused on health care.
The Commonwealth Fund rated states based on 32 indicators, including access,
quality, cost, insurance, preventive care, potentially avoidable hospital
visits, and premature death (death before age 75).
The top five states in order are Hawaii, Iowa, New Hampshire, Vermont, and
The bottom five states are Nevada, Arkansas, Texas, Mississippi, and
A full list of state rankings follows later in this article.
The top-rated states scored two to three times higher than the lowest-ranked
"Where you live really matters in terms of your experience with the
American health care system," Commonwealth Fund President Karen Davis told
reporters at a news conference.
"The wide variation and gaps between leading and lagging states add up
to substantial human and economic cost for the nation," says Cathy Schoen,
the Commonwealth Fund's senior vice president for research and evaluation.
Schoen says that if all states equaled the top-rated states, there would be
90,000 fewer premature deaths before age 75 from conditions such as diabetes,
infection, respiratory disease, and treatable cancers. In addition, 22 million
more adults and children would be insured, cutting U.S. uninsured rates in
Every state has room for improvement -- even those leading the scorecard --
notes Schoen, who worked on the scorecard with other experts.
"Each of the top states has some indicators in the bottom half of the
state distribution," Schoen says. In other words, though those states may
rank highly overall, they're not acing every category in the scorecard.
Insurance tracked with the states' ratings.
"In general, states that did well in the overall rankings had the lowest
rates of uninsured in the nation, and states that did poorly had the highest
rates of uninsured in the nation," Schoen says.
But high ratings didn't always mean high costs.
"Indeed, some states have high quality and lower cost," Schoen says.
She adds that "high costs tend to track higher rates of potentially
preventable hospital use and 30-day re-admission rates, indicating a need for a
focus on prevention and primary care and care coordination."
Here is the list of how the states and Washington, D.C., ranked overall.
States with the same ranking are listed together.
SOURCES: The Commonwealth Fund Commission on a High-Performance Health
System: "Aiming Higher: Results from a State Scorecard on Health System
Performance," June 2007. Karen Davis, president, The Commonwealth Fund.
Cathy Schoen, senior vice president for research and evaluation, The
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