Report: Hawaii Has the Strongest Health System in the U.S. | Best States

Hawaii, Massachusetts and Connecticut are among the states with the best health care systems in the country, according to an annual report released Thursday that also reviewed how each state managed the coronavirus pandemic.

The findings by The Commonwealth Fund, a private foundation that promotes high-performing health care in the U.S., were determined by studying more than 50 health metrics across categories such as access, quality, costs, disparities and outcomes. For the first time, the foundation also scored states on their COVID-19 management, with measures including vaccination rates, hospital capacity and excess mortality rates from the start of the pandemic through March of this year.

Hawaii shined brightest, ranking No. 1 both overall and on the pandemic response-specific list. The state had the lowest excess death rate, at 110 per 100,000 population. It also ranked in the top three of every other category except for one: prevention and treatment.

Massachusetts was a close second on the overall ranking and had the best scores in four categories, such as racial and ethnic equity. There was quite a bit of scoring distance between it and the No. 3-ranked state, Connecticut, according to the foundation.

Unsurprisingly, the Commonwealth Fund’s analysts found that states that have historically scored well in its rankings “also performed well as the pandemic unfolded,” both in terms of the usual health metrics and the new pandemic-specific ones. In addition to Hawaii, states that fit this description include Maine, Washington and Vermont – which was highlighted in the report for its strong COVID-19 vaccination rollout.

The link between overall and coronavirus-specific performance applied to states at the bottom of the list as well. The lowest-ranked states overall – Mississippi, Oklahoma and West Virginia, which was hailed for its initial vaccination efforts before eventually falling behind others – also had among the worst scores in the pandemic response category. Texas and Missouri rounded out the bottom five, while Alabama – with the lowest COVID-19 response score – ranked No. 46. Southeastern and Southwestern states generally ranked the lowest overall.

51. Mississippi
50. Oklahoma
49. West Virginia
48. Texas
47. Missouri
46. Alabama
44 (tie). Arkansas
44 (tie). Georgia
41 (tie). Kentucky
41 (tie). Nevada
41 (tie). Wyoming

The report also underscores that COVID-19 had health impacts that were far-reaching. Every state experienced “higher-than-expected” mortality rates from all causes of death since the start of the pandemic. Of particular concern was the increase in premature deaths from preventable causes such as diabetes and drug overdoses. Relatedly, Nevada and Wyoming had the lowest scores in the prevention and treatment category of the rankings.