Massachusetts ranks first for healthcare quality in the latest full US state health system scorecard, followed by Hawaii, New Hampshire, Rhode Island, and Washington, D.C. Mississippi ranks last, with Texas, Oklahoma, Arkansas, and West Virginia also occupying the bottom five positions.
For this comparison, we use the latest Commonwealth Fund State Scorecard on Health System Performance.
The scorecard uses 50 indicators covering healthcare access, affordability, prevention, treatment, avoidable hospital use, medical costs, health outcomes, income disparities, and racial health equity.
US States Ranked by Healthcare Quality in 2026
| Rank | State |
| 1 | Massachusetts |
| 2 | Hawaii |
| 3 | New Hampshire |
| 4 | Rhode Island |
| 5 | District of Columbia |
| 6 | New York |
| 7 | Maryland |
| 8 | Vermont |
| 9 | Washington |
| 10 | Colorado |
| 11 | Connecticut |
| 12 | Oregon |
| 13 | Pennsylvania |
| 14 | Virginia |
| 15 | Minnesota |
| 16 | New Jersey |
| 17 | Utah |
| 18 | Iowa |
| 19 | Idaho |
| 19 | California |
| 21 | Maine |
| 22 | North Dakota |
| 23 | Michigan |
| 24 | Nebraska |
| 25 | Delaware |
| 26 | Wisconsin |
| 27 | Illinois |
| 28 | Montana |
| 29 | North Carolina |
| 29 | Ohio |
| 29 | New Mexico |
| 32 | South Dakota |
| 33 | Kansas |
| 33 | Arizona |
| 35 | Indiana |
| 36 | South Carolina |
| 37 | Kentucky |
| 38 | Alaska |
| 39 | Florida |
| 40 | Wyoming |
| 41 | Louisiana |
| 42 | Alabama |
| 43 | Missouri |
| 44 | Tennessee |
| 45 | Georgia |
| 46 | Nevada |
| 47 | West Virginia |
| 48 | Arkansas |
| 48 | Oklahoma |
| 50 | Texas |
| 51 | Mississippi |
What the Healthcare Quality Ranking Actually Measures
Healthcare quality in this ranking is much wider than hospital quality. The Commonwealth Fund combines 50 measures across four main performance areas, then adds measures of income disparity and racial health equity to the overall score.
Access and affordability include adult and child insurance coverage, medical debt, cost-related barriers to care, dental care, and out-of-pocket expenses. Prevention and treatment cover cancer screening, vaccinations, mental healthcare, hospital mortality, nursing home care, home health services, and other clinical measures.
Avoidable hospital use and cost include emergency department visits that may have been prevented with earlier care, preventable admissions, readmissions,
Medicare and employer-sponsored insurance spending, and the share of medical spending directed to primary care. Healthy lives include premature deaths, infant mortality, overdose deaths, suicide, smoking, obesity, cancer mortality, and other health outcomes.
These rankings reflect the healthcare system from the patient and population perspective, rather than the operating environment for individual physicians. Factors such as professional liability exposure, malpractice premiums, licensing requirements, and other practice expenses are not included.
Illinois, which ranks 27th overall, is a good example: physicians practicing there may face a very different professional liability environment than the state’s middle-of-the-pack healthcare quality ranking would suggest. Medical malpractice insurance in Illinois can vary considerably depending on specialty and location, particularly in higher-cost areas such as Cook County.
The Top 5 Healthcare Systems in the United States
The first five positions go to Massachusetts, Hawaii, New Hampshire, Rhode Island, and Washington, D.C.
1. Massachusetts
Massachusetts ranks first overall, first for access and affordability, second for prevention and treatment, and first for healthy lives.
Only 4 percent of adults are uninsured, compared with an 11 percent national rate in the Commonwealth Fund data.
The state also records 201 premature avoidable deaths per 100,000 people, one of its strongest results. Infant mortality is 3.3 deaths per 1,000 live births, the lowest figure listed in the scorecard benchmark table.
First place does not mean Massachusetts performs well everywhere. It ranks 35th for avoidable hospital use and cost. The Commonwealth Fund specifically notes weaker results for preventable hospitalizations and readmissions among adults age 65 and older.
2. Hawaii
Hawaii ranks second overall and second for access and affordability. Only 5 percent of adults are uninsured, and 7 percent reported going without care because of cost, the lowest rate in the national benchmark data.
Premature avoidable mortality stands at about 224 deaths per 100,000 people. Potentially avoidable emergency department visits among Medicare beneficiaries age 65 and older are 139 per 1,000, lower than the national rate of 155.2.
Hawaii is much weaker in prevention and treatment, where it ranks 45th. Its second-place overall position therefore comes from strong performance in other parts of the system rather than consistently high scores across every category.
3. New Hampshire
New Hampshire ranks third overall and third for access and affordability. About 7 percent of adults are uninsured, and only 8 percent lack a usual source of care, the best result among states in the Commonwealth Fund regional benchmark.
The state records around 232 premature avoidable deaths per 100,000 people. Its rate of potentially avoidable emergency department use among older Medicare beneficiaries is 165 per 1,000.
New Hampshire ranks seventh for healthy lives and ninth for prevention and treatment. Income disparity is a weaker area, where it falls to 41st.
4. Rhode Island
Rhode Island ranks fourth overall. Its strongest individual results include affordability, with 5.6 percent of people under age 65 facing high out-of-pocket medical spending relative to household income, the best rate in the national benchmark.
About 7 percent of adults are uninsured. Premature avoidable mortality stands at around 232 deaths per 100,000, and potentially avoidable emergency department use among older Medicare beneficiaries is 133 per 1,000.
Rhode Island ranks eighth for healthy lives but 33rd for avoidable hospital use and cost. Strong coverage and health outcomes help offset weaker hospital-use measures.
5. District of Columbia
Washington, D.C. ranks fifth overall and first for prevention and treatment. It also records the lowest adult uninsured rate in the scorecard at 3 percent.
D.C. performs particularly well on several preventive measures. It has the highest rate of adults receiving all recommended cancer screenings at 73 percent and the highest rate receiving age-appropriate vaccines at 53 percent.
Its health outcomes are much weaker than its access and treatment results. The District records about 357 premature avoidable deaths per 100,000 people and ranks 25th for healthy lives. The contrast is one of the clearest examples of why the overall ranking needs more than one type of measure.
Insurance Coverage Explains Part of the Gap Between States
Adult insurance coverage varies enormously across the ranking. Nationally, 11 percent of adults ages 19 to 64 were uninsured in the latest scorecard data.
Washington, D.C. records the lowest rate at 3 percent. Massachusetts follows at 4 percent. Hawaii has 4 percent in the scorecard appendix data used for access rankings.
Texas sits at the opposite end with 22 percent of working-age adults uninsured. Oklahoma follows at 16 percent, while Mississippi and Wyoming are at 15 percent.
Coverage alone does not determine the overall rank. West Virginia, for example, has an adult uninsured rate of 9 percent, lower than the national average, yet ranks 47th overall because health outcomes and avoidable hospital use are far weaker.
The Bottom 5 and the Problems Pulling Their Scores Down
West Virginia, Arkansas, Oklahoma, Texas, and Mississippi occupy the final five positions.
There is no single explanation shared by all five. Coverage gaps dominate in some states, while poor health outcomes, preventable deaths, hospital use, and disparities are much larger problems in others.
47. West Virginia
West Virginia demonstrates why insurance coverage alone cannot produce a strong healthcare system ranking. Only 9 percent of adults are uninsured, yet the state ranks last for both avoidable hospital use and cost and healthy lives.
The state records 318.6 premature deaths from preventable causes per 100,000 people, the highest rate in the entire scorecard. Potentially avoidable emergency department use among people age 65 and older reaches about 202 visits per 1,000 Medicare beneficiaries, also near the worst end of the national range.
West Virginia also faces a severe overdose burden. Weak outcomes across multiple measures push the state down even though insurance access is not as poor as in Texas or Oklahoma.
48. Arkansas
Arkansas ties for 48th overall and ranks 49th for healthy lives. Around 13 percent of adults are uninsured, above the national average.
The state records about 393 premature avoidable deaths per 100,000 people. Premature deaths from treatable causes reach 133.2 per 100,000, among the highest rates in the country, while preventable mortality is 259.6 per 100,000.
Arkansas also has high levels of poor self-reported health and obesity. Around 24 percent of adults report fair or poor health, and 42 percent meet the obesity measure used in the scorecard.
48. Oklahoma
Oklahoma shares 48th place with Arkansas. Access is one of its biggest weaknesses. 16 percent of adults are uninsured, placing the state 48th for access and affordability.
Premature avoidable mortality reaches about 410 deaths per 100,000 people. Potentially avoidable emergency department use among older Medicare beneficiaries stands at roughly 182 visits per 1,000.
Oklahoma ranks 48th for healthy lives and 46th for prevention and treatment. The combination of limited coverage, weak outcomes, and below-average treatment measures leaves little room for stronger categories to lift the overall score.
50. Texas
Texas ranks 50th overall and last for access and affordability. The state has the highest adult uninsured rate in the scorecard at 22 percent, roughly twice the national level.
Its health outcomes are not as poor as those in West Virginia, Arkansas, Oklahoma, or Mississippi. Texas records about 275 premature avoidable deaths per 100,000 people, close to the national level.
Access is what damages the Texas score most. Twelve percent of children are uninsured, also the worst result in the scorecard, and 18 percent of adults report going without care because of cost.
Texas ranks 27th for healthy lives, far above its 50th overall position. The difference shows how a state can have middling population outcomes but still rank near the bottom because large numbers of residents struggle to obtain or pay for care.
51. Mississippi
Mississippi ranks last overall. It sits 50th for access and affordability, 48th for prevention and treatment, and 50th for healthy lives.
Around 15 percent of adults are uninsured. Premature avoidable mortality reaches roughly 430 deaths per 100,000 people, more than twice the Massachusetts rate.
Mississippi also records high infant mortality, poor general health, and weak results across several prevention and treatment measures. Hospital 30-day mortality is 16.5 percent in the scorecard data, compared with a national figure of 14.4 percent.
Not every Mississippi measure is poor. The Commonwealth Fund notes that the state ranks in the top quartile for the share of healthcare spending directed toward primary care, and its home health results are strong on some measures. Those isolated strengths are not enough to offset weak access and population health outcomes.
Healthcare Spending Does Not Follow the Quality Ranking
Higher healthcare spending does not automatically produce a higher healthcare quality rank. Our state-by-state healthcare spending analysis shows major differences in per-person spending across the country, but the spending order looks very different from the performance table.
New York is one example. Healthcare spending per resident is among the highest in the country, yet New York ranks sixth rather than first. West Virginia also has relatively high per-capita spending but sits 47th for health system performance.
Prices, population age, disease prevalence, hospital markets, insurance arrangements, and the amount of care people use all affect spending. A state can spend large amounts treating an unhealthy population without achieving better preventive outcomes or wider access.
Hospital Costs Tell a Similar Story
Hospital prices also do not line up neatly with healthcare quality.
Our data on the average cost of a hospital stay by state put California at $4,337 per inpatient day and Massachusetts at $3,529.
California ranks 19th overall in the Commonwealth Fund scorecard, tied with Idaho, while Massachusetts ranks first. Mississippi has one of the lowest average inpatient costs at $1,425 per day but sits last in health system performance.
The comparison shows why price cannot stand in for quality. Low hospital charges do not erase problems with insurance coverage, premature mortality, prevention, or access to treatment. High charges do not guarantee better outcomes either.
Racial and Ethnic Disparities Remain in Every State
The statewide ranking also hides large differences within individual states.
The Commonwealth Fund State Health Disparities Report uses newer data to examine healthcare access, service quality, use, and health outcomes across racial and ethnic groups.
The report found disparities in every state. Connecticut, Maryland, Massachusetts, New York, and Rhode Island performed relatively well across several racial and ethnic populations, yet none eliminated the gaps.
Arkansas, Mississippi, Oklahoma, and West Virginia performed particularly poorly across the racial and ethnic groups for which enough data were available. All four also sit near the bottom of the overall state scorecard.
The disparities report found that cost-related barriers to care have begun rising again. Hispanic and American Indian and Alaska Native populations experienced some of the largest increases in people reporting that they skipped needed care because of cost.
Avoidable Deaths Show How Large the State Divide Is
Premature avoidable mortality combines deaths before age 75 from causes that prevention or timely treatment could potentially have prevented. The measure exposes one of the largest gaps between leading and lower-ranked healthcare systems.
Massachusetts records about 201 premature avoidable deaths per 100,000 people. Mississippi records around 430. Oklahoma reaches about 410, Arkansas about 393, and West Virginia has exceptionally high preventable mortality even though its insurance coverage is stronger than several other bottom-ranked states.
The national benchmark separates those deaths into preventable and treatable causes. Preventable causes include conditions and events that public health and prevention can reduce. Treatable mortality covers deaths that effective and timely medical care can potentially prevent.
The distinction explains why states with similar overall death rates can still have very different healthcare problems. One state may struggle mainly with disease prevention and behavioral risk factors, while another may have larger gaps in timely diagnosis and treatment.
Preventable Hospital Use Is Another Major Difference
The Commonwealth Fund also looks at emergency department visits, admissions, and readmissions that timely outpatient care may help reduce.
The national rate of potentially avoidable emergency department visits among people age 65 and older is 155.2 per 1,000 Medicare beneficiaries. Rhode Island sits well below that level at about 133. West Virginia exceeds 200.
Colorado ranks first for the complete avoidable hospital use and cost category even though it ranks 10th overall. Utah ranks second in the same category and 17th overall.
Massachusetts illustrates the reverse pattern. It is first overall but only 35th for avoidable hospital use and cost. Looking at category scores prevents the overall rank from hiding weaknesses that matter to patients and healthcare systems.
State Rankings Do Not Tell You Which Hospital Is Best
A statewide score is not a hospital ranking. Massachusetts finishing first does not mean every Massachusetts hospital outperforms every hospital in Texas, Mississippi, or another lower-ranked state.
The score measures the healthcare system experienced by the population. Insurance coverage, affordability, preventive treatment, hospital use, mortality, medical debt, disparities, and health behavior all contribute.
Patients choosing a hospital or specialist still need provider-level information for the condition being treated. State rankings are better suited to comparing how healthcare systems perform across large populations.
Healthcare Quality in the US Still Depends Heavily on Location
The gap between first-place Massachusetts and last-place Mississippi comes from much more than hospital care.
Massachusetts combines near-universal insurance coverage with low premature mortality and strong preventive and treatment measures. Mississippi struggles with access, mortality, prevention, and several other indicators at the same time.
The bottom five also show that there is no single route to a low rank. Texas is damaged most by its severe insurance coverage gap. West Virginia has much wider problems with preventable mortality and avoidable hospital use. Oklahoma and Arkansas combine weak outcomes with access and treatment problems.
Public opinion suggests Americans are noticing problems across the system as well.
We also analyzed the Gallup data on US healthcare quality, which found that only 44 percent of Americans rated the quality of healthcare as excellent or good, the lowest share since Gallup began tracking the measure in 2001.
The state rankings add detail to that national result. Healthcare access, cost, treatment, and outcomes still differ sharply depending on where people live, and even the highest-ranked jurisdictions have areas where their health systems perform poorly.
