Special Report

25 States With Worst Health Care Systems

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25. Wyoming
> Uninsured rate: 12.3% — 6th highest
> Health care spending in 2019: $513 per capita — 2nd highest
> Adults in poor or fair health: 15.3% — 17th lowest
> Hospital beds: 3.5 per 1,000 people — 6th most
> Employee premium contribution, single coverage: $96 a month — 7th lowest

The health care system in Wyoming ranks worse than half of all other states in the country. This is due in large part to the fact that 12.3% of residents are not insured — the sixth highest percentage among states and well above the national uninsured rate of 9.2%. Uninsured Americans tend to have worse health outcomes as they often skip needed medical care because the costs can be too high without coverage.

Wyoming residents may also struggle to receive needed medical care due to a lack of doctors. There are just 68.2 physicians in the state per 100,000 residents, well below the concentration nationwide of 75.8 doctors per 100,000 residents.

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24. Delaware
> Uninsured rate: 6.6% — 15th lowest
> Health care spending in 2019: $480 per capita — 4th highest
> Adults in poor or fair health: 16.3% — 23rd lowest
> Hospital beds: 2.2 per 1,000 people — 20th fewest
> Employee premium contribution, single coverage: $128 a month — 11th highest

Though Delaware’s health care system ranks worse than that of 26 other states, it has several positive aspects as well. For example, a relatively low share of its population is uninsured, at 6.6%, and its residents are among the most likely to have received preventive medical care like flu shots and mammograms.

However, the state’s medical care infrastructure has some gaps. Hospital funding in Delaware is among the lowest in the nation, at just $82 per capita. This is less than a third of the average per capita hospital spending nationwide of $294. Delaware also has fewer hospital beds per capita than most other states, at 2.2 beds per 1,000 residents.

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23. Montana
> Uninsured rate: 8.3% — 24th highest
> Health care spending in 2019: $167 per capita — 25th lowest
> Adults in poor or fair health: 14.1% — 11th lowest
> Hospital beds: 3.3 per 1,000 people — 7th most
> Employee premium contribution, single coverage: $94 a month — 6th lowest

Though Montana’s uninsured rate is slightly lower than the national rate, and the ratio of certain health professionals relative to the population is slightly higher than the national figures, the state ranks among those with the worst health care system because of relatively low spending on hospitals and health care. The state spends $61 on hospitals per resident, which is a fraction of the U.S. average of $294 per person. Montana spends about $167 on health care per person, also less than the national average of $205 per person.

About 23.3% of adults in Montana report having unmet mental health needs, the 15th highest share in the country.

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22. Missouri
> Uninsured rate: 10.0% — 15th highest
> Health care spending in 2019: $332 per capita — 8th highest
> Adults in poor or fair health: 19.5% — 11th highest
> Hospital beds: 3.1 per 1,000 people — 12th most
> Employee premium contribution, single coverage: $110 a month — 15th lowest

Missouri is on the list of states with the worst health care system in the U.S. for several reasons. One is the higher uninsured rate than the national average. An estimated 10.0% of adult residents don’t have health insurance, the 15th highest share in the country. Another reason is the relatively limited access to health professionals compared to most other states. There are 70.3 primary care doctors per 100,000 residents in the state, compared to 75.8 per 100,000 across the U.S. Missouri also has lower concentrations of dentists and mental health providers per 100,000 residents than most states.

Missouri has one of the highest rates of people reporting poor or fair health, at 19.5% compared to 16.5% in the U.S. as a whole. The state also has one of the highest premature mortality rates at 404 residents dying before the age of 75 per 100,000 people. The national premature mortality rate is below 340 per 100,000.

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21. Nebraska
> Uninsured rate: 8.3% — 23rd highest
> Health care spending in 2019: $151 per capita — 21st lowest
> Adults in poor or fair health: 13.8% — 10th lowest
> Hospital beds: 3.6 per 1,000 people — 5th most
> Employee premium contribution, single coverage: $113 a month — 18th lowest

Though Nebraska’s uninsured rate is lower than the national rate and the concentrations of certain health professionals relative to the population is slightly higher than the national figures, the state ranks among those with the worst health care system because of relatively low spending on hospitals and health care. The state spends $102 on hospitals per resident, which is about half the U.S. average of $294 per person. Nebraska spends about $151 on health care per person, significantly less than the national rate of $205 per person.