Special Report

25 States With Worst Health Care Systems

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15. West Virginia
> Uninsured rate: 6.7% — 18th lowest
> Health care spending in 2019: $160 per capita — 22nd lowest
> Adults in poor or fair health: 23.6% — the highest
> Hospital beds: 3.8 per 1,000 people — 4th most
> Employee premium contribution, single coverage: $113 a month — 21st lowest

West Virginia’s health care system faces more challenges than virtually any other — 23.6% of adults in the state reported feeling in fair or poor health, higher than in all other states. West Virginians are also more likely to lack access to health care. There are just 137.8 doctors per 100,000 residents, the third lowest ratio in the nation, and well below the national concentration of 261.2 doctors per 100,000 residents.

West Virginia has by far the highest premature mortality rate in the country, at 504.8 deaths before age 75 per 100,000 residents. Nationwide, the premature death rate is less than 340 per 100,000 residents. The state’s high premature death rate is due in part to the opioid epidemic. West Virginia has the highest rate of fatal overdoses among states, and the rate has been increasing during the COVID-19 pandemic.

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14. Oklahoma
> Uninsured rate: 14.3% — 2nd highest
> Health care spending in 2019: $223 per capita — 18th highest
> Adults in poor or fair health: 20.9% — 8th highest
> Hospital beds: 2.8 per 1,000 people — 17th most
> Employee premium contribution, single coverage: $115 a month — 25th lowest

Oklahoma’s health care system faces more challenges than most other states – 20.9% of adults in the state reported feeling in fair or poor health, higher than in all but seven other states. Oklahomans are also more likely to lack health insurance and access to health care. The uninsured rate in the state is 14.3%, the second highest in the U.S. There are also just 60.9 doctors per 100,000 residents, the fifth lowest ratio in the nation and well below the national concentration of 75.8 doctors per 100,000 residents.

Oklahoma has the sixth highest premature mortality rate in the country, at 456.6 deaths before age 75 per 100,000 residents. Nationwide, the premature death rate is less than 340 per 100,000.

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13. South Dakota
> Uninsured rate: 10.2% — 13th highest
> Health care spending in 2019: $178 per capita — 24th highest
> Adults in poor or fair health: 13.4% — 5th lowest
> Hospital beds: 4.8 per 1,000 people — the most
> Employee premium contribution, single coverage: $120 a month — 19th highest

South Dakota is one of just 14 states in which more than one in 10 residents are uninsured. People without insurance are more likely to skip needed medical care because of cost, potentially leading to more severe health issues later on.

South Dakota struggled with COVID-19 more than almost any other state. It reported the third highest COVID-19 case rate among states, at 13,903 cases per 100,000 residents. It also had one of the 10 highest death rates, at 223 COVID-19-related fatalities per 100,000.

12. Louisiana
> Uninsured rate: 8.9% — 21st highest
> Health care spending in 2019: $101 per capita — 8th lowest
> Adults in poor or fair health: 21.4% — 5th highest
> Hospital beds: 3.3 per 1,000 people — 7th most
> Employee premium contribution, single coverage: $122 a month — 15th highest

Despite a lower than average uninsured rate, Louisiana ranks among the states with the worst health care system in part due to relatively low state spending on health care as well as hospitals. The state spends $101 per capita on health care and just $76 per resident on hospitals. Both amounts are significantly lower than their respective nationwide figures of $205 and $294.

Louisiana also has a lower concentration of dentists and primary care doctors relative to the population. It also has a high share of adults reporting being in poor or fair health as well as relatively high infant and child mortality. About 21.4% adults report poor or fair health, the fifth highest share in the U.S. The infant mortality rate is 7.9 per 1,000 births, and the child mortality rate is 70.0 per 100,000 children, the third and second highest rates in the country.

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11. Alabama
> Uninsured rate: 9.7% — 17th highest
> Health care spending in 2019: $117 per capita — 17th lowest
> Adults in poor or fair health: 21.4% — 6th highest
> Hospital beds: 3.1 per 1,000 people — 12th most
> Employee premium contribution, single coverage: $133 a month — 8th highest

Alabama ranks among the states with the worst health care system in part due to the state’s low concentration of health professionals relative to the population. There are 108.3 mental health providers per 100,000 residents, the lowest ratio in the U.S., and 65.2 primary care physicians per 100,000 residents, the seventh lowest ratio. About 21.4% of adults report being in poor or fair health, the sixth highest share in the country.

Alabama has the third highest premature mortality rate in the country, at 472 deaths before the age of 75 per 100,000 residents. Nationwide, the premature death rate is less than 340 per 100,000 people. The state’s high premature death rate is due in part to the opioid epidemic. The state had more opioid prescriptions than residents in 2015, according to the CDC.