Scorecard on State Health System Performance

A state-by-state report measuring access to care, quality of care, health outcomes, and health disparities across the United States

by David C. Radley, Douglas McCarthy, and Susan L. Hayes

Browse by Key Trends or State

The Top & Bottom

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We use recently available data to assess every state and Washington, DC on more than 40 measures of health care access, quality, efficiency, health outcomes and disparities.

Hawaii, Massachusetts, Minnesota, Vermont, and Utah are the top-ranked states according to the Commonwealth Fund’s 2018 Scorecard on State Health System Performance, which assesses all 50 states and the District of Columbia on more than 40 measures of access to health care, quality of care, efficiency in care delivery, health outcomes, and income-based health care disparities.

The 2018 Scorecard reveals that states are losing ground on key measures related to life expectancy. On most other measures, performance continues to vary widely across states; even within individual states, large disparities are common.

Still, on balance, the Scorecard finds more improvement than decline between 2013 and 2016 in the functioning of state health care systems. This represents a reversal of sorts from the first decade of the century, when stagnating or worsening performance was the norm.


All states can improve their health care performance, including those that topped the Scorecard rankings.

On certain health system indicators, states ranked lower overall performed better than the overall leaders. This suggests that even the lower-ranking states have something to teach.

If every state achieved the performance of the top-ranked state on each Scorecard indicator, the gains in health care access, quality, efficiency, and outcomes would be dramatic. At current rates of improvement, however, it may take many years or decades for states and the nation to see such progress.