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States with the Worst Health Return on Investment


What are Americans' healthcare dollars really buying? A new study examined the quality of each state's healthcare relative to the cost.

What are our healthcare dollars really buying us? A new study from WalletHub found some Americans are getting the short end of the stick when it comes to the quality of care they receive for the money they spend.

Despite spending more per capita than any other industrialized nation, Americans live shorter lives, have higher infant mortality rates, and are diagnosed with more cases of chronic diseases. WalletHub reported that the average annual health insurance premium for an individual in 2013 cost $5,885, while families paid an average of $16,351 for group coverage.

WalletHub recently examined the quality of American healthcare relative to its cost using data from 47 states to create a health-related return on investment (ROI) metric. The 2 states not included in the rank were Maine, Rhode Island, and Vermont.

The results show that expensive health costs are no guarantee of superior care.

According to the study, residents in blue states have a better health ROI with an average rank of 20.35 compared to red states’ 27.42 (a smaller number is a better ROI). WalletHub designated states as red or blue based on how they voted in the 2012 presidential election.

These are the states with the worst health ROI:

10. Nevada

Healthcare cost rank: 32

Death rate rank: 36

Nation’s health rank: 37


Nevada’s health ROI may be poor, but the state’s well-being is improving. According to the annual Gallup-Healthways Well-Being Index, Nevada’s well-being improved by 2.4 points from 2010 to 2013, which is better than any other state in the nation—even if it’s health is still among the worst.

9. (tie) Ohio

Healthcare cost rank: 30

Death rate rank: 38

Nation’s health rank: 40


Ohio’s healthcare costs aren’t particularly high compared to other states; however, the state’s residents don’t have particularly good health either. According to Gallup, Ohio was given one of the worst well-being scores in the nation. In fact, most of the states in the top 10 of this list were among the worst well-being scores.

9. (tie) Alabama

Healthcare cost rank: 5

Death rate rank: 49

Nation’s health rank: 47


Although Alabama has one of the lowest costs in the nation, that doesn’t automatically equal a poor health ROI. For instance, Minnesota has the least expensive healthcare in the nation, and it ranked best overall for its health ROI.

7. Kentucky

Healthcare cost rank: 20

Death rate rank: 43

Nation’s health rank: 45


While Kentucky is another state with less expensive healthcare costs, that translates into poor health outcomes. For 5 years in a row, Kentucky has had one of the two lowest well-being scores from Gallup, which determines its scores based on life evaluation, emotional health, work environment, physical health, healthy behaviors, and access to basic necessities.

6. South Carolina

Healthcare cost rank: 31

Death rate rank: 42

Nation’s health rank: 43


A recent report found that people in the southern states, including South Carolina, endure 28% to 33% of all potentially preventable deaths, such as heart disease, cancer, chronic lower respiratory disease, stroke, and unintentional injury.

5. Indiana

Healthcare cost rank: 41

Death rate rank: 40

Nation’s health rank: 41

Indianapolis. Photo by Daniel Schwen.

With one of the most expensive healthcare costs in the nation, one would think Indiana’s health outcomes would be better. Unfortunately, the state does not rank well in either death rate or overall health rank, which makes it obvious that residents are not getting a good return on their investment.

4. West Virginia

Healthcare cost rank: 36

Death rate rank: 45

Nation’s health rank: 46


West Virginia has one of the lowest well-being scores, according to Gallup, and it was at the bottom on 5 out of the 6 key areas of well-being: life evaluation, emotional health, physical health, healthy behaviors, and access to basic necessities.

3. Arkansas

Healthcare cost rank: 29

Death rate rank: 45

Nation’s health rank: 49

Fayetteville. Photo by Brandon Rush.

Arkansas is among the states that were dubbed the “Diabetes Belt” because it, along with Alabama, Kentucky, Louisiana, and Mississippi, all had higher rates of diabetes than the rest of the country. Residents of Arkansas likely were unhappy with the Affordable Care Act. Premiums for a 27-year-old single male increased from $31 to $190 on a bronze plan.

2. Louisiana

Healthcare cost rank: 22

Death rate rank: 47

Nation’s health rank: 48

New Orleans

Despite being part of the Diabetes Belt, and even though it has the second worst health in the country, Louisiana has some happy patients—at least in New Orleans. Possibly because healthcare is relatively inexpensive compared with many other states. However, Louisiana is also in the so-called Stroke Belt.

1. Mississippi

Healthcare cost rank: 34

Death rate rank: 50

Nation’s health rank: 50

Jackson. Photo by Natalie Maynor.

Adjusted for age group, Mississippi has the highest death rate in the nation and the worst ranking health, too. Its cost are slightly more expensive than average, though. The state also has one of the worst well-being scores, according to the Gallup-Healthways Well-Being Index.

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