Ranking the States on Equity in Health Care

The Commonwealth Fund’s 2015 Scorecard on State Health System Performance (Scorecard) highlighted both positive and negative changes in health equity from 2014 to 2015. The Scorecard assesses states on 42 indicators grouped into five categories: 1) access and affordability; 2) prevention and treatment; 3) avoidable hospital use and cost; 4) healthy lives; and 5) equity. To understand equity, the researchers evaluate how low income individuals and racial and ethnic minorities fair in accessing care, the quality of the care they receive, and their likelihood of living a long and healthy life.

Across the 50 states and the District of Columbia, the Scorecard found wide variations in performance “with up to an eight-fold difference between top- and bottom-ranked states.” In terms of the equity measure the Scorecard revealed six interesting lessons:

  1. Rhode Island has made the most strides in promoting equity in health care since the previous scorecard (2014).
  2. In 37 states, the percentage of low-income elderly adults receiving a high-risk prescription medication declined and the equity gap narrowed.
  3. The majority of states saw an increase in obesity among low-income and minority adults in 2014 compared with 2013.
  4. Premature death rates among racial and ethnic minority populations declined in most states.
  5. For equity gaps based on income, more states improved than worsened.
  6. However, for equity gaps based on race or ethnicity, more states worsened than improved.

In terms of the equity gaps based on race or ethnicity, half of the States received worse scores than 2014 on six of the indicators.

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