The Disparity between State Health Rankings

By Clive Riddle, November 19, 2009

How much difference is there between overall health care performance rankings of states, conducted by major organizations? I thought I’d peek into two recent studies and compare them. Interestingly, the two studies both agreed on who was first (Vermont), who was last (Mississippi), generally agreed on this highest and lowest ranking states, but agreed on little in-between.

This week, United Health Foundation, the American Public Health Association and Partnership for Prevention released the 20^th Anniversary Edition of America’s Health Rankings. The full report can be downloaded, or drop-down queries can be made from www.americashealthrankings.org. 

Their press release states that the rankings “provide an analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socio-economic data to determine national health benchmarks and state rankings. The Rankings employs a unique methodology, developed and annually reviewed by a Scientific Advisory Committee of leading public health scholars.” 21 core measures and 15 supplemental measures were used, categorized into determinants including Behaviors, Community Environment, Public and Health Policies, Clinical Care, and Outcomes.

Last month, The Commonwealth Fund released their report "Aiming Higher: Results from the 2009 State Scorecard on Health System Performance." This is a comparative follow up to their 2007 state scorecard report. The report has been released in the context of health reform, with the finding that there continues to be significant disparities between states regarding a wide number of health care measures. The Commonwealth Fund states their report "includes 38 indicators grouped into five dimensions of performance—access, prevention/treatment quality, avoidable hospital use and costs, equity, and healthy lives. The analysis ranks states on each indicator and then averages the indicator ranks to determine the dimension rank. Dimension scores determine the overall rank. Equity measures the gaps in performance between vulnerable groups and the national average."

So I compiled the overall state rankings for both reports (but I encourage you to review the individual measures in both reports- it gets more meaningful when you examine the specifics.) I indicated the absolute difference in rankings between the reports for each state (factoring out DC which was included in the Commonwealth report but not America’s Health Rankings- also it should be noted there are duplicate rankings in both reports when states tied.)

The exercise kind of reminded me of the college football ranking comparisons displayed this time of year with the BCS, AP and Harris polls.

State	Commonwealth	America's	Difference
Alabama	39	48	9
Alaska	33	34	1
Arizona	35	27	8
Arkansas	47	40	7
California	30	23	7
Colorado	24	8	16
Connecticut	8	7	1
Delaware	14	32	18
Florida	42	36	6
Georgia	36	43	7
Hawaii	2	4	2
Idaho	28	14	14
Illinois	41	29	12
Indiana	27	35	8
Iowa	2	15	13
Kansas	23	24	1
Kentucky	44	41	3
Louisiana	48	47	1
Maine	5	9	4
Maryland	17	21	4
Massachusetts	7	2	5
Michigan	20	30	10
Minnesota	4	5	1
Mississippi	50	50	0
Missouri	36	38	2
Montana	18	26	8
Nebraska	13	16	3
Nevada	46	45	1
New Hampshire	5	5	0
New Jersey	29	18	11
New Mexico	42	31	11
New York	21	25	4
North Carolina	40	37	3
North Dakota	9	17	8
Ohio	26	33	7
Oklahoma	49	49	0
Oregon	31	13	18
Pennsylvania	15	28	13
Rhode Island	11	10	1
South Carolina	32	46	14
South Dakota	12	20	8
Tennessee	38	44	6
Texas	45	39	6
Utah	19	2	17
Vermont	1	1	0
Virginia	22	22	0
Washington	16	11	5
West Virginia	34	42	8
Wisconsin	10	12	2
Wyoming	25	19	6