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2018 Scorecard on State Health System Performance


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.

Overall, four major trends emerge from our analysis of the Scorecard results:

  • Rising death rates, high levels of obesity, and gaps in care are pressing challenges for states
  • Regional differences in performance persist, as do within-state disparities
  • Many states are not getting good value for their health care dollars
  • States made progress in areas that were the target of efforts to improve

View the complete interactive report.

Visit the U.S. Health System Data Center for state maps and profiles.

Publication Details

Publication Date: May 3, 2018
Contact: David C. Radley, Senior Scientist, Tracking Health System Performance, The Commonwealth Fund

David C. Radley, Douglas McCarthy, and Susan L. Hayes, 2018 Scorecard on State Health System Performance (Commonwealth Fund, May 2018).


David Radley
Senior Scientist, Tracking Health System Performance
Douglas McCarthy
Senior Research Advisor
Susan L. Hayes
Former Senior Researcher, Tracking Health System Performance