Editor's Note: The research below was conducted in partnership between West Health and Gallup.
WASHINGTON, D.C. — The West Health-Gallup Center on Healthcare’s new study, State of the States 2025: Insights on Healthcare in America, ranks all 50 U.S. states and the District of Columbia (D.C.) based on Americans’ self-reported experiences with healthcare in their communities. These rankings reveal that where people live profoundly shapes how they interact with the healthcare system.
While many existing rankings focus on system-level metrics or health outcomes — such as hospital capacity or mortality rates — the West Health-Gallup rankings fill a critical gap by capturing how Americans perceive cost, quality and access in their daily lives. By centering the voices of individuals, this approach reveals the real-world realities of interacting with the healthcare system in America.
Developing the Health Experiences State Rankings
Between June and August 2025, West Health and Gallup surveyed nearly 20,000 U.S. adults aged 18 and older nationwide, including a representative sample in each state and D.C. Respondents were asked a series of questions about their experiences with healthcare cost, quality and access.
To ensure comprehensive measurement, Gallup fielded and reviewed more than 40 survey items spanning three dimensions of healthcare: cost, quality and access. These items represent the culmination of more than seven years of research conducted through the West Health-Gallup partnership.
The final set of 27 survey questions were selected based on relevance, construct coverage and empirical performance. Factor analysis confirmed that these questions strongly aligned with their respective dimensions of cost, quality and access, and reliability analysis (Cronbach’s alpha) further supported that the items for each dimension worked well together to reflect people’s experiences of cost (α = .84), quality (α = .86) and access (α = .81), respectively.
Gallup created composite scores for each domain — cost, quality and access — by averaging the standardized scores of the selected items (see tables at the end of this article). Each state’s three domain scores were then averaged to produce an overall healthcare experience score for each state. There was empirical support for creating a single overall ranking on three key findings: The cost, quality and access scores were moderately-to-strongly related; a factor analysis showed they combined to reflect a unified view of healthcare experiences; and a reliability analysis confirmed that the items were well aligned (Cronbach’s alpha = 0.72).
States were ranked by ordering their scores from highest to lowest, resulting in four distinct rankings for each state: one for overall healthcare experience and separate rankings for the dimensions of cost, quality and access. On all rankings, higher scores indicate more favorable healthcare experiences.
Exploring the Health Experiences State Rankings
People’s everyday experiences with healthcare don’t always match up with traditional measures like health outcomes or system performance. That’s because those metrics often miss the real-life challenges like delays, trade-offs and concerns about cost or quality that individuals face when trying to get care. Still, it is reasonable to expect that states offering better healthcare experiences — where care is more affordable, accessible and of higher quality — will generally perform better on outcomes and system-level indicators too.
To understand whether the West Health-Gallup health experiences rankings show these expected relationships to traditional health indicators, Gallup examined how the health experience measures aligned with other well-known state-level metrics. Finding the expected connection provides evidence of convergent validity, supporting that the healthcare experiences rankings capture meaningful differences across states.
This analysis provided evidence that the rankings not only reflect Americans’ perceptions but also correspond meaningfully with broader health outcomes and system performance. The West Health-Gallup health experiences rankings were moderately correlated with self-reported health status at both the individual level (r = 0.31) and at the state level (r = 0.42), indicating that residents in higher-ranked states were more likely to report good or excellent health.
The rankings also aligned with external health system indicators. States with better rankings tended to have longer life expectancies (r = 0.43), more residents with a primary care doctor (r = 0.47) and higher rates of recent doctor visits (r = 0.52), based on data from the Kaiser Family Foundation. Finally, the rankings demonstrated a strong correlation (r = 0.57) with the Commonwealth Fund’s state healthcare rankings.
Leveraging the Health Experiences State Rankings
The rankings reveal meaningful variation in Americans’ healthcare experiences across states. In the highest-ranked states, residents are significantly less likely to skip needed care or medications due to cost and more likely to report being able to access and experience high-quality care compared with those in the lowest-ranked states. Read more about the findings here.
However, even in the highest-ranked states, many individuals still face challenges affording and accessing quality care. No state is without gaps, and every state has room for improvement.
These rankings help to bring the human experience back into healthcare conversations, capturing aspects of healthcare cost, quality and access that are not well represented by traditional metrics. By focusing on how people experience the system and not just on how it performs on paper, this work aims to elevate the voices of everyday Americans and support more responsive policy solutions.
For detailed results, see the state scorecards and explore the interactive digital platform.
Questions Included in the Health Experiences Rankings
The following are a complete listing of the questions that were included in the health experiences rankings. They fall into three categories: experiences with healthcare cost, quality and access.
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