STATE RURAL HEALTH RANKINGS & FINAL GRADES STATE RANK GRADE
STATE RANK GRADE
45
F
IN
29
C-
MT
19
B-
SC
44
F
AK
22
C+
IA
9
A-
NE
8
A-
SD
11
B+
AZ
33
D
KS
24
C
NV
30
D+
TN
43
F
AR
38
D-
KY
42
F
NH
1
A+
TX
36
D-
CA
15
B
LA
46
F
NM
31
D+
UT
23
C+
CO
12
B+
ME
13
B+
NY
18
B-
VT
2
A+
CT
3
A+
MD
16
B
NC
34
D
VA
32
D+
FL
37
D-
MA
6
A
ND
10
A-
WA
17
B
GA
40
F
MI
21
C+
OH
28
C-
WV
39
F
HI
4
A
MN
5
A
OK
41
F
WI
7
A
ID
20
B-
MS
47
F
OR
26
C
WY
14
B
IL
27
C-
MO
35
D
PA
25
C
R
RHQ
STATE RANK GRADE
AL
HQ’s U.S. Rural Health Report Card was created to answer a simple question: How does each state’s rural health care stack up when compared to other states? It seemed like a fairly straightforward question, and a useful one, too. How do you know if your state is doing an adequate job without a baseline for comparison? You can’t manage what you don’t measure, right? It quickly became clear, however, that finding a satisfactory answer to this question would be a challenge. First, we had to settle on definitions of “rural” and “rural health.” We weren’t trying to quantify all health care in America, just rural health care, and just rural America. But which rural America? Second, we had to determine which factors to measure and which ones to exclude. That’s harder than it sounds if fairness and utility are your ultimate goals. Suffice it to say, we had some pretty spirited discussions.
12
STATE RANK GRADE
Finally, we had to assign weight to everything we measured. All things are not equally important. That means conscientiously ranking the relative importance of many important things. More hand wringing ensued. After many months of discussion, analysis, research and reflection, we finally found consensus, equilibrium and even a sense of satisfaction. We hope you agree that the RHQ Rural Health Report Card is a fair and useful document. If so, please let us know. We plan to make it an annual affair. If you have suggestions or criticisms, please let us know those, too. METHODOLOGY When it came to defining rurality, we settled on counties as our sole unit of measurement. This had the virtue of allowing us to use well-established and reliable data sources. It also helped us ensure a greater measure
*DE, NJ, and RI excluded.
of fairness; i.e., we would always be comparing “apples to apples,” regardless of data source. That did mean excluding three states and Washington D.C. from our study, however. While Delaware, New Jersey and Rhode Island each contains pockets of rurality, these states, like D.C., are largely urbanized, and none contains a single county with a nonmetropolitan population. Following a discussion with the USDA, all the counties in the remainder of the states were sorted as either metropolitan (urban) or non-metropolitan (rural) as defined by the 2013 Rural-Urban Continuum Codes (RUCC). RUCC simply defines a county as rural if it has a population under 50,000 people, whereas the rural-urban commuting area (RUCA) codes classify U.S. census tracts using measures of population density, urbanization and daily commuting. A final composite score was then given to all rural counties individually.