Healthcare in the U.S. improved between 2011 and 2014, when the Affordable Care Act was implemented, according to the 2016 edition of The Commonwealth Fund's Scorecard on Local Health System Performance. However, widespread differences in health outcomes persist between different geographic areas.
The Commonwealth Fund's scorecard assesses the state of healthcare in 306 U.S. regional healthcare markets, known as "hospital referral regions." It uses three dozen indicators grouped into four main dimensions, including access and affordability of care; prevention and treatment; potentially avoidable hospital use and cost; and health behaviors and outcomes.
The scorecard largely attributes the improvements to higher rates of insurance coverage under the ACA, the provision of higher quality care and fewer hospital readmissions. Overall, healthcare improved more than it worsened in 302 of the 306 assessed hospital referral regions, according to the 2016 scorecard.
Below are the 61 top performing hospital referral regions ranked by overall performance. These markets comprise the first quintile of the ranking, with the second quintile beginning at No. 62.
No. 1 — Honolulu
No. 2 — St. Paul, Minn.
No. 3 — San Mateo County, Calif.
No. 4 — Rochester, Minn.
No. 5 — Appleton, Wis.
No. 6 — St. Cloud, Minn.
No. 7 — San Jose, Calif.
No. 7 — San Francisco
No. 9 — Minneapolis
No. 10 — Dubuque, Iowa
No. 11 — Cedar Rapids, Iowa
No. 12 — Boulder, Colo.
No. 13 — Madison, Wis.
No. 14 — San Luis Obispo, Calif.
No. 15 — La Crosse, Wis.
No. 16 — Seattle
No. 17 — Contra Costa County, Calif.
No. 18 — York, Pa.
No. 19 — Green Bay, Wis.
No. 20 — Providence, R.I.
No. 21 — Alameda County, Calif.
No. 22 — Lebanon, N.H.
No. 23 — Santa Rosa, Calif.
No. 24 — Mason City, Iowa
No. 25 — Fort Collins, Colo.
No. 26 — Boston
No. 27 — Iowa City, Iowa
No. 28 — Worcester, Mass.
No. 29 — Arlington, Va.
No. 30 — Sioux Falls, S.D.
No. 30 — Rochester, N.Y.
No. 32 — Des Moines, Iowa
No. 33 — Fargo/Moorhead, Minn./N.D
No. 34 — Santa Barbara, Calif.
No. 34 — Morristown, N.J.
No. 34 — Traverse City, Mich.
No. 34 — Neenah, Wis.
No. 38 — Wausau, Wis.
No. 39 — Hinsdale, Ill.
No. 40 — Manchester, N.H.
No. 40 — Portland, Maine
No. 42 — Ogden, Utah
No. 43 — Hartford, Conn.
No. 44 — Duluth, Minn.
No. 45 — Albany, N.Y.
No. 46 — Everett, Wash.
No. 47 — Takoma Park, Md.
No. 48 — Springfield, Mass.
No. 49 — Marshfield, Wis.
No. 50 — Lincoln, Neb.
No. 50 — Denver
No. 52 — Grand Rapids, Mich.
No. 53 — Marquette, Mich.
No. 54 — Sacramento, Calif.
No. 54 — Sioux City, Iowa
No. 56 — Waterloo, Iowa
No. 57 — Bismarck, N.D.
No. 58 — Santa Cruz, Calif.
No. 59 — Syracuse, N.Y.
No. 60 — Lancaster, Pa.
No. 61 — Orange County, Calif.
For more information on the scorecard methodology, click here.