Healthcare worker taking a Covid test on an older man.

Health systems in Hawaii and Maine led the state rankings as far as vaccination rates, capacity in hospital and intensive care units, and death rates throughout the COVID-19 pandemic, in new rankings released Thursday by the Commonwealth Fund.

Alabama placed low in the rankings at 46, followed by Oklahoma, Kentucky, Mississippi and Georgia.

“Generally, the states judged to have overall stronger health systems also ranked well in their COVID-19 performance. The reverse was true of those scoring poorly in their overall healthcare rankings,” Michael Olive wrote Thursday in a Pew Trust stateline article.

Hawaii and Massachusetts scored the highest overall among the states, based on performance across 56 measures of healthcare access and quality, service use and cost, health disparities, and health outcomes during the COVID-19 pandemic in 2020. 

“These two states’ overall performance separates them from other states, even other top performers. Both were consistently among the top three states across each of the seven dimensions of performance the State Scorecard evaluates,” according to the report.

Connecticut, Washington and Vermont made the top 10 list. The lowest-performing states were Mississippi, Oklahoma and West Virginia.

“We found that states that have historically performed well on our State Scorecard also performed well as the pandemic unfolded, both on our usual set of health system measures and the new COVID-19-specific measures,” the report states.

All states have made progress in getting their populations vaccinated, but according to the Commonwealth Fund, some states have done a better job than others. In the states that moved the fastest to get shots in arms — Vermont, Massachusetts, Connecticut and Maine — 70% of the population aged 12 and older had completed a full vaccine series (typically, two doses) within 200 days from when the vaccine became available. Still, the report shows, 21 states still had not reached a 70% vaccination by the end of March. Alabama, Wyoming and Mississippi lagged in the state rankings, having not yet reached a 60% vaccination rate.

The Commonwealth Fund also looked at the number of “excess” deaths — deaths from COVID-19 in addition to deaths from other causes such as heart disease, cancer and drug overdoses — that occurred during the pandemic, ranging from a low of 110 per 100,000 people in Hawaii to a high of 596 per 100,000 in Mississippi. 

“While COVID has been the driving force behind high rates of excess deaths across the U.S., states with historically strong health systems — low uninsured rates, robust primary care capacity, and effective care management — generally had lower rates than states with weaker health systems,” the organization found.