FILE - Hospital emergency room

Colorado ranks seventh among U.S. states for its health care system, according to the consumer website WalletHub.

Colorado ranked 23rd in health care cost, 15th in accessibility and third in outcomes. It has the fifth-lowest cancer rate, the fourth-lowest heart disease rate, and 49th in having the highest at-risk adults with no routine doctor visit in the past two years.

WalletHub analyst Jill Gonzalez told that Colorado’s high ranking is attributed to several factors.

“Colorado has the shortest average emergency room wait time of just 13 minutes," Gonzalez said. "The overall results of high quality health care are best shown by its residents' good health. Colorado has the lowest share of adults with Type 2 diabetes, the fourth lowest maternal mortality rate, and one of the lowest heart disease rates in the country."

To determine where Americans receive the best and worst health care, WalletHub compared the 50 states and the District of Columbia across 40 metrics within three main categories: cost, accessibility and outcome. Costs include medical visits, monthly premiums, and out-of-pocket expenses. Access includes quality of public hospital system, response and wait times for emergency services, a range of providers per capita, acceptance rates for Medicaid and Medicare, and shares of insured adults and children. The outcomes category includes mortality rates, share of readmission and discharges of hospital patients, life expectancy, disease rates, among other factors.

The top ten states for health care, according to WalletHub’s methodology, are Vermont, which ranks first, followed by Massachusetts, New Hampshire, Minnesota, Hawaii, Rhode Island, Colorado, District of Columbia, Iowa and Maryland.

WalletHub uses data from the Centers for Disease Control (CDC), which indicates that 88 percent of Americans have a regular place where they can receive medical care. But the cost of care and level of quality vary widely by state. Costs are affected by the overall health of the population, more advanced medical equipment, and a general lack of awareness about treatment options.

The report also points to estimates from the Centers for Medicare and Medicaid, indicating that Americans, on average, spend more than $10,000 per year on personal health care, roughly 17.9 percent of the U.S. GDP.

Adam McCann, WalletHub financial writer argues that “higher costs don’t necessarily translate to better results.” Pointing to a Kaiser Family Foundation Study, he clarifies that despite high costs, the U.S. lags behind several countries in several areas related to health care. Despite this, he adds, the U.S. has improved in providing more health care access for people who exhibit worse health, “and health care cost growth has slowed somewhat.”

Critics say that when discussing health care, the term “health system” is too vague. In the U.S., unlike other countries, health systems could refer to the Veterans’ Administration, Medicare, Medicaid, Social Security, and Indian Health Services. Using the phrase “access to medical care” is more accurate, they argue.

Linda Gorman of the Denver-based free-market think tank the Independence Institute, takes issue with WalletHub’s methodology.

“The measures in the CDC report are population health measures," Gorman told "Many of them really measure individual behavior, SES status, or demographics rather than how well a state’s medical services function.”

She points to the category of “life-expectancy,” which is unrelated to medical care in that its calculation can be radically affected by high rates of accidents, suicides and murders at younger ages.

“Conversely,” she said, "an industrialized country with good medical care is likely to have a higher ‘disease burden’ as people who would otherwise die from chronic diseases like diabetes, hepatitis, and various kinds of cancers, end up living longer.”

Ranking states by percentage of insured adults and income does not correlate to an individual’s positive or negative health condition.

“Lower-income people tend to be younger and are less likely to work in jobs offering benefits," Gorman said. "Evidence showing that not having coverage increases mortality rates is slim.”

Alternatively, she argues, “By measures that matter, Colorado has historically had good medical care because it has had a lightly regulated, competitive, health system. It does not have certificate of need regulations and has had liberal clinical licensing laws that allowed rapid development of urgent care, independent outpatient surgery centers, freestanding advanced imaging centers, and freestanding emergency rooms. Before Obamacare, it had a competitive individual insurance market with relatively low rates, a relatively high number of consumer-directed health plans, a high risk pool to cover people with pre-existing conditions, and innovative programs for Medicaid recipients with disabilities.”

According to Becker’s Hospital Review, four Colorado institutions made the 2018 “100 great leaders in healthcare” ranking. They are UCHealth in Aurora, Medical Group Management Association of Englewood, Catholic Health Initiatives of Englewood, and DaVita Medical Group of Denver.