According to Health Risk Management Inc., a consulting company, states with higher quality of care generally have lower per-capita health care costs. HRM's annual "Quality First" index includes 46 weighted quality indicators that consider what individuals, health care systems, and states do to affect health status and care, and the degree to which those efforts improve outcomes. One of the most compelling findings is that the top 10 states in quality had an average per-capita health care cost of $239 in 1999, 11 percent lower than the bottom 10 states' average of $268.
| Top 10 states in quality | Lowest 10 states in quality | ||||
| Rank | State | Per-capita cost | Rank | State | Per-capita cost |
| 1 | Minnesota | $228 | 49* | Mississippi | $255 |
| 2 | Hawaii | $227 | 49* | Louisiana | $317 |
| 3 | Wisconsin | $218 | 48 | Arkansas | $248 |
| 4 | New Hampshire | $235 | 47 | Tennessee | $295 |
| 5 | Vermont | $218 | 46 | Oklahoma | $242 |
| 6 | Massachusetts | $315 | 45 | South Carolina | $231 |
| 7 | Connecticut | $274 | 44 | New Mexico | $223 |
| 8 | Washington | $230 | 43 | Alabama | $281 |
| 9 | Maine | $221 | 42 | Texas | $253 |
| 10 | Iowa | $222 | 41 | Kentucky | $253 |
* Tie.
SOURCE: QUALITY FIRST INDEX, HEALTH RISK MANAGEMENT INC., MINNEAPOLIS, 1999
