Locating high-quality healthcare near you

Percentage of the U.S. population living near a U.S. News & World Report Honor Roll hospital versus those with access to a reliably excellent hospital

Every year, U.S. hospital quality stakeholders such as U.S. News & World Report (U.S. News) and the Centers for Medicare & Medicaid Services (CMS) publish hospital rankings and ratings to help guide patients seeking the highest-quality care. While these endeavors are well-intended, these ratings are often reported to conflict with each other, which can be confusing. Another issue that is rarely discussed is whether the average U.S. person has geographic proximity to — that is, lives near — a top-ranked hospital.

In this analysis, the research team explored the percentage of the U.S. population geographically near one of the Top 20 U.S. News Honor Roll hospitals. We then compared it with the percentage of the U.S. population that lives near one of 125 hospitals we have previously determined to be "reliably excellent." We have defined "reliably excellent" as meaning that they are in the 90th percentile or higher in 90% or more of CMS Five-Star Quality Rating System scoring simulations, using random weighting for each of the underlying 45 measures. The idea is that if a hospital can get a good CMS Star rating regardless of the methodology used, it must be reliably excellent across all measures.

For this analysis, we defined geographic proximity as whether a person lives in the same health referral region as a top-ranked or reliably excellent hospital. The Dartmouth Atlas developed "health referral regions," which define 306 geographically distinct healthcare markets in the U.S. centered around the availability of tertiary medical care.

Each health referral region contains at least one hospital performing major cardiovascular procedures and neurosurgery, so every person within any region should have reasonable geographic access to at least one hospital performing major complex procedures.

The 20 U.S. News Honor Roll hospitals are spread across 15 health referral regions. The Los Angeles, Boston, Chicago, and Manhattan regions each include multiple top-ranked hospitals.

Table 1: Health referral regions that include a U.S. News Honor Roll hospital and the populations in those regions

Note that all population numbers are derived from 2020 U.S. census data.

Health referral region Health referral region population % of U.S. population
Baltimore, Maryland 2,628,830 0.8%
Boston, Massachusetts 5,235,393 1.6%
Chicago, Illinois 2,628,186 0.8%
Cleveland, Ohio 2,068.357 0.6%
Durham, North Carolina 1,447,073 0.4%
East Long Island, New York 4,948,168 1.5%
Houston, Texas 7,683,528 2.3%
Los Angeles, California 10,075,230 3.0%
Manhattan, New York 5,396,092 1.6%
Philadelphia, Pennsylvania 4,371,218 1.3%
Phoenix, Arizona 3,839,462 1.2%
Rochester, Minnesota 437,323 0.1%
San Diego, California 3,952,020 1.2%
San Francisco, California 1,556,343 0.5%
San Mateo County, California 854,269 0.3%
Total population (% of U.S.) = 57,121,492 (17.2%)

Only 17.2% of the U.S. population resides within these 15 health referral regions. This means that fewer than 1 in 5 Americans lives in geographic proximity to a U.S. News Honor Roll hospital. Thus, while rankings such as these may be beneficial to those in these 15 health referral regions, most people may have difficulty accessing a U.S. News Honor Roll hospital.

However, when we expand the analysis to include the U.S. population residing in one of the 74 health referral regions that contain at least one of the 125 reliably excellent U.S. hospitals (again, several health referral regions include multiple reliably excellent hospitals), we can see that 38.7%, or nearly 2 in 5 Americans, live near a reliably excellent hospital.

Table 2: Health referral regions that include a reliably excellent hospital

Health referral regions by state
Arizona Phoenix Montana Missoula
California Los Angeles Nebraska Omaha
  San Diego New Jersey Morristown
  San Luis Obispo   Ridgewood
  San Mateo County New York Manhattan
  Santa Barbara North Carolina Raleigh
Colorado Boulder   Winston-Salem
  Denver Ohio Akron
  Fort Collins   Canton
Florida Jacksonville   Cincinnati
Georgia Atlanta   Cleveland
  Macon   Columbus
Hawaii Honolulu   Youngstown
Idaho Boise Oklahoma Oklahoma City
Illinois Elgin   Tulsa
  Evanston Oregon Medford
  Hinsdale Pennsylvania Harrisburg
  Melrose Park   Lancaster
Indiana Fort Wayne South Dakota Sioux Falls
  Indianapolis Tennessee Chattanooga
Iowa Cedar Rapids   Kingsport
  Dubuque Texas Austin
Kansas Wichita   Corpus Christi
Kentucky Lexington   Dallas
Maine Portland   Houston
Massachusetts Boston Utah Provo
  Springfield   Salt Lake City
Michigan Ann Arbor Vermont Burlington
  Grand Rapids Virginia Arlington
  Kalamazoo   Norfolk
  Marquette Washington Seattle
  Petoskey   Spokane
  Saginaw   Yakima
Minnesota Minneapolis Wisconsin La Crosse
  Rochester   Madison
Mississippi Tupelo   Marshfield
Missouri Kansas City   Milwaukee
Total population (% of U.S.) = 128,279,050 (38.7%)

These 74 health referral regions include the 125 reliably excellent hospitals and serve 128,279,050 people — 38.7% of the U.S. population.

Take-home point

Our analysis underscores the need for U.S. hospital quality stakeholders to work toward providing benchmarked, geographically relevant information to patients about the best hospitals within a reasonable distance from their homes.

Related publications

Contact

Ben D. Pollock, Ph.D., M.S.