It is little wonder that Californians have a valued tradition of being health conscious.

After all, we have an abundance of sunshine and mild climate, easy access to a broad array of healthy outdoor activities from hiking to cycling to swimming, among others, not to mention a decided societal aversion to anything involving tobacco.

With those credentials, one might assume that health care experiences here are among the best in the country.

But a first-of-its-kind, state-by-state national score card devised by the Commonwealth Fund recently found that while such experiences in California are slightly better than average, there is room for improvement.

A jogger gets some exercise on the Coyote Creek Trail in south San Jose on a beautiful, and mild Wednesday, Sept. 25, 2013. (Patrick Tehan/Bay Area News
A jogger gets some exercise on the Coyote Creek Trail in south San Jose on a beautiful, and mild Wednesday, Sept. 25, 2013. (Patrick Tehan/Bay Area News Group)

The study measured a broad spectrum of factors, from accessibility to health care to tooth loss to obesity, and ranked the nation's most populous state 20th of the 50 states in its health care climate.

California scored well in dental health categories and its obesity rates are better than the national average. Not surprisingly its best performance was in the area of smoking. Only 17 percent of the low-income population in the state smoke tobacco, which is 10 percentage points below the national average. Among higher earners, just 8 percent smoke tobacco, against the category's national average of 12 percent.

Also interesting was the study's comparison of health care experiences of Americans based on their place on the socioeconomic ladder.


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For purposes of comparison, the study defined low-income as a family of four making less than $47,000 a year or a single person making $23,000. It used annual family income of $94,000 or above to define higher wage earners.

"The most striking finding in this report is that those with lower incomes in states that rank well do better than those of higher incomes in the lagging states," said Dr. David Blumenthal of the Commonwealth Fund. "Where you live plays a big part in your health care experience."

That appears true. For example, low-income people in Hawaii, which was the top-ranked state, reported decidedly better experiences than the high earners in West Virginia, one of the lowest ranked states in the study.

And when it came to paying for health care services, 30 percent of lower-income Californians had what the Commonwealth Fund considered high out-of-pocket medical costs relative to their income, while only 2 percent of upper-income people shouldered a similar burden, the report said.

California also scored in the bottom quarter for preventive care for older adults.

Like any such analysis, this study is limited by its assumptions and parameters, but it still has value. It sets a data benchmark before the sign-ups for Obamacare, which begin Tuesday and should serve as a state-by-state barometer of the effectiveness of Obamacare.