Methodology
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Data Sources
This platform integrates data from three primary sources outlined in greater detail in the sections below: (1) surveys fielded since 2019 through the West Health-Gallup partnership (Explore Data by Topic); (2) the first wave of an extensive, nationally and state-representative survey conducted in summer 2025, which will be repeated annually (Explore Data by Location); and (3) the November health and healthcare module of the Gallup Poll Social Series (GPSS), which has provided annual data since 2001 (Explore Data by Long-Term Trends).
Question Selection and Processing
Multiple survey research methodology experts at Gallup carefully reviewed every question from each survey administration across the included data sources. Only questions for which Gallup could fully recover the original wording, and the associated final data, were retained. Questions with open-ended numeric responses were included, while all other open-ended responses were excluded.
A researcher manually tagged each retained question with the appropriate pillars and topics, and a secondary researcher verified the tagging to ensure accuracy. Discrepancies in coding were resolved with an independent third researcher.
Across the “Topic” and “Location” data sources, some questions that were modified across separate surveys were collapsed and displayed as a single variable in the platform. This process was applied only when questions were nearly identical, with differences limited to minor wording changes or the inclusion or exclusion of additional response options (e.g., “Don’t know”). To be combined, questions had to be asked in a complementary mode, and at least two Gallup researchers had to independently confirm that the differences were too minor to affect participant interpretation or result distributions. When questions were merged, the most recent version of the question text was used for display, but all response options from across the combined versions were retained for comprehensiveness.
Non-answer options such as “Don’t know” or “Not applicable” were consistently included in reporting for transparency. For phone surveys, “Don’t know” and “Refused” were combined to “Don’t know/Refused” for simplicity. Item nonresponse (i.e., skipped questions) for web and mail modes was excluded from frequency displays and percentage denominators.
Sample Inclusions and Reporting Rules
All survey participants aged 18 or older at the time of survey administration were included in the dataset. Although data cleaning may have been conducted at the time of survey administration, no other parameters for demographic validity or additional cleaning rules were applied to the data for this platform.
Survey field termination dates were defined as the last response submission date for each survey.
To ensure stability in reported estimates, data were displayed only when the unweighted sample size met a minimum threshold of 200 respondents.
Reported sample sizes are always unweighted, while reported percentages are always weighted. In some instances, percentages may not sum to 100% due to rounding.
All reporting derives from final respondent-level datasets. Only cases with a valid and verified weight value were retained in the platform. For analytical purposes, respondents are assumed to be unique across surveys, with no duplication across administrations.
Filters and “View by” Variables
Filters and "View by" variables allow users to view results by key demographic and contextual variables. For these tools, the most recent recorded value was used to ensure the most up-to-date data. Note that the 'View by' feature is currently only available for West Health-Gallup sourced items. See below for key details about featured variables:
Race/Ethnicity: Although respondents were allowed to select multiple race/ethnicity categories, race was recoded into mutually exclusive categories: Respondents identifying as Hispanic were classified as Hispanic regardless of race; non-Hispanic respondents selecting only White were classified as White; non-Hispanic respondents selecting Black or Asian were classified accordingly; non-Hispanic respondents selecting American Indian, Native Hawaiian or Other were grouped as Other; and respondents selecting both White and American Indian were classified as White.
Income: Income reflects annual household income.
Geographic Variables: Region and division were derived from ZIP code, while urbanicity was defined using Metropolitan Statistical Area (MSA) designations (urban for valid MSAs vs. rural for non-valid MSAs).
Explore Data by Topic
Since 2018, West Health and Gallup have partnered to track perceptions of the U.S. healthcare system in relation to cost, quality, access and mental health, with the aim of giving voice to everyday Americans and their healthcare experiences. The goal is to identify strengths, weaknesses, issues and trends that can better inform public policy and healthcare practice and delivery.
By partnering with Gallup, West Health spotlights the experiences and opinions of the American people via rigorous survey methodology that accurately details Americans’ perceptions of healthcare affordability and its impact on their ability to live well and age healthily. Our ongoing partnership emphasizes solutions that the public supports and highlights a path toward achieving meaningful change.
All West Health-Gallup surveys conducted since the beginning of this partnership are included in this platform, providing a comprehensive longitudinal resource. This continuity makes it possible to track changes in perceptions over time and place new results in the context of broader historical trends.
The majority of these surveys have been sampled via the Gallup Panel™, either via web surveys or via combined web plus mail modalities. In select cases, additional sampling frames, such as address-based sampling (ABS) or random digit dialing (RDD), have been used to ensure adequate coverage and representativeness of the population being studied.
Caution should be used when interpreting longitudinal trends for West Health-Gallup sourced items due to differences in survey mode and contextual influences across fielding periods. First, observed variance in response patterns over time could partly reflect known mode effects. In particular, items collected from surveys with termination dates between February 2019 and August 2020 were administered exclusively via phone. Measurable mode effects for phone-based interviewing relative to web or mail survey administrations are a well-documented phenomenon in survey research. As such, comparisons involving these data points and those subsequently collected via web or mail should be made cautiously. Second, estimates from the component items of the West Health Indices should be interpreted with care for surveys terminating between January 2021 and June 2021. During this period, the Indices were embedded within a much larger questionnaire focused on COVID-19. Subsequent methodological analyses have shown that the pandemic-related content preceding the indices introduced some measurable context effects by influencing response estimates to these items. Therefore, trended comparisons involving these data should be treated with caution.
Explore Data by Location
All data in this section are based on the West Health-Gallup State Survey, conducted online from June 9-July 25, 2025, with a sample of 19,535 adults aged 18 and older residing in all 50 U.S. states and the District of Columbia. Respondents were recruited from two sources: 13,721 respondents were recruited from the Gallup Panel and 5,814 respondents were recruited from an address-based sampling (ABS) frame provided by Marketing Systems Group (MSG). Individuals in the ABS sample received mailed invitations and reminder communications to complete the survey online, either through a QR code or a web link with a unique ID access code. All surveys were conducted in English. Respondents without internet access were not covered by this study.
Data was collected from the Gallup Panel sample from June 9-24, 2025, and data was collected from the ABS sample from June 11-July 25, 2025. Due to lower-than-expected response rates in some states, an additional Gallup Panel sample was added during fieldwork, with data collected from July 11-25, 2025. All reported results combine these sample sources.
Sampling for the Gallup Panel was conducted with stratified random sampling based on state, age and education. Sampling for the ABS sample was based on simple random sampling, stratified by state, which gives an equal probability of selecting each address within the same state; random selection within the household was assumed.
Gallup weighted the combined samples to correct for unequal selection probability and nonresponse, and to align with state-level demographics of age, gender, education, race and Hispanic ethnicity. Demographic weighting targets were based on the most recent American Community Survey figures for the 18 and older population in each state. Weighting for national estimates entailed further adjustments to reflect each state’s share of the national population.
For results based on the full sample, the design-effect-adjusted margin of error (MOE) at the 95% confidence interval is ±1.3 percentage points for response percentages around 50%. The table below provides additional methodological detail broken out by reported states. Six states used the Gallup Panel sample only; the rest used a combination of Gallup Panel and ABS samples. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.
State Sample Details
| State | Sample Size | Response Rate | Design Effect | MOE | ||||
|---|---|---|---|---|---|---|---|---|
| Panel | ABS | Total | Panel | ABS | Total | Total | Total | |
| AK | 40 | 295 | 335 | 49% | 7% | 7% | 2.1 | ±7.8 |
| AL | 250 | 90 | 340 | 45% | 4% | 13% | 1.7 | ±6.9 |
| AR | 151 | 170 | 321 | 47% | 5% | 9% | 1.8 | ±7.3 |
| AZ | 323 | 56 | 379 | 53% | 4% | 18% | 1.8 | ±6.7 |
| CA | 441 | 0 | 441 | 51% | - | 51% | 1.7 | ±6.1 |
| CO | 387 | 22 | 409 | 51% | 4% | 32% | 1.9 | ±6.6 |
| CT | 206 | 138 | 344 | 55% | 5% | 11% | 1.9 | ±7.3 |
| DC | 148 | 195 | 343 | 56% | 6% | 9% | 2.1 | ±7.7 |
| DE | 69 | 247 | 316 | 50% | 6% | 8% | 1.9 | ±7.6 |
| FL | 454 | 0 | 454 | 53% | - | 53% | 1.6 | ±5.9 |
| GA | 396 | 0 | 396 | 46% | - | 46% | 1.6 | ±6.2 |
| HI | 60 | 263 | 323 | 50% | 7% | 8% | 1.9 | ±7.6 |
| IA | 274 | 87 | 361 | 51% | 5% | 17% | 1.6 | ±6.6 |
| ID | 145 | 175 | 320 | 55% | 7% | 11% | 2.0 | ±7.7 |
| IL | 453 | 0 | 453 | 53% | - | 53% | 1.6 | ±5.9 |
| IN | 452 | 0 | 452 | 48% | - | 48% | 1.7 | ±6.0 |
| KS | 188 | 150 | 338 | 51% | 6% | 12% | 1.8 | ±7.1 |
| KY | 259 | 82 | 341 | 44% | 5% | 16% | 1.7 | ±6.9 |
| LA | 193 | 107 | 300 | 43% | 4% | 9% | 1.9 | ±7.8 |
| MA | 499 | 0 | 499 | 54% | - | 54% | 1.9 | ±6.0 |
| MD | 377 | 43 | 420 | 51% | 7% | 30% | 1.7 | ±6.2 |
| ME | 114 | 211 | 325 | 55% | 6% | 9% | 2.0 | ±7.7 |
| MI | 442 | 24 | 466 | 52% | 5% | 34% | 1.5 | ±5.5 |
| MN | 447 | 27 | 474 | 51% | 5% | 35% | 1.7 | ±6.0 |
| MO | 406 | 29 | 435 | 50% | 6% | 33% | 1.5 | ±5.8 |
| MS | 102 | 222 | 324 | 44% | 4% | 6% | 1.7 | ±7.2 |
| MT | 64 | 262 | 326 | 52% | 7% | 9% | 2.1 | ±7.8 |
| NC | 411 | 26 | 437 | 48% | 5% | 32% | 1.5 | ±5.8 |
| ND | 70 | 186 | 256 | 47% | 5% | 7% | 1.7 | ±8.0 |
| NE | 128 | 223 | 351 | 50% | 7% | 11% | 2.1 | ±7.6 |
| NH | 102 | 221 | 323 | 50% | 6% | 8% | 2.0 | ±7.8 |
| NJ | 435 | 20 | 455 | 52% | 4% | 34% | 1.7 | ±6.0 |
| NM | 139 | 200 | 339 | 53% | 5% | 9% | 2.0 | ±7.5 |
| NV | 113 | 234 | 347 | 48% | 4% | 6% | 1.7 | ±6.9 |
| NY | 439 | 29 | 468 | 51% | 6% | 34% | 1.6 | ±5.6 |
| OH | 453 | 31 | 484 | 53% | 6% | 36% | 1.5 | ±5.4 |
| OK | 200 | 129 | 329 | 47% | 5% | 11% | 1.7 | ±7.1 |
| OR | 317 | 101 | 418 | 56% | 7% | 21% | 2.0 | ±6.9 |
| PA | 440 | 21 | 461 | 51% | 4% | 34% | 1.4 | ±5.4 |
| RI | 129 | 220 | 349 | 51% | 5% | 8% | 2.1 | ±7.6 |
| SC | 266 | 88 | 354 | 50% | 4% | 14% | 1.9 | ±7.2 |
| SD | 109 | 194 | 303 | 52% | 5% | 8% | 1.8 | ±7.6 |
| TN | 374 | 23 | 397 | 50% | 4% | 29% | 1.7 | ±6.5 |
| TX | 416 | 21 | 437 | 49% | 4% | 32% | 1.7 | ±6.2 |
| UT | 248 | 128 | 376 | 54% | 6% | 15% | 2.0 | ±7.2 |
| VA | 470 | 23 | 493 | 55% | 5% | 36% | 1.8 | ±5.9 |
| VT | 45 | 287 | 332 | 57% | 8% | 9% | 2.0 | ±7.6 |
| WA | 434 | 38 | 472 | 51% | 8% | 35% | 1.7 | ±5.9 |
| WI | 431 | 35 | 466 | 55% | 7% | 36% | 1.7 | ±6.0 |
| WV | 114 | 202 | 316 | 48% | 5% | 7% | 1.8 | ±7.5 |
| WY | 98 | 239 | 337 | 54% | 6% | 8% | 2.0 | ±7.6 |
| National (Total) | 13,721 | 5,814 | 19,535 | 51% | 6% | 15% | 3.3 | ±1.3 |
Note: Sample sizes are unweighted. Response rates are calculated as the number of retained survey responses after data cleaning, divided by the number of individuals invited to participate in the survey.
Note that on the scorecards, the "driver" percents are included in the broader set of indicators used to calculate the rankings; they do not directly factor into the grading framework.
Letter Grades
To provide a familiar and interpretable framework for assessing Americans' perceptions of healthcare performance in their local areas, a GPA-based grading system aligned with standard U.S. academic grading conventions was used to assign letter grades. Responses to five items assessing perceptions of healthcare (overall healthcare system, healthcare cost, healthcare quality and healthcare access) were recoded from the original 1 to 5 letter-grade scale (A to F) to a 0 to 4 numeric scale (A = 4, B = 3, C = 2, D = 1, F = 0). Skipped responses were treated as missing. Weighted mean scores for each item were then calculated both nationally and within each state using survey weights to ensure population-representative estimates. The resulting unrounded weighted mean scores were then mapped to GPA bands and corresponding letter grades according to the standard GPA thresholds shown below.
| GPA Threshold | GPA Band Range | Letter Grade |
|---|---|---|
| 4.0 | 4.00 | A+ |
| 4.0 | 4.00 | A |
| 3.7 | 3.70–<4.00 | A− |
| 3.3 | 3.30–<3.70 | B+ |
| 3.0 | 3.00–<3.30 | B |
| 2.7 | 2.70–<3.00 | B− |
| 2.3 | 2.30–<2.70 | C+ |
| 2.0 | 2.00–<2.30 | C |
| 1.7 | 1.70–<2.00 | C− |
| 1.3 | 1.30–<1.70 | D+ |
| 1.0 | 1.00–<1.30 | D |
| 0.7 | 0.70–<1.00 | D− |
| 0.0 | 0.00–<0.70 | F |
This approach allows state-level and national averages to be expressed using a familiar grading scale, providing an intuitive benchmark for interpreting public evaluations of healthcare performance.
Ranking
The West Health-Gallup healthcare experience rankings were developed using composite scales derived from multiple survey questions that assessed healthcare experiences across three key dimensions: cost, quality and access. To begin, Gallup identified several survey items (about 40) that were conceptually related to at least one of the three dimensions. These items were then recoded to handle missing data and "Don't know" or "Does not apply" responses, applied dummy coding to dichotomous items, and reverse-coded items so that higher scores consistently reflected more favorable healthcare experiences. All items were then standardized using z-scores to ensure equal weighting in the analysis, regardless of their original response scales.
Following this, Gallup conducted exploratory factor analysis (EFA) using different sets of survey items. The EFA was run using the items intended to measure each scale (cost, quality and access). The final items selected for each subscale demonstrated strong factor loadings (absolute value of 0.4 or higher), indicating they were reliable indicators of their respective constructs.
Composite measures for cost, quality and access were then calculated by averaging the standardized scores of the selected items. For the access dimension specifically, items related to barriers in accessing healthcare were averaged separately to ensure they were weighted equally (one-third) with general perceptions of access to physical (one-third) and mental health services (the final third). The overall healthcare experience score was computed by averaging the standardized composite scores of cost, quality and access.
Finally, states were ranked by sorting the scores for each dimension – cost, quality, access and overall experience – from highest to lowest, with higher rankings indicating more favorable healthcare experiences.
To provide convergent validity evidence for the West Health-Gallup health experiences rankings, Gallup examined how these rankings aligned with related constructs and other established healthcare ranking systems. The analysis revealed that the West Health-Gallup rankings were associated with key indicators in expected and meaningful ways, supporting their overall validity.
First, the overall index correlates with self-reported health status at the individual (r=0.31) and state levels (r=0.42). States that ranked higher on the health experiences scale also had a greater proportion of residents who rated their health as good, very good or excellent. This self-reported health status was collected within the same survey as the items used to construct the health experiences rankings, reinforcing the internal consistency of the findings.
Second, the rankings aligned with external health system performance indicators. States with higher overall rankings tended to have longer life expectancies (r=0.43) and a greater percentage of residents who reported having a primary care doctor (r=0.47) and seeing a doctor in the past year (r=0.52). These indicators were sourced from the widely respected Kaiser Family Foundation's State Health Facts.
Finally, the West Health-Gallup rankings showed positive correlations with other state-level healthcare ranking systems, specifically those developed by the Commonwealth Fund (r=0.54 for the overall ranking). Although the Commonwealth Fund rankings include additional factors such as health status, system utilization and other performance metrics not captured in the West Health-Gallup framework, the theoretical overlap between these measures supports the validity of the Gallup rankings as a reflection of overall healthcare experiences.
Final Items Included in Ranking Composites
Note. All items included in this table are included in the Overall Health Experiences Ranking.
Experiences With Healthcare Cost
- To what extent are healthcare costs a financial burden for you and your family?
- How much stress does the cost of healthcare for you and your family contribute to your daily life?
- Has there been a time in the last three months when you or a member of your household had a health problem, but you did not seek treatment due to the cost of care?
- Has there been a time in the last three months when you or a member of your household has been unable to pay for medicine or drugs that a doctor had prescribed for you because you did not have enough money to pay for them?
- If you needed access to quality healthcare today, would you be able to afford it?
- Generally, do you think that your household pays too much, too little, or about the right amount for the quality of healthcare you receive?
- Thinking of the most recent time that you received medical care in-person or remotely, was your experience worth what it cost?
- Thinking about the last 12 months, have you or a family member skipped a prescribed pill, dose, or other type of medication in order to save money?
- Has there been a time in the past 12 months when you chose not to have a medical procedure, lab test, or other evaluation that a doctor recommended to you because you didn't have enough money to pay for it?
- Has there been a time in the last 12 months when a friend or family member passed away after not receiving treatment for their condition due to their inability to pay for it?
Experiences With Healthcare Quality
- You can see the same medical professional(s) consistently when you need care.
- Your medical professional(s) knows your medical history well.
- Your medical professional(s) knows your health needs and preferences for care.
- Your medical professional(s) provides high quality care.
- Your medical professional(s) treats you with respect.
- Does your primary care provider typically …? Ensure that you receive all recommended health screenings or evaluations.
- Does your primary care provider typically …? Discuss healthy lifestyle choices, such as dietary or physical activity recommendations.
- Does your primary care provider typically …? Ask about your mental health.
Experiences With Healthcare Access
- How easy or difficult is it for you to access the healthcare services you need to meet your physical health needs?
- How easy or difficult is it for you to access the healthcare services you need to meet your mental health needs?
- In the past 12 months, have any of the following prevented or delayed you from accessing healthcare that you or a family member needed? You did not know how to find a medical professional.
- In the past 12 months, have any of the following prevented or delayed you from accessing healthcare that you or a family member needed? Long wait times for appointments.
- In the past 12 months, have any of the following prevented or delayed you from accessing healthcare that you or a family member needed? The distance to, or location of, medical professionals.
- In the past 12 months, have any of the following prevented or delayed you from accessing healthcare that you or a family member needed? Lack of access to personal or public transportation.
- In the past 12 months, have any of the following prevented or delayed you from accessing healthcare that you or a family member needed? Your work schedule or employer policies.
- In the past 12 months, have any of the following prevented or delayed you from accessing healthcare that you or a family member needed? Childcare, caretaking, or other family obligations.
- In the past 12 months, have any of the following prevented or delayed you from accessing healthcare that you or a family member needed? Your health or physical mobility.
Alignment of Sample Sources
To assess whether adjustments were needed between participants sampled from the Gallup Panel and those sampled via ABS, we first compared weighted demographic compositions to external benchmarks within each state. Specifically, we calculated the average absolute percentage-point difference between each demographic group’s weighted estimate and its benchmark value, averaging across all demographic levels within each state. We then compared this measure across two groups: the 10 states with the largest ABS sample composition and the 10 states with the largest Gallup Panel sample composition. Although the average absolute differences were slightly higher in the states with a high proportion of ABS sample than the states with a high proportion of Gallup Panel sample, the magnitude of the difference was small. This indicated that weighting effectively balanced demographic differences across sampling modes and that any remaining differences reflected expected variation between states rather than systematic bias.
Second, we compared response distributions between the two sample sources across key variables that have been asked repeatedly in past surveys (thus acting as benchmarks) to test for systematic differences (e.g., consistent skews toward more positive or negative responses). Among the 10 states with the largest blended sample composition, we found no meaningful or consistent differences of large magnitude on any of the key variables, indicating no systematic bias between Gallup Panel and ABS samples. We further validated this by comparing the combined sample results from the current study with prior survey results on these same variables; no major unexpected differences emerged either overall or within key demographic groups. Taken together, this evidence confirmed that the Gallup Panel and ABS samples were aligned, and therefore no adjustments or other calibrations beyond standard weighting procedures were necessary to integrate the ABS sample into extant research in the platform.
Explore Data by Long-Term Trends
Long-term trend data was collected from the Gallup Poll Social Series (GPSS), a series of public opinion surveys designed to monitor U.S. adults’ views on numerous social, economic and political topics. The topics are arranged thematically across 12 surveys conducted annually. Introduced in 2001, Gallup administers each of the 12 surveys during the same month every year and includes the survey’s core trend questions in the same order each administration. Using this consistent standard allows for unprecedented analysis of changes in trend data that are protected from question order bias and seasonal effects.
Gallup conducts one GPSS survey per month, with each devoted to a different topic. The data in this platform include the November survey about health and healthcare, which is always conducted via random digit dialing (RDD) phone surveys. Only data where the survey was conducted in English are retained in this platform.
The Gallup-West Health Center co-sponsors the GPSS healthcare trends survey to continue tracking the state of healthcare in America.
For more information on GPSS, please visit: How Does the Gallup Poll Social Series Work?
Video Vignettes
To better understand Americans' perceptions of healthcare in the United States, Gallup conducted five in-depth interviews with individuals with direct experience or insights relevant to the research focus. The interviews were designed to gather rich, first-hand feedback in participants' own words.
Participant Selection
Participants were identified and recruited between April 2025 and June 2025 through a three-step process described below. All participants were recruited from the Gallup Panel®, a nationally representative panel of U.S. adults (18 and older) who have agreed to participate in research.
- Intake Form: Gallup Panel members were emailed an invitation to complete an intake form. The form asked about their healthcare experiences and their interest in a full-length interview.
- Screener Calls: Gallup conducted short introductory calls with panel members who completed the intake form and indicated interest in participating in a full interview. These calls confirmed eligibility, ensured participants had the appropriate background and experience to provide meaningful input, and verified they had the technology required for recording.
- Interview Invitations: Those who completed screener calls and were determined to be a good fit for the interviews were emailed invitations to participate in a full interview. The invitations included information about the types of topics the interviews might cover.
This approach ensured a diverse and relevant mix of participants. The sample is not intended to be statistically representative but to provide a foundation for identifying key themes and patterns and highlighting relatable experiences.
Interview Approach
- Format: Interviews were semi-structured and guided by a discussion outline, allowing flexibility to follow new insights.
- Length: Each interview lasted approximately 60 minutes.
- Mode: Interviews were conducted virtually.
- Consent: All participants provided informed consent to take part in the study. They agreed to have their interviews audio- and video-recorded, with the understanding that selected quotes and video clips could be used for research and reporting purposes alongside their first name, last initial, photograph, state of residence and age.
- Oversight: All research procedures were approved by Gallup's Institutional Review Board (no. 2025-04-02).
Analysis and Reporting
Interviews were recorded (with permission) and summarized into transcripts. Using thematic analysis, Gallup identified recurring ideas, unique perspectives and points of convergence and divergence. Selected quotes and video clips presented on this platform represent the diverse experiences of participants and are not meant to be exhaustive. However, they can be utilized to better understand Americans' healthcare experiences, inform strategic decision-making, highlight opportunities and guide next steps. Gallup recommends using these qualitative insights alongside quantitative data available on this platform for the most robust foundation for strategy and action.
Additional Questions
For additional methodology questions, please contact galluphelp@gallup.com.