Rhode Island has the best healthcare system in the U.S. while Mississippi has the worst, according to a WalletHub report released Monday.

The study analyzed all 50 states and the District of Columbia on more than 40 metrics, including healthcare cost, average monthly insurance premiums, access, physicians per capita and patient outcomes. 

Rhode Island ranked as the top state overall, followed by Massachusetts, Hawaii, Minnesota and Maryland. Maryland led the way for cost, while Massachusetts led the way in both access and outcomes. 

Alongside Mississippi at the bottom of the survey were Alabama, Louisiana, Oklahoma and Arkansas. Alaska finished last for cost, Alabama had the lowest ranking for access and Mississippi produced the worst outcomes.

“Americans need affordable, quality health care more than ever as we continue to deal with the COVID-19 pandemic,” the report noted. “State healthcare systems need to administer vaccines and care for those who contract the virus, including new variants, while making sure not to neglect the regular health care needs of their residents.”

As for specific metrics, Utah had the lowest average monthly insurance premium and West Virginia and Wyoming had the highest. The District of Columbia had the most hospital beds per capita and Utah had the fewest. D.C. also had the most physicians per capita; Idaho had the fewest.

WalletHub’s report was released just over a month after U.S. News & World Report unveiled its Healthiest Communities rankings. The project, conducted in collaboration with CVS Health, named Los Alamos County, New Mexico, as the healthiest community in America.