While the United States ranks dead last in quality among 11 wealthy nations, a new report reveals that Louisiana is the worst state for healthcare overall.

The Pelican State has one of the highest rates of heart disease in the country, the third highest cancer rate and a significantly low number of dentists per capita, according to WalletHub’s annual list of the best and worst states for healthcare.

The personal finance website compared the 50 states and the District of Columbia for healthcare cost, access and outcomes. Among the 35 measures they considered within those categories were: costs of medical and dental visits, average emergency room wait times, physicians per capita, average monthly insurance premiums, heart disease and cancer rates, and life expectancy rates.

Louisiana was also ranked one of the worst states for nurses in a recent WalletHub report. And New Orleans held the distinction earlier this year of being one of the worst cities in the nation in which to practice medicine, according to a Medscape report.

WalletHub determined that the best state overall for healthcare was Hawaii, which has one of the highest percentages of insured children and adults and the lowest heart disease rate in the country. However, the report notes that the Aloha State also has the lowest rate of physician acceptance of Medicare.

The 10 best states in the nation overall for healthcare:
1. Hawaii
2. Iowa
3. Minnesota
4. New Hampshire
5. District of Columbia
6. Connecticut
7. South Dakota
8. Vermont
9. Massachusetts
10. Rhode Island

The 10 worst states for healthcare:
51. Louisiana
50. Mississippi
49. Alaska
48. Arkansas
47. North Carolina
46. Georgia
45. South Carolina
44. Alabama
43. Florida
42. Nevada