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23 | District of Columbia
Score: 3.34 (US mean: 3.27, median: 3.26), Rank: 23
The Healthcare Openness and Access Project (HOAP) measures the extent to which states leave patients, providers, and businesses free to seek or provide healthcare as they deem best. Each state is evaluated on 41 different indicators, receiving a score of 1 (lowest) to 5 (highest) for each indicator. These 41 indicators are grouped into 5 categories. A state’s category score is the average of all the indicators in that category. A state’s overall score is the average of the five category scores. Finally, the states are ranked by their overall scores.
The HOAP index ranks the District of Columbia near the middle of the 51 jurisdictions analyzed. Some of the state’s highest scores are in the Patient Regulation category and the Professional Regulation category, and some of its lowest are in the Institutional Regulation category and the Payment Regulation category. The District of Columbia’s score and rank in each category are given below. The table shows the District of Columbia’s score for each indicator, along with the distribution of scores across the 50 states and Washington, DC.
Professional Regulation Category
Score: 3.40 (US mean: 3.14, median: 3.00), Rank: 18
A higher score indicates that healthcare professionals have easier access to licensure and greater flexibility with regard to employment in the healthcare sector.
Indicator | DC Score | US Mean |
|---|---|---|
State allows medical licensure reciprocity with other states | 3 | 3.20 |
State has fewer continuing medical education requirements | 3 | 2.88 |
State grants nurse practitioners broad scope of practice | 5 | 3.43 |
State has fewer optician licensing requirements | 5 | 3.55 |
State grants behavioral health providers broad scope of practice | 3 | 3.71 |
State grants midwives broad scope of practice | 1 | 3.35 |
State grants pharmacists broad scope of practice | 3 | 3.86 |
State grants dental hygienists broad scope of practice | 3 | 2.57 |
State has less restrictive licensing of certified registered nurse anesthetists | 5 | 1.94 |
State limits liability for charity caregivers | 3 | 2.92 |
Institutional Regulation Category
Score: 2.83 (US mean: 2.96, median: 3.17), Rank: 31
A higher score indicates that healthcare institutions such as hospitals, payers, and pharmacies have greater flexibility to determine their business operations.
Indicator | DC Score | US Mean |
|---|---|---|
State has fewer certificate-of-need restrictions | 2 | 3.45 |
State puts fewer restrictions on compounding pharmacies | 1 | 1.86 |
State does not mandate payers submit data to an all-payer claims database | 5 | 3.51 |
State has fewer provider taxes | 1 | 2.08 |
State allows entrepreneurial business structures | 3 | 2.88 |
State does not have mandatory generic substitution laws | 5 | 3.98 |
Patient Regulation Category
Score: 3.67 (US mean: 3.10, median: 3.00), Rank: 5
A higher score indicates that patients have easier access to certain types of drugs and harm-reducing substances and that they enjoy other protections.
Indicator | DC Score | US Mean |
|---|---|---|
State allows access to CBD oil | 5 | 3.49 |
State allows access to oral contraceptives without physician prescription | 5 | 1.78 |
State has lower excise taxes on e-cigarettes | 1 | 4.10 |
State allows access to naloxone | 5 | 3.92 |
State offers protection for Good Samaritans | 5 | 4.14 |
State has Free Speech In Medicine law | 1 | 1.16 |
Payment Regulation Category
Score: 3.22 (US mean: 3.47, median: 3.56), Rank: 36
A higher score indicates that patients, insurers, and others have greater flexibility to determine the structure and pricing of health insurance policies and that individuals face a lower burden of taxation for certain healthcare services and devices.
Indicator | DC Score | US Mean |
|---|---|---|
State mandates fewer health insurance benefits | 4 | 3.06 |
State does not constrict age rating further than federal law | 5 | 4.80 |
State has fewer health savings account (HSA) taxes | 5 | 4.69 |
State has less medical taxation | 5 | 3.41 |
State does not mandate that individuals buy health insurance | 1 | 4.53 |
State does not restrict short-term renewable health plans | 2 | 3.45 |
State allows drug manufacturer copay coupons | 5 | 4.69 |
State allows insurers in other states to issue health insurance in the state | 1 | 1.47 |
State allows prescription drug reimportation | 1 | 1.12 |
Delivery Regulation Category
Score: 3.60 (US mean: 3.70, median: 3.60), Rank: 26
A higher score indicates that the state’s environment is more conducive to the establishment of new technologies and business arrangements that affect the delivery of care, including telemedicine and direct primary care (DPC) practices.
Indicator | DC Score | US Mean |
|---|---|---|
State reimburses Medicaid providers at parity for store-and-forward telemedicine | 3 | 2.06 |
State reimburses Medicaid providers at parity for remote monitoring | 1 | 2.80 |
State allows broad Medicaid reimbursement by provider type | 5 | 4.22 |
State has less restrictive telepresenter requirements | 5 | 4.90 |
State has less restrictive telepharmacy location laws | 1 | 2.47 |
State allows online prescribing | 3 | 3.12 |
State allows online eye exams | 5 | 4.53 |
State does not treat DPC as insurance | 3 | 4.08 |
State allows DPC drug dispensing | 5 | 4.02 |
State allows DPC wholesale lab pricing | 5 | 4.84 |
For a complete explanation of the methodology used to calculate the District of Columbia’s HOAP index score, see Jared M. Rhoads, Darcy N. Bryan, and Robert F. Graboyes, "Healthcare Openness and Access Project 2020: Full Release" (Project Overview, Mercatus Center at George Mason University, Arlington, VA, December 2020).
To go to the HOAP 2020 homepage, click here.
To go to the HOAP 2018 homepage, click here.