3 | Missouri

Missouri ranks near the top in the HOAP Index with a score of 3.66.

**Update March, 26, 2019: The latest edition of HOAP is currently under data review and will be updated shortly. Please refer to the 2016 edition of this report. Contact Kate De Lanoy at [email protected] with any questions.**

The Healthcare Openness and Access Project (HOAP) measures how open and accessible each state’s healthcare system is to patient and provider preferences. The overall HOAP index is the average of 10 categories, referred to as subindexes, each of which is in turn an average of multiple indicators.

The HOAP index ranks Missouri near the top of the 51 jurisdictions analyzed. Some of the state’s highest scores are in the Corporate Subindex and the Public Health Subindex and some of its lowest are in the Telemedicine Subindex and the Pharmaceutical Access Subindex. Missouri’s score and rank in each subindex are given below, along with its score for each individual indicator.

For the overall index, the subindexes, and the indicators, 1 is the lowest score and 5 is the highest.

Corporate Subindex

Score: 5.00 (US mean: 2.59, median: 2.00), Rank: 1

A higher score indicates that healthcare professionals and others have greater flexibility with regard to ownership, business structure, and employment in the healthcare sector.

IndicatorState scoreUS mean
State allows the corporate practice of medicine5.002.25
State allows business to employ licensed healthcare professionals5.003.04
State allows nonlicensed individuals to own/operate medical entities5.002.88
State allows licensed individuals to split fees with nonlicensed individuals5.002.18

Direct Primary Care Subindex

Score: 3.67 (US mean: 3.02, median: 3.00), Rank: 6

A higher score indicates the state’s environment is more conducive to the establishment of direct primary care (DPC) practices as an alternative method of financing primary care.

IndicatorState scoreUS mean
State has pro-DPC laws5.003.65
State has higher market demand for DPC3.002.96
State has more DPC practices per capita3.002.45

Insurance Subindex

Score: 4.20 (US mean: 3.40, median: 3.60), Rank: 6

A higher score indicates that insurers have greater flexibility to determine the structure and pricing of health insurance policies.

IndicatorState scoreUS mean
State mandates fewer health insurance benefits1.001.65
State mandates less rate review5.002.10
State does not expand on federal age rating limitations5.004.73
State does not expand on federal tobacco rating limitations5.004.25
State does not expand on federal geographic rating limitations5.004.25

Medical Liability Subindex

Score: 3.67 (US mean: 3.27, median: 3.33), Rank: 8

A higher score indicates that physicians and others are less constrained by the threat of malpractice litigation.

IndicatorState scoreUS mean
State physicians pay fewer malpractice actions4.003.61
State physicians pay lower malpractice premiums4.003.45
State has adopted more reforms to modulate malpractice litigation3.002.76

Occupational Regulation Subindex 

Score: 3.80 (US mean: 3.15, median: 3.40), Rank: 7

A higher score indicates that medical professionals have easier access to licensure and employment and greater discretion regarding the services they offer.

IndicatorState scoreUS mean
State allows medical licensure reciprocity with other states5.002.80
State has fewer continuing medical education requirements3.002.90
State allows nurse practitioners broad scope of practice1.003.39
State has fewer optician licensing requirements5.003.55
State allows direct-entry midwifery5.003.08

Pharmaceutical Access Subindex

Score: 3.00 (US mean: 2.98, median: 3.0), Rank: 19

A higher score indicates that patients have easier access to certain classes of drugs, including experimental and unconventional treatments.

IndicatorState scoreUS mean
State allows greater access to experimental drugs5.003.04
State allows access to medical marijuana4.003.71
State allows easier access to pseudoephedrine2.004.02
State allows over-the-counter access to oral contraceptives1.001.16

Provider Regulation Subindex

Score: 3.00 (US mean: 2.69, median: 2.67), Rank: 16

A higher score indicates that healthcare providers have greater flexibility to determine hospital and pharmacy operations.

IndicatorState scoreUS mean
State has fewer certificate-of-need restrictions2.002.86
State puts fewer restrictions on compounding pharmacies3.002.37
State lacks burdensome prescription monitoring mandates4.002.82

Public Health Subindex

Score: 4.33 (US mean: 4.22, median: 4.33), Rank: 19

A higher score indicates that residents have easier access to substance abuse remedies and greater discretion when offering medical assistance to other people.

IndicatorState scoreUS mean
State allows access to e-cigarettes4.003.37
State allows access to naloxone5.004.65
State has strong "Good Samaritan" protection4.004.65

Taxation Subindex

Score: 3.67 (US mean: 3.69, median: 3.67), Rank: 18

A higher score indicates that the state imposes a lower burden of taxation for certain healthcare services, financing methods, and devices.

IndicatorState scoreUS mean
State has fewer provider taxes1.002.18
State has fewer health savings account (HSA) taxes5.004.69
State has fewer medical device taxes5.004.20

Telemedicine Subindex

Score: 2.25 (US mean: 2.74, median: 2.50), Rank: 39

A higher score indicates that the state’s environment is more conducive for telemedicine practitioners.

IndicatorState scoreUS mean
State reimburses Medicaid providers at parity for telemedicine3.003.27
State has less restrictive telepresenter requirements3.003.84
State reimburses Medicaid providers at parity for remote monitoring2.001.94
State allows online prescribing1.001.90

For a complete explanation of the methodology used to calculate Missouri's HOAP index score, see the Healthcare Openness and Access Project page.

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