South Carolina healthcare quality sits in the lower-middle of national rankings, with strong hospital patient safety scores offset by high uninsured rates, doctor shortages, limited mental health access, and some of the country’s worst chronic disease and infant mortality outcomes. The Commonwealth Fund’s 2025 scorecard ranks the state 36th out of 51, a slight improvement from 37th in 2023.1Commonwealth Fund. South Carolina The short answer is that the system has real bright spots, but most residents encounter more friction and worse outcomes than the national average.
How the State Ranks Nationally
The major scorecards agree on the general picture. The Commonwealth Fund puts South Carolina 36th overall, with sub-rankings of 42nd in reproductive and women’s health and 46th in racial and ethnic health equity.2Commonwealth Fund. 2023 Scorecard on State Health System Performance – South Carolina The United Health Foundation’s America’s Health Rankings also placed the state 36th in its most recent annual report, its best finish since the report launched in 1990.3South Carolina Department of Public Health. DPH Highlights Notable Improvement in South Carolinas Health Ranking The trajectory is up, but the starting point is low.
Where the System Is Strong
Hospital patient safety is where South Carolina genuinely outperforms most of the country. The Leapfrog Group’s Spring 2025 Hospital Safety Grades ranked the state fifth nationally, with 47.1% of assessed hospitals earning an “A.”4South Carolina Hospital Association. Celebrating South Carolina Hospitals Success in Quality and Patient Safety That result reflects sustained work by the South Carolina Hospital Association’s Zero Harm programs and Surgical Quality Collaborative.
Flagship hospitals also compete nationally. MUSC Health University Medical Center in Charleston is U.S. News and World Report’s top-ranked hospital in the state, with obstetrics and gynecology ranked 16th nationally and pediatric cardiology and heart surgery ranked 4th.5U.S. News and World Report. MUSC Health-University Medical Center in Charleston, SC The catch is geography. These hospitals cluster in Charleston, Greenville, and Columbia. A patient in a rural county with a two-hour drive to Charleston benefits less from that quality than the rankings suggest.
The Uninsured Rate and the Medicaid Gap
About 9% of South Carolinians lack health insurance, roughly 460,000 people, and the uninsured rate is notably higher than the national average.6America’s Health Rankings. Explore Uninsured in South Carolina Hispanic, Black, and American Indian residents are uninsured at disproportionately high rates, and nearly one in five people below the federal poverty level have no coverage.
The structural cause is that South Carolina has not expanded Medicaid under the Affordable Care Act. That leaves a coverage gap: low-income adults who earn too much for traditional Medicaid but too little for federal marketplace subsidies. A bill introduced in the 2025-2026 legislative session would authorize full Medicaid expansion, though its prospects are uncertain.7South Carolina Legislature. 2025-2026 Bill 3109 – Medicaid Expansion For the people stuck in the gap, the consequences are delayed care, more emergency room visits for conditions that could have been managed in a clinic, and accumulating medical debt.
Doctor Shortages and Rural Access
Insurance is only half the equation. Finding a doctor is the other half, and South Carolina has fewer primary care physicians per capita than the national average: roughly 58 per 100,000 residents versus 76 nationally as of a 2018 analysis.8The Robert Graham Center. The State of Primary Care Physician Workforce – South Carolina Counting physician assistants and nurse practitioners raises the total to about 276 providers per 100,000, but the underlying physician gap still drives long waits and stretched practices.9America’s Health Rankings. Explore Primary Care Providers in South Carolina
Rural areas take the hardest hit. Over a quarter of the state’s population lives outside urban centers, and six rural hospitals have closed since 2010. A state legislative study found eight more are at risk of closing, with five facing possible immediate closure.10South Carolina Legislature. Certificate of Needs Impact on Rural Healthcare in South Carolina When the nearest hospital is 30 or 40 miles away, the difference matters most for time-sensitive emergencies like heart attacks and strokes.
Mental Health Care
Mental health is one of the state’s weakest areas. About one in five residents lives with a mental health condition, and the treatment infrastructure falls short. The state has roughly 875 psychiatrists for a population of nearly 5.5 million, working out to one psychiatrist per 6,262 residents compared to a national ratio of one per 5,058. Federal data identifies 58 designated Mental Health Professional Shortage Areas in the state, and existing providers meet only about 27% of estimated need.
Practically, that means long waits for psychiatric appointments, heavy reliance on primary care doctors who may lack specialized mental health training, and many people who go without treatment entirely. The rural access problems affecting primary care are worse for specialty mental health services.
Chronic Disease and Life Expectancy
Outcomes are where the picture darkens. Six in ten South Carolina adults live with at least one chronic condition, and one in three has two or more. Heart disease was responsible for over 12,274 deaths in 2023, and chronic diseases together account for more than half of all deaths statewide.11South Carolina Department of Public Health. Chronic Disease in South Carolina
Life expectancy was 73.5 years in 2021, ranking 42nd nationally and nearly four years below the U.S. average.12Centers for Disease Control and Prevention. U.S. State Life Tables, 2021 The state sits within the Stroke Belt, a cluster of southeastern states with historically elevated stroke mortality.13Centers for Disease Control and Prevention. Differences in Stroke Mortality Among Adults Aged 45 and Over
Diabetes prevalence is the sixth-highest in the country: 13.5% of adults have been diagnosed, and another 34.9% have prediabetes.14American Diabetes Association. The Burden of Diabetes in South Carolina Obesity rates diverge sharply by race. CDC data for 2021-2023 shows obesity prevalence of 45.6% among non-Hispanic Black adults, 32.6% among non-Hispanic white adults, and 32.7% among Hispanic adults.15Centers for Disease Control and Prevention. DNPAO State Obesity Prevalence Map 2021-2023 Black adults face more than double the risk of dying from diabetes compared to white adults.
Infant Mortality and Racial Disparities
South Carolina recorded 7.0 infant deaths per 1,000 live births in 2023, well above the national average and up 2.9% from the prior year. The racial gap is severe: non-Hispanic Black infants died at 11.7 per 1,000 live births, compared to 5.2 for non-Hispanic white infants.16South Carolina Department of Public Health. 2023 South Carolina Infant Mortality and Selected Birth Characteristics Data Leading causes include congenital malformations and complications from prematurity and low birth weight, and the disparities track deeper inequities in prenatal care access, insurance coverage, and social conditions that shape outcomes before a baby is born.
What This Means for the Average Resident
If you live in Charleston, Greenville, or Columbia and have solid insurance, South Carolina can deliver excellent care. Hospital safety is genuinely among the country’s best, and specialty care at flagship medical centers competes nationally. If you live in a rural county, work a job that doesn’t provide insurance, need a psychiatrist, or manage a chronic condition on a limited budget, the experience looks different: fewer doctors, longer drives, longer waits, and a coverage gap that keeps affordable care out of reach for hundreds of thousands of people. The state is improving, and the rankings reflect that, but the distance between where it is and where a well-functioning system would be remains large.