Utah's in-home health-care services are No. 1 in the country, and care providers in Utah are good at avoiding unnecessary hospital stays.

However, the overall equity of who has access to medical care leaves a lot to be desired, according to a comprehensive, state-by-state health-systems scorecard being released Thursday by the Commonwealth Fund.

Comparing 38 indicators across four different categories — access, quality, costs and general health outcomes — the State Scorecard on Health System Performance shows 41 percent of patients in Utah who received in-home health care, such as post-surgery nursing and physical or respiratory therapy, do markedly better because of the visits.

The state's system is best at avoiding unnecessary hospitalizations and commensurate costs, but it is near the bottom in how well it does in providing access to general health care, particularly to low-income and working-poor Utahns, according to the study.

The Commonwealth Fund is a private foundation started in 1918 whose stated goal is to provide national health-care performance data with the intent of improving care across the country. The report was compiled before the economic downturn and does not reflect the dramatic increases in the number of people who have lost insurance coverage because they have been laid off work.

Utah scores high marks for critical and emergency intervention and outcomes, but it is near the bottom in how well it does in preventive care access.

"Given Utah's generally healthy, largely nonsmoking population, its overall No. 19 rating systemwide is lower than one would expect," Caren Schoen, Commonwealth Fund senior vice president and co-author of the study, told the Deseret News.

Utah improved to 35th in the country in terms of the number of adults under age 65 who are able to see a doctor. But because the working poor and minorities have lower health-care access across the board, the overall performance score is far below the above-par capacity "of what by many other measures is an excellent system of care," Schoen said.

Utah's high rate of obesity and diabetes is reflected in the study as well, with only 40 percent of adults under 65 who have the disease receiving care that would stave off kidney failure, amputations and other serious — and seriously expensive — complications associated with the disorder when left unchecked.