The state also ranked 24th for access to care through the private insurance market and 38th for the quality of its tort system, according to the report.

The so-called U.S. Index of Health Ownership, an annual report by the Pacific Research Institute, used 24 variables to quantify how state laws and regulations affect people involved in state government health plans, the private health-insurance market and the provision of medical services. It also assessed the effect of medical tort on people's freedom to engage health services.

“The lack of health ownership is a real problem,” said John R. Graham, director of Health Care Studies at PRI and author of the Index. “Almost half of the country's health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.”

Alabama, Montana, Nebraska, North Dakota and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market and good control of state government programs, according to the report. Also, the state performed well on medical tort indicators. Alabama's regulatory environment for providers favors competition, and government health programs run more effectively than in most states.