NATIONAL -- Receiving health care can be both difficult and expensive.

According to the Centers for Medicare and Medicaid Services, the average American spends almost $10,000 a year on personal health care.

WalletHub recently released its list of the “Best & Worst States for Health Care” in 2017, and North Carolina was ranked 47th.

The study compared three factors for the 50 states and the District of Columbia: cost, access and outcome.

The personal finance website also ranked North Carolina 47th when it comes to the average monthly insurance premium.

Hawaii was ranked as having the best heath care in the country while Louisiana was the worst.

Arizona was also ranked as having the lowest average monthly insurance premium.