A new WalletHub study of 148 U.S. cities is turning heads: San Francisco ranks dead last for turning tax dollars into results—despite having the nation's #1 health system.
Meanwhile, Provo, Utah, landed at #1 overall by delivering strong education, safety, and infrastructure on a modest budget.
How they ranked it: Researchers divided each city's "Quality of Services" score (36 metrics across 6 categories) by its per-capita spending. Bigger budgets ≠ , better marks.
San Francisco's paradox:
- Health outcomes: 🥇 #1 in the U.S.
- Infrastructure: 🥉 #3 nationally
- Education: 137th out of 148
- Economy: 130th out of 148
- Per-capita spending: **Highest of any city studied**
The result? High spending + uneven results = last place.
Provo's formula:
- Per-capita spending: 2nd-lowest in the study
- Quality of services: 15th overall
- High school graduation rate: ~91%
- Violent & property crime: 7th and 8th lowest
- Road quality & commute times: solid
Consistency + efficiency = #1.
Top 5 Best-Run:
1. Provo, UT
2. Nampa, ID
3. Manchester, NH
4. Boise, ID
5. Nashua, NH
Bottom 5:
144. Chicago, IL
145. Oakland, CA
146. New York, NY
147. Detroit, MI
148. San Francisco, CA
The takeaway? It's not about how much you spend—it's about what you deliver with it. Small and mid-sized cities are consistently outperforming major metros on efficiency.
What do you think—does this ranking match your experience?
*Source: WalletHub, data as of May 19, 2026*