Californians may lead healthier lives than most Americans, but the state's record on health care is mostly mediocre or dismal, according to a study released today that provides a state-by-state snapshot of health care in this country.

"Where you live in the U.S. matters in terms of your health care, and it shouldn't," said Cathy Schoen, a co-author of the report and senior vice president for the Commonwealth Fund, a private foundation that supports independent re- search on health care issues.

California ranked fifth among all states in having a population leading "healthy lives," but ranked in the bottom 10 on such measures as access to health care and prevention and treatment.

Residents may love the fresh air of the outdoors and easy access to fresh food, but the state's high ranking for "healthy lives" is based on the low infant mortality rate (the state ranks sixth) and the low number of smokers (second).

The study underscored a health care system split by the haves and have-nots, with some states rising to challenges while others lagged.

The state-by-state scorecard, compiled by the Commonwealth Fund in conjunction with Rutgers University, examined data from a multitude of sources -- including information filed with state agencies -- to measure 38 health care indicators grouped according to access, prevention and treatment, avoidable hospital use and costs, equity and healthy lives.

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