Per-person healthcare spending -- including both insurance and out-of-pocket payments -- varies widely among states, with New England residents outspending the rest of the nation, according to the Centers for Medicare and Medicaid Services.
Personal healthcare spending -- which includes hospital care, physician visits and prescription drugs, among other services -- totaled $1 trillion in 1998, the most recent year for which figures are available. That equates to a national per-resident average of $3,759. Massachusetts residents recorded the highest per-person costs, averaging $4,810 apiece, and Utah residents the lowest, at $2,731, according to the CMS' report. Administrative costs, such as third-party payer processing fees, are not included.
The report appears in the July/August issue of Health Affairs.
Researchers said several factors contribute to the geographic variation, including socioeconomic and demographic differences, access to insurance, degree of managed-care penetration, and diversity in practice patterns. Personal healthcare spending patterns "are useful as baselines to measure the impact of proposed policy changes," the CMS said.
This is the first time since 1991 that nationwide comparative data has been produced, according to the CMS.
"High costs can come from a variety of factors," said Katie Levit, director of the national health statistics group in the CMS' actuary's office. "It could mean you're treating a sicker population. It could mean you have an older population . . . . From a hospital and physician standpoint, it would be important for providers to assess whether these differences are actually driven by the healthcare needs of the population or by something else."
Spending on hospital services largely followed the broader geographic trends. In the U.S. overall, spending for hospital services amounted to an average of $1,405 per individual; residents of the District of Columbia required the most hospital spending, $3,467 per capita, compared with an average of $1,656 for the entire Mideast region.
Medicare per-enrollee spending was highest in Louisiana in 1998 at $7,219 and the lowest in South Dakota at $3,936, which had below-average utilization of hospital, physician and home health services, the CMS said. Medicare and Medicaid figures don't include individuals' out-of-pocket expenditures, Levit said.
Between 1991 and 1998, per-capita health spending grew at a rate of 3.5% in California and 7.3% in Maine. While those states represent the extremes, the Great Plains region posted the fastest growth at 5.9% and the far West the slowest at 3.8%.
Click here for an abstract of the report.