U.S. health care spending highest in Northeast states

Randolph E. Schmid

WASHINGTON — Staying healthy is a costly business in the United States, particularly in the Northeast, government statistics show.

Annual health care spending per person totaled $6,409 in New England and $6,151 in the rest of the Northeast, compared to a national average of $5,283, the Centers for Medicare and Medicaid Services (CMS) reported in an issue of the journal Health Affairs published last week.

The totals include spending on individual health care from all sources, including insurance, personal expenses, Medicare, Medicaid and other sources, for 2004, the most recent figures available.

Highest per capita spending was recorded in the District of Columbia, $8,295, followed by Massachusetts, $6,683; Maine, $6,540; and New York, $6,535.

“Most of these states have consistently had the highest spending over time,” said report co-author Anne Martin, an economist with the CMS Office of the Actuary. “There is no one clear explanation, but there are several similar characteristics among these states.”

For example, many of these states have high personal income, a high concentration of physicians and are among the states with the lowest rates of uninsured.

On the other hand, health care spending was below the national average in the Southwest and Rocky Mountain regions, which also tend to have lower-than-average per enrollee Medicare and Medicaid spending and, because they are more rural, less access to physicians and hospitals.

The only state outside the Northeast where per capita health spending topped $6,000 was Alaska at $6,450.

The lowest per person health care spending was $3,972 in Utah.

Nationally, per capita health spending increased on average 6.3 percent per year from 1998 to 2004, the report said.

Other findings included:

• Two states that have actively worked to improve health care had widely different spending patterns. California’s per capita spending level was 12 percent below the national average at $4,638 while Massachusetts was nearly 27 percent above the average.

California had a below-average percentage of the population under age 65, an above-average share of the uninsured population, and a higher proportion of residents enrolled in health maintenance organizations in 2004, compared to Massachusetts.

• States with generous Medicaid programs also tended to have the highest spending, such as Massachusetts, New York and Maine.

• However, the number of people enrolled in Medicaid doesn’t affect per capita spending levels. For example, New York and New Mexico have larger-than-average populations that receive Medicaid. New York was among the highest Medicaid spenders on health care while New Mexico was among the lowest.

• Florida has the highest percentage of residents over age 65 and the Sunshine State’s Medicare spending per enrollee was among the highest in the nation, $8,462, compared to the U.S. average of $7,439. While Maine also has a higher-than-average proportion of elderly people, its Medicare per enrollee spending was among the lowest, $6,015.

• Per capita spending on prescription drugs grew faster in 1998-2004 than in 1991-1998 everywhere except Colorado and the District of Columbia. The reasons for the faster growth are expanded prescription drug coverage, lower co-payments, development of new drugs and expanded Medicaid and state-sponsored coverage for drugs.

(Associated Press)