Per capita health spending was 15 percent higher in Massachusetts, New York, Connecticut and Rhode Island than in the rest of the country in 1998, according to the survey by the Department of Health and Human Services' Centers for Medicare and Medicaid Services.
"Urban areas in general tend to be higher-priced than rural areas," said Anne Martin, one of the report's authors. "There's also more concentration of population that can support teaching hospitals and other specialized facilities that can cost more."
Katie Levit, who is in charge of national health statistics for the agency, cautioned that the numbers cannot be used to determine if residents of one state are getting better health care than those of another.
"People in lower-spending states may be younger, may be healthier, may live in lower-cost areas," Levit said. "It doesn't necessarily mean they're not getting adequate or effective care. More research needs to be done to unravel all of these effects."
Personal health care spending includes amounts that a person and his health plan pay for such things as hospital care, physician services and prescription drugs.
Agency economists conducted the study by examining Internal Revenue Service receipts for for-profit health care businesses, the American Hospital Association's Annual Survey of Hospitals and other data on population, wages and salaries. The study appears Tuesday in the journal Health Affairs.
In 1998, personal health care spending in the United States totaled $1 trillion. The national average per resident was $3,759.
In Massachusetts, which led all states, spending was $4,810 per resident. The average in New York was $4,706; Connecticut, $4,656; and Rhode Island, $4,497.
Washington, D.C., had spending of $6,656 per resident.
On the other end, Utah had the lowest health spending for 1998 - just $2,731 per resident. Idaho spending was $3,035 per resident; Arizona, $3,100; Nevada, $3,147; and New Mexico, $3,209.
Health spending in Washington state was $3,382, compared with $2,545 in 1991, the last time the Centers for Medicare and Medicaid Services examined state health spending figures.
Tuesday's report showed that the slowest growth in spending was in the West. California's health spending per resident rose at average annual rate of 3.5 percent, from $2,690 in 1991 to $3,429 in 1998.
Some states saw huge growth. Maine's health spending per resident rose 7.3 percent annually, from $2,464 in 1991 to $4,025 in 1998.
Overall, however, the Plains region — which includes Kansas, Minnesota and Missouri — had the fastest average annual growth, 5.9 percent.
The report also examined per-person spending within the states for Medicare, the government's health insurance program for the elderly, and Medicaid, the health insurance program for the poor.
Nationwide, Medicare enrollees represented 14 percent of the total population in 1998.
Florida had the largest share of enrollees — 19 percent — but Louisiana had the highest Medicare spending per enrollee at $7,219. Florida's spending per enrollee was $6,147 for 1998. South Dakota has the lowest Medicare spending that year at $3,936 per enrollee.
Economists said Louisiana's higher number was due to higher than average utilization and payments for home health services in that state. Medicare beneficiaries in Louisiana also paid more than average for short-term hospital stays, the report said.
The Medicare spending numbers include the amount the federal government is paying either health providers through traditional Medicare or HMOs that participate in its managed care program.
By Janelle Carter