The State of Health Care Spending: Health Care Spending in the 50 States and Select Counties

Source: Jeremy Nighohossian, Andrew J. Rettenmaier, And Zijun Wang, Private Enterprise Research Center,
March 2013

The compendium is divided in two main parts. Part 1 summarizes the four ways by which the geography of health care spending is described. Health care spending as a percent of the states’ GDP is the first way in which the geography of health care is presented and is separated between Medicare, Medicaid, and non-Medicare/Medicaid spending. These data allow for analysis that extends back to 1980 for each state. Next, health care spending is analyzed on a per capita basis and is again divided between Medicare and Medicaid per enrollee in the programs, and average non-Medicare/Medicaid spending for the states’ population who are not enrolled in the programs. The per capita data are available beginning in 1991. Third, health care is summarized by state level enrollment in the public programs, the percentage of the states’ populations who are uninsured, and by the prevalence of managed care in the two public programs. The final view of the geography of health care is based on county level Medicare spending. The county level data are available from 1998 to 2010. The annual county level Medicare data include total reimbursements and enrollee counts for Parts A and B, fee-for-service aged and disabled enrollees. Disproportionate share, graduate medical education, and indirect medical education spending are broken out separately. County level average risk scores for the aged and the disabled are available for recent years. The advantages of the county level data are the ability to include or exclude the Medicare add-on payments at the county level detail. The disadvantage is that the data is limited to fee-for-service enrollees. However, this restriction is also used in compiling the Dartmouth Atlas data, the data on which most geographic variation studies are based.

The second part of the compendium comprises 50 state summaries. The two-page summaries are based on the four ways of viewing geographic variation in health care spending and the health care markets. The first page summarizes the key health care spending indicators in each state, and provides graphical representations of how the state compares to the national average now and in the past. Also depicted is the variation in county level Medicare spending. The second page of each state’s summary presents all of the recent metrics in tabular form. Medicare spending in four large or geographically dispersed counties is also presented at the end of each table.