Byline: ROBERT PEAR - New York Times
The federal government issued new data Wednesday showing huge variations in health care spending from state to state. The figures suggest that the government would have difficulty setting local budgets for health spending, as President Clinton has proposed.
An explicit goal of Clinton's health plan is to reduce variations in the level of medical spending and its growth.
The new data, from the Department of Health and Human Services, show that Clinton's proposal to revamp the nation's health care system will affect different states in very different ways, a fact already complicating the politics of health care legislation.
Health Affairs, a quarterly journal of health policy, published the department's data.
Summarizing the new data, Katharine R. Levit, chief of the government's office of national health accounts, said, 'Per capita spending for hospital and physician services and for prescription drugs ranged from a high of $2,112 in New England to a low of $1,567 in the Rocky Mountain region in 1991 -- a difference of 35 percent.'
For the United States as a whole, spending on these health care items totaled $1,877 per person in 1991, the government reported.
Besides New England, the only region in which per capita spending exceeded the national average was the Middle Atlantic region of Delaware, Maryland, New Jersey, New York, Pennsylvania and the District of Columbia. Per capita spending for this region was $2,105 in 1991. New York state's per capita spending was more than $2,100.
Levit said that personal income appeared to be the most important factor influencing the level of health care spending in a state. In addition, the study said, high levels of health care spending may reflect the presence of large numbers of doctors, a large proportion of medical specialists and a high concentration of elderly people.
But some disparities have no simple or obvious explanation. Earlier studies have found large geographical variations in medical practice and prevailing medical wisdom. The frequency of hysterectomies, coronary bypass operations and other surgery varies widely, even in population groups of similar age and income.
In its report on Wednesday, the government made these points:
Two states, New York and California, accounted for one-fifth of all spending on hospital care, doctors' services and prescription drugs in 1991. Spending in California, $58.1 billion, was 51 percent higher than in New York, where it totaled $38.5 billion.
New York and California account for about a fifth of the nation's population. According to the 1990 Cenus, California's population was 29,760,021. New York's population was 17,990,455.
From 1980 to 1991, spending grew faster in New Hampshire than in any other state. Growth was slowest in Illinois. Personal income and population grew rapidly in New Hampshire, but population growth was slow in Illinois. Among regions, the Southeast had the highest growth, while the Great Lakes region had the slowest.
In the Middle Atlantic region, per capita spending for hospital care was 19 percent higher than the national average. But it was 17 percent lower than the national average in the Rocky Mountain states. The Middle Atlantic region ranked first in the nation in hospital admissions per person and in the average length of hospital stays.
The report noted that 'Hawaii has led the nation in health care reform by providing almost universal health insurance coverage for its population since the early 1970s.' But spending per person on health care rose slightly faster in Hawaii at 9.8 percent a year than in the nation as a whole, which was 9.4 percent.
New York state's spending rose an average of 10.1 percent a year during the period covered by the study, 1980-1991.
Near-universal coverage in Hawaii may have encouraged people to use extra health care services, the study said. Nationwide, the use of hospitals (measured by inpatient days per capita) declined 26 percent from 1980 to 1991, but it rose 3.6 percent in Hawaii.
Data in the report came from many sources, including the Census Bureau, the Internal Revenue Service, the Bureau of Labor Statistics and the AmericanHospital Association. The estimates show spending for doctors, hospitals and pharmacies in each state. The data in the report, for doctors, hospitals and drugs, account for 70 percent of spending on personal health care. The cost of nursing homes, home health care, dentists, psychologists and certain types of medical equipment is not included.
