U.S. States That Spend the Most on Health and Hospitals
The country spends heavily to support the healthcare system—$4.1 trillion per year, nearly 20% of the nation’s GDP. The bulk of this comes from the federal government and U.S. households, but state and local governments contribute as well. States and localities frequently fund public hospitals, mental health and substance abuse programs, water and air quality programs, and payments to private hospitals for public health services. While this spending is one of the most significant budgetary responsibilities of state and local governments, it varies from state to state. Researchers calculated health and hospital spending as a share of total spending for each state, then ranked states accordingly.
Health and hospital spending accounts for nearly 10 percent of state and local government budgets
This spending is one of the most significant budgetary responsibilities of state and local governments. Health and hospitals represent the third largest spending category for state and local governments, behind only public welfare and elementary and secondary education. Collectively, governments spend $345 billion on health and hospitals each year, accounting for nearly 10% of all state and local spending.
Health and hospital spending per capita is up over 50 percent
State and local spending on health and hospitals on a per-capita basis has also grown over time. In the year 2000, state and local governments spent $678 per capita on health and hospitals in inflation-adjusted dollars. By 2020, that figure had risen to $1,040—an increase of more than 50%.
Vermont and Utah saw the largest increases in health and hospital spending over the past decade
However, this trend has not played out the same in all locations. In fact, 13 states have seen a decline in health and hospital spending per capita over the last decade, led by Arizona, where spending has declined by more than 50%. In contrast, other states have seen rapid growth in health spending. Vermont’s inflation-adjusted state and local spending per capita more than doubled between 2010 and 2020, from $355 to $730, and Utah’s 96.2% rate of growth was not far behind.
Just as trends in health spending have varied by geography, total spending also looks different from state to state. Nationwide, states and localities spend around 9.9% of their budgets on health and hospitals, at a total of $1,047 per capita. But a number of states and localities spend well above these figures, including Wyoming, where the per-capita spending is nearly triple the national average, and South Carolina, where health and hospital spending represents nearly 20% of state and local expenditures.
The data used in this analysis is from the U.S. Census Bureau. To determine the states that spend the most on health and hospitals, researchers at HowtoHome.com calculated health and hospital spending as a share of total spending. In the event of a tie, the state with the greater total health and hospital spending per capita was ranked higher.
Here are the states that spend the most on health and hospitals.
15. Indiana
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- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $999
- Total health & hospital spending: $6,747,518,000
- Total direct expenditures: $62,806,487,000
14. Virginia
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- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $1,061
- Total health & hospital spending: $9,112,433,000
- Total direct expenditures: $85,243,956,000
13. Michigan
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- Health & hospital spending as a share of total: 11.2%
- Total health & hospital spending per capita: $1,078
- Total health & hospital spending: $10,748,283,000
- Total direct expenditures: $95,700,844,000
12. Texas
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- Health & hospital spending as a share of total: 11.3%
- Total health & hospital spending per capita: $1,013
- Total health & hospital spending: $29,753,376,000
- Total direct expenditures: $263,279,685,000
11. California
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- Health & hospital spending as a share of total: 12.2%
- Total health & hospital spending per capita: $1,677
- Total health & hospital spending: $66,029,051,000
- Total direct expenditures: $541,102,413,000
10. Utah
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- Health & hospital spending as a share of total: 12.8%
- Total health & hospital spending per capita: $1,289
- Total health & hospital spending: $4,190,560,000
- Total direct expenditures: $32,812,538,000
9. Iowa
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- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,557
- Total health & hospital spending: $4,925,808,000
- Total direct expenditures: $35,283,924,000
8. Washington
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- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,623
- Total health & hospital spending: $12,487,009,000
- Total direct expenditures: $89,455,201,000
7. Missouri
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- Health & hospital spending as a share of total: 14.2%
- Total health & hospital spending per capita: $1,208
- Total health & hospital spending: $7,431,898,000
- Total direct expenditures: $52,380,770,000
6. Kansas
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- Health & hospital spending as a share of total: 15.5%
- Total health & hospital spending per capita: $1,561
- Total health & hospital spending: $4,548,137,000
- Total direct expenditures: $29,333,928,000
5. Mississippi
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- Health & hospital spending as a share of total: 17.1%
- Total health & hospital spending per capita: $1,597
- Total health & hospital spending: $4,736,972,000
- Total direct expenditures: $27,688,049,000
4. Alabama
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- Health & hospital spending as a share of total: 18.7%
- Total health & hospital spending per capita: $1,687
- Total health & hospital spending: $8,302,347,000
- Total direct expenditures: $44,406,818,000
3. North Carolina
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- Health & hospital spending as a share of total: 18.8%
- Total health & hospital spending per capita: $1,665
- Total health & hospital spending: $17,650,732,000
- Total direct expenditures: $93,667,411,000
2. Wyoming
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- Health & hospital spending as a share of total: 18.9%
- Total health & hospital spending per capita: $2,936
- Total health & hospital spending: $1,709,488,000
- Total direct expenditures: $9,029,287,000
1. South Carolina
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- Health & hospital spending as a share of total: 19.3%
- Total health & hospital spending per capita: $1,787
- Total health & hospital spending: $9,326,575,000
- Total direct expenditures: $48,273,596,000
