If you feel like health care costs are on the rise in the U.S., you are right on the money, according to a report published Tuesday in Health Affairs magazine. The total amount Americans spent annually on health care nearly doubled from 1991 to 2004, from $2,645 per capita to $5,283. The study, conducted by researchers at the Center for Medicare and Medicaid Services, also found wide variations at the state level.

The information was published as an onslaught of proposals advanced by presidential candidates rev up the national discourse surrounding health care reform. Such proposals, according to Karen Davis and Cathy Schoen, two authors of the study, tend to focus "on improving health insurance coverage, but other important dimensions of performance, including quality and cost, are receiving less attention."

Those costs were drastically different from state to state, the report showed, with the highest per capita spending recorded in the District of Columbia, $8,295, followed by Massachusetts, $6,683; Maine, $6,540; and New York, $6,535. Meanwhile, in many states in the Southwest, where most residents live in rural areas far from hospitals and doctors offices, health care spending fell far below the national average. Per capita spending in Utah was found to be the lowest in the country, at $3,972.

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

The report attributed the disparities to a range of factors, including median age and income of the population, the concentration of doctors in a state, the generosity of public programs and the extent of private health insurance coverage.

The study also found wide disparity between state spending per Medicaid enrollee, with New York spending $10,173 per person and Alabama spending a mere $4,089. California spent even less, at $3,664 per enrollee. According to John Holahan, Director of the Urban Institute's Health Policy Center, a national remedy is necessary to lessen regional inequalities. However, he added, there is little political will in Washington to expand coverage on a federal level. "The result of a stalemate will be that low-income people will continue to be treated very differently depending on where they live," he wrote in an analysis of the report. "This not only will have consequences for the states in which they reside, but because poor access to health care will affect health outcomes, it will have implications for the nation as well."