Nick Vailas of Bedford Ambulatory Surgical Center

Nick Vailas is shown giving a tour last year of the imaging center at Bedford Ambulatory Surgical Center in Bedford, which he oversees. “The way we deliver the cost of care in New Hampshire is very high because it’s hospital-based,” he says.

New Hampshire is one of the highest-spending states when it comes to health care, a new report says.

The state ranked fourth highest in per-person spending for medical and prescription drug expenses in 2017 for those covered by employer-sponsored insurance, according to the Health Care Cost Institute, a nonprofit research institute.

Between 2013 and 2017, the per-person cost in New Hampshire rose 21.2 percent compared to 16.7 percent nationally.

For 2017 alone, the per-person New Hampshire average grew by 4.8 percent compared to 4.2 percent across the U.S.

The per-person cost for both the payer (usually an employer) and patient totaled $6,720 in 2017 in New Hampshire compared to the national average of $5,641.

That $6,720 New Hampshire bill was broken down the following way: $2,292 for outpatient visits and procedures, $2,110 for professional services, $1,166 for inpatient admissions and $1,152 for prescriptions, according to the report.

“The way we deliver the cost of care in New Hampshire is very high because it’s hospital-based,” said Nick Vailas, a former state commissioner for Health and Human Services who is overseeing the launching of a medical plan for self-insured businesses.

“If you end up going to a hospital-employed doctor, you’re most likely going to have your procedure or your lab or your diagnostics all done in the hospital, which is much higher in the state than freestanding independent providers,” said Vailas, president and CEO of the Bedford Ambulatory Surgical Center.

The New Hampshire Hospital Association, whose 31 members include major hospitals across the state, said the report’s findings “can’t be considered a true reflection” of the state’s health care costs.

“The HCCI report on health care pricing represents claims data from Aetna, Humana, Kaiser Permanente and UnitedHealthcare, four of the largest health insurance providers in the country, representing approximately 26 percent of the employer-sponsored insured population. However, these four health insurance providers represent a very small segment of the health insurance market, and therefore (have) less negotiating power with providers, in New Hampshire,” the association said in a statement.

“The HCCI report did not include the state’s largest insurance providers, being Anthem, Harvard Pilgrim Health Care, Tufts (Health Freedom) Plan and Cigna, which represent the vast majority of the state’s insurance market, therefore the HCCI report can’t be considered a true reflection of the health care costs in New Hampshire, either as an individual state or in comparison to other states across the country,” the association said.

Vailas said the industry needs more transparency, providing patients with a “guaranteed price” that includes all costs, including doctors, medical procedure and lab results. He said hospitals making alliances with, or acquisitions of, other hospitals will not reduce costs.

“What it does is strengthen their position in negotiating with health plans (to charge more),” he said.

The report said the largest rate of increase between 2013 and 2017 occurred in inpatient admissions, a 31.1 percent surge in New Hampshire compared to 9.8 percent nationally. Vailas attributed that to “lack of competition.”

New Hampshire’s “utilization” — or number of health care services used per person — grew by 4.9 percent in New Hampshire between 2013 and 2017 compared to a slight dip, 0.2 percent, nationally, according to the report.

Nationally, “Spending per person and spending growth varied widely by age,” the report said.

In 2017, people age 18 and younger spent $3,170 in average spending while those age 55 to 64 spent an average of $10,476.

The highest increased rate of spending between 2013 and 2017 occurred with those 18 and younger (19.9 percent) while the smallest increase occurred for those between age 26 and 44 (14.3 percent).

The national share of spending paid out of pocket stood at 15.4 percent in 2017 compared to 16.1 percent in 2013. But people spent 12.2 percent — or $94 — more over that span.

When it came to five chronic conditions — hypertension, asthma, diabetes, attention-deficit/hyperactivity disorder and congestive heart failure — 19.8 percent of those in the study had one of those conditions in 2017, up slightly from 17.9 percent in 2013. For those with two or more chronic diseases, that population rose from 4.9 percent in 2013 to 5.6 percent in 2017, according to the report.

Those with chronic conditions also spent more.

People with one chronic condition spent an average of $8,921 in 2017 compared to $3,603 for those with none. People with at least two chronic conditions spent an average of $20,257 in 2017.

The report relied on claims data, and prescription drug prices include discounts from the wholesale or list price but not any manufacturer rebates.