Americans spent $3.65 trillion on health care in 2018 — 4.6% more than the year before. That growth also was higher than the 4.2% rate from 2017, according to revised figures from independent federal actuaries.

Between the lines: U.S. health care spending climbed again not because people went to the doctor or hospital more frequently, but because the industry charged higher prices. And private health insurers didn't do a particularly good job negotiating lower rates.

By the numbers: The 4.6% growth rate in 2018 was revised up slightly from preliminary numbers released in February, and it came in below the broader economic growth rate.

All other figures on what Americans spent on hospitals, doctors and prescription drugs sold at pharmacies also were similar to February's report.

The intrigue: The number of people with private health plans — which mostly consists of the coverage people get through their jobs — dipped in 2018, yet the amount spent per person soared 6.7%.

That is the highest per-enrollee spending growth rate among people with private health insurance since 2004, actuaries wrote.

Part of that increase was due to higher premiums that insurance companies passed on from the Affordable Care Act's health insurance tax.

More importantly: Hospitals, doctors and drugmakers continued to wring out much higher rates from private insurers thanks to provider mergers and perverse negotiating incentives.

Medicare and Medicaid had much lower per-enrollee spending growth rates in 2018 than private insurance, but those figures were the highest they've been since 2015 — again due to higher costs for the private insurers that are increasingly running those government programs.