EXHIBIT 5.6 Reasons for Hospital Stays by Payer
PDFPercent Distribution of Principal CCS Body System and Condition Category Discharges by Expected Primary Payer, 2007
| PRINCIPAL CCS BODY SYSTEM AND CONDITION CATEGORY |
MEDICARE |
MEDICAID |
PRIVATE INSURANCE |
UNINSURED* |
| All discharges |
100.0% |
100.0% |
100.0% |
100.0% |
| Circulatory |
26.9 |
5.8 |
12.0 |
13.9 |
| Pregnancy and childbirth |
0.3 |
27.6 |
18.2 |
9.7 |
| Perinatal (newborns) |
0.2 |
25.8 |
16.8 |
11.3 |
| Digestive |
10.3 |
5.4 |
9.3 |
11.3 |
| Respiratory |
12.6 |
7.0 |
5.5 |
7.0 |
| Injury and poisoning |
9.3 |
4.2 |
6.6 |
10.6 |
| Mental |
4.1 |
7.0 |
3.7 |
12.0 |
| Musculoskeletal |
6.6 |
1.4 |
5.6 |
1.9 |
| Neoplasms |
5.3 |
2.4 |
6.4 |
3.0 |
| Genitourinary |
6.0 |
2.6 |
4.6 |
4.1 |
| Endocrine |
4.3 |
2.6 |
2.8 |
4.0 |
| Symptoms |
4.7 |
1.5 |
2.2 |
2.4 |
| Infectious and parasitic |
3.7 |
1.7 |
1.4 |
1.9 |
| Nervous |
2.3 |
1.9 |
2.2 |
2.3 |
| Skin |
1.9 |
1.5 |
1.5 |
3.4 |
| Blood |
1.3 |
1.1 |
0.8 |
1.0 |
| Congenital |
0.1 |
0.6 |
0.4 |
0.2 |
*Includes discharges classified as self-pay or no charge.
Note: Body systems and condition categories are listed in order by largest number of discharges for all payers combined.
Note: Values in bold are the top five most frequent body systems and condition categories for each payer.
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2007. |
Body system and condition categories are collections of specific diagnoses grouped into 17 broad system or condition clusters.
- The 5 most frequent body system categories responsible for hospitalizations differed by expected primary payer, in part because the major payers and their eligibility criteria tend to cover different groups of patients by age and disability status.
- Only circulatory conditions were among the top five most frequent body systems for each payer, accounting for 27 percent of Medicare discharges, 6 percent of Medicaid discharges, 12 percent of private insurance discharges, and 14 percent of uninsured discharges.
- A high proportion of Medicare stays were for respiratory conditions (13 percent), digestive conditions (10 percent), injuries and poisonings (9 percent), and musculoskeletal conditions (7 percent).
- More than half of all Medicaid discharges were for pregnancy and childbirth (28 percent) or perinatal/newborns (26 percent) conditions. Respiratory and mental body system discharges each accounted for 7 percent of stays billed to Medicaid.
- For patients with private insurance as the expected payer, more than one-third of all discharges were for pregnancy and childbirth (18 percent) or perinatal/newborns (17 percent) conditions. Digestive body system conditions accounted for 9 percent of private insurance discharges and injury and poisoning accounted for 7 percent.
- Discharges for mental conditions were common among the uninsured, accounting for 12 percent of all discharges. Perinatal/newborns and digestive body system discharges each accounted for 11 percent of uninsured stays and injury and poisoning discharges for another 11 percent.
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