HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2007 presents information derived from the 2007 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), with trend information as far back as 1993. This report includes information from the 2007 database containing discharge records for all patients treated in a sample of approximately 1,000 hospitals. These discharges are weighted to represent all inpatient stays in community hospitals across the nation. Community hospitals include all non-Federal, short-term, acute care hospitals; psychiatric and substance abuse facilities and short-term rehabilitation hospitals are not included.

• The number of hospital discharges increased from 34.7 million in 1997 to 39.5 million in 2007, a 14-percent increase overall, or an average increase of 1.3 percent annually.
• The average length of stay (ALOS) in 2007 was 4.6 days—almost 20 percent shorter than in 1993, when the ALOS was 5.7 days. The ALOS declined throughout most of the 1990s and has stabilized during the current decade.
• While people 65 years and older represented 13 percent of the population in 2007, they comprised 33 percent of all hospitalizations.
• The number of discharges to home health care grew by 55 percent (up 1.3 million discharges). Discharges to nursing homes and long term care increased by 32 percent (1.2 million discharges). The number of patients who left the hospital against medical advice, although small, rose by 39 percent (up 103,700 discharges) — the second fastest increase of any discharge type.
• Even when pregnancy and childbirth stays are excluded, females accounted for more stays than males—18.2 million stays for females compared to 16.2 million stays for males.

• Conditions related to pregnancy and childbirth were the reason for more than 1 out of every 5 female hospitalizations in 2007. When combined with stays for newborn infants, these hospitalizations accounted for one-quarter of all male and female stays.
• Maternal discharges increased to 5.0 million in 2007, a 16-percent increase since 1997.
• Previous C-sections increased 107 percent between 1997 and 2007.
• Infant hospitalizations increased to 4.7 million in 2007, a 21-percent increase since 1997.
• Circulatory conditions were the most frequent major cause of hospital stays in 2007, accounting for 16 percent of all discharges. Five circulatory conditions were among the top 10 most frequent principal diagnoses in 2007.
• Several frequently occurring infections were among the most rapidly increasing reasons for hospitalizations between 1997 and 2007.
• Stays for skin and subcutaneous tissue infections rose 90 percent for men and 75 percent for women.
• Septicemia increased by 63 percent—up 77 percent among men and 53 percent among women.
• Several conditions were common among children and young adults.
• Asthma, the most common reason for hospital admission among children 1–17, declined by 28 percent between 1997 and 2007.
• Hypertension was a comorbidity in 35 percent of all hospital stays in 2007, diabetes in 17 percent of stays, depression in 7 percent stays, and alcohol abuse, drug abuse, and/or psychoses each in 3 percent of stays.
• Chronic conditions were a principal or secondary diagnosis for 74 percent of all hospital stays in 2007.

• During almost two out of every three hospital stays in 2007, at least one procedure was performed.
• Six of the top procedures in 2007 were associated with giving birth or newborns.
• C-section was the most frequent major operating room procedure—performed on 1.5 million women in 2007. Growth in C-sections, up 85 percent between 1997 and 2007, outpaced increases in most other frequently performed maternal procedures and was among the fastest growing procedures for women 18-44 years old.
• Blood transfusions occurred in one out of every 10 hospital stays that included a procedure. There were 1.1 million stays with this procedure in 1997 and 2.6 million in 2007, for a cumulative growth of 140 percent.
• Discharges for respiratory intubation rose steadily, increasing 48 percent over the 1997-2007 period.
• From 1997 to 2007, arthroplasty of the knee increased by 86 percent.
• Hemodialysis procedures for renal failure grew by 66 percent.
• The use of tube feeding during infant hospitalizations increased 219 percent, compared with a 16-percent growth in all infant discharges.
• Diagnostic cardiac catheterization was performed on 890,000 males and 581,000 females in 2007 and ranked as the 2nd most frequent procedure in men and the 4th most frequent procedure in women.

• Inflation-adjusted aggregate costs for hospital stays rose from $222.4 billion in 1997 to $343.9 billion in 2007 — an increase of 55 percent.
• The most important driver of cost increases was greater intensity of services provided during the hospital stay. Costs per discharge increased by 3.1 percent annually.
• Circulatory conditions accounted for 22 percent ($74.6 billion) and injury and poisonings for 11 percent ($37.2 billion) of all costs for inpatient stays in 2007.
• Hospital stays related to pregnancy, childbirth, and newborns together accounted for the most stays (9.7 million) and the third highest costs ($34.2 billion) among body systems. The average hospital cost for these conditions was less than that for any other body system condition, making the aggregate costs relatively low despite the high volume of stays.
• The fastest increase in body system costs was for infectious and parasitic diseases, more than doubling between 1997 ($6.6 billion) and 2007 ($15.3 billion). Septicemia was responsible for almost all (94 percent) of the increase in costs of infectious and parasitic conditions as it tripled in costs from $4.1 billion in 1997 to $12.3 billion in 2007.

Discharges

• In 2007, Medicare and Medicaid were the expected primary payers for more than half (56 percent) of all inpatient hospital discharges, private insurance for 35 percent, and the uninsured for 6 percent. Other payers accounted for the remaining 3 percent of discharges.
• Medicaid was billed for 44 percent of stays among 0-17 year olds, but only 23 percent of stays among 18-64 year olds and less than 5 percent of stays among those 65 and older.
• Medicaid was the primary payer for 64 percent of maternal discharges among 18-24 year olds, about one-third of maternal stays for 25-34 year olds, and 21 percent of maternal stays for 35-49 year olds.
• Twenty-seven percent of stays among 60-64 year olds were billed to Medicare, compared to less than 5 percent of non-maternal stays among 18-24 year olds.
• About 10 percent of discharges for patients 18-64 years old were uninsured, compared to 5 percent of discharges among 0-17 year olds and less than 1 percent of discharges among patients 65 and older.
• About 4-5 percent of maternal stays among all age groups were uninsured.
• The share of discharges billed to private insurance fell from 39 percent to 35 percent between 1997 and 2007, reflecting the steady decline in the share of the population with private insurance coverage. The share of discharges billed to Medicare and the share of uninsured discharges held relatively stable, while those billed to Medicaid increased from 16 to 19 percent.
• Between 1997 and 2007, the number of uninsured discharges grew by 38 percent and the number Medicaid discharges grew by 36 percent—more than double the rate of growth of all discharges (14 percent). The number of Medicare discharges grew by 14 percent while stays billed to private insurance grew by just 2 percent.
• Hospitalizations billed to Medicare and Medicaid accounted for more than three-quarters of the increase in discharges from 1997 to 2007.
• The average length of stay for hospitalizations billed to Medicare decreased substantially from 1997 to 2007 (from 6.3 days to 5.6 days) while the ALOS for stays covered by Medicaid, uninsured, and private insurance remained relatively unchanged. Virtually the entire decline in the all payer length of stay from 1997 to 2007 was attributable to Medicare.
• Patients discharged against medical advice were more likely to be uninsured. Three percent of uninsured discharges occurred against medical advice, compared to less than 1 percent of discharges billed to Medicare, Medicaid, and private insurance.

Costs

• In 2007, costs for Medicare stays amounted to $156.0 billion and Medicaid stays accounted for $50.4 billion—a total of about 60 percent of aggregate hospital costs. Discharges billed to private insurance accounted for 31 percent ($107.8 billion), while the uninsured accounted for a much smaller share (5 percent, or $16.5 billion).

Conditions

• Stays for some body system conditions and payers grew rapidly:
• For Medicare stays, pregnancy and childbirth grew by 185 percent, although the total number of stays remained relatively low (16,400 in 1997 and 46,700 in 2007). Infectious and parasitic conditions (up 57 percent) and blood disorders (up 56 percent) also rose rapidly.
• There was large growth in Medicaid stays for skin conditions (92 percent), perinatal/newborns (55 percent), pregnancy and childbirth (47 percent), and musculoskeletal conditions (43 percent).
• There was rapid growth in stays billed to private insurance for skin conditions (63 percent), musculoskeletal conditions (44 percent), blood disorders (31 percent), and endocrine conditions (26 percent).
• For uninsured stays, large increases occurred in skin (136 percent), blood (112 percent), and endocrine (67 percent) conditions.
• Rapid growth in specific CCS conditions contributed to body system growth:
• There was rapid growth in stays for acute renal failure billed to the uninsured (387 percent), Medicare (315 percent), Medicaid (306 percent), and private insurance (273 percent).
• There was also rapid growth in the number of hospitalizations across all payers for skin and subcutaneous tissue infections, anemia, non-specific chest pain, septicemia (blood infection), osteoarthritis, complication of device, implant, or graft, and complication of surgical procedures or medical care.

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