Section 5: Payers for Inpatient Hospital Stays PDF

EXHIBIT 5.1 Discharges by Payer PDF
EXHIBIT 5.2 Average Length of Stay by Payer PDF
EXHIBIT 5.3 Discharge Status by Payer PDF
EXHIBIT 5.4 Patient Age by Payer PDF
EXHIBIT 5.5 Costs by Payer PDF
EXHIBIT 5.6 Reasons for Hospital Stays by Payer PDF
EXHIBIT 5.7 Growth in Body System Conditions: All Payers PDF
EXHIBIT 5.8 Growth in Discharges for Selected Conditions: Medicare PDF
EXHIBIT 5.9 Growth in Discharges for Selected Conditions: Medicaid PDF
EXHIBIT 5.10 Growth in Discharges for Selected Conditions: Private Insurance PDF
EXHIBIT 5.11 Growth in Discharges for Selected Conditions: Uninsured PDF

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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