TABLE OF CONTENTS
HIGHLIGHTS
INTRODUCTION
HCUP PARTNERS
1. OVERVIEW
2. DIAGNOSES
3. PROCEDURES
4. COSTS
5. WOMEN'S HEALTH
SOURCES/METHODS
DEFINITIONS
FOR MORE INFO
ACKNOWLEDGMENTS
CITATION
FACTS & FIGURES 2009 PDF
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EXHIBIT 2.5 Most Frequent Principal Diagnoses by Payer (PDF)
Number of Stays, Percent Distribution, and Growth of the Most Frequent Principal Diagnoses for Hospital Stays by Payer, 1997 and 2009
| PAYER† AND PRINCIPAL CCS DIAGNOSIS |
NUMBER OF STAYS IN THOUSANDS |
PERCENT OF PAYER-SPECIFIC TOTAL STAYS |
CUMULATIVE GROWTH IN NUMBER OF STAYS |
| 1997 |
2009 |
1997 |
2009 |
1997-2009 |
| All payers, total stays* |
34,679 |
39,435 |
100% |
100% |
14% |
| Medicare |
12,618 |
14,708 |
100% |
100% |
17%‡ |
| Congestive heart failure |
757 |
762 |
6% |
5% |
1% |
| Pneumonia |
703 |
643 |
6% |
4% |
-9% |
| Septicemia |
276 |
547 |
2% |
4% |
98% |
| Cardiac dysrhythmias |
375 |
525 |
3% |
4% |
40% |
| Chronic obstructive pulmonary disease and bronchiectasis |
380 |
507 |
3% |
3% |
34% |
| Medicaid |
5,644 |
8,027 |
100% |
100% |
42% |
| Liveborn (newborn infant) |
1,224 |
1,874 |
22% |
23% |
53% |
| Trauma to vulva and perineum due to childbirth |
224 |
291 |
4% |
4% |
30% |
| Mood disorders |
147 |
239 |
3% |
3% |
63% |
| Maternal stay with previous C-section |
84 |
237 |
1% |
3% |
182% |
| Pneumonia |
166 |
178 |
3% |
2% |
7%‡ |
| Private insurance |
13,388 |
12,958 |
100% |
100% |
-3%‡ |
| Liveborn (newborn infant) |
2,204 |
1,948 |
16% |
15% |
-12%‡ |
| Trauma to vulva and perineum due to childbirth |
431 |
401 |
3% |
3% |
-7%‡ |
| Osteoarthritis |
117 |
359 |
1% |
3% |
207% |
| Spondylosis, intervertebral disc disorders, and other back problems |
258 |
288 |
2% |
2% |
11%‡ |
| Mood disorders |
227 |
285 |
2% |
2% |
26% |
| Uninsured** |
1,676 |
2,388 |
100% |
100% |
42% |
| Liveborn (newborn infant) |
191 |
218 |
11% |
9% |
15%‡ |
| Mood disorders |
55 |
90 |
3% |
4% |
64% |
| Non-specific chest pain |
39 |
78 |
2% |
3% |
99% |
| Skin and subcutaneous tissue infections |
28 |
77 |
2% |
3% |
176% |
| Alcohol-related disorders |
48 |
65 |
3% |
3% |
36% |
† Population denominators are not available by payer.
* Excludes a small number of stays (68,000 or 0.2 percent) with missing payer.
‡ 2009 stays are not statistically different from 1997 stays at p<0.05.
** Includes stays classified as self-pay or no charge.
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997 and 2009. |
This exhibit shows the top five reasons for hospital stays for each primary payer. The principal diagnoses for hospitalizations by primary payer generally varied, although some conditions were frequent across payers.
Medicare:
- Congestive heart failure (CHF) was the most common principal diagnosis among stays with Medicare as a primary payer, making up 5 percent of all Medicare stays in 2009.
- Pneumonia (643,000 Medicare stays in 2009) was the second most common diagnosis.
- Septicemia, cardiac dysrhythmias, and chronic obstructive pulmonary disease were also frequent reasons for hospital stays among Medicare stays. The number of Medicare stays for septicemia grew by 98 percent between 1997 and 2009. The number of stays for cardiac dysrhythmias and chronic obstructive pulmonary disease grew by 40 percent and 34 percent, respectively.
Medicaid:
- Three of the most common conditions with Medicaid as the primary payer were pregnancy and childbirth-related: liveborn (newborn infant), trauma to the vulva and perineum due to childbirth, and previous C-section. Altogether, stays for these conditions made up approximately 30 percent of all Medicaid stays.
- Liveborn (newborn infants) with a primary payer of Medicaid grew 53 percent from 1997 to 2009. Previous C-section grew 182 percent over this same time period.
- Mood disorders was the third most common condition with Medicaid as the primary payer and grew 63 percent from 1997 to 2009.
Private Insurance:
- Liveborn (newborn infant) stays were the most common hospital stay paid for by private insurance, accounting for 15 percent of all private insurance stays. The number of liveborn (newborn infants) covered by private insurance remained relatively stable between 1997 and 2009.
- Osteoarthritis and back problems were also among the top conditions for private insurance. Private insurance stays for osteoarthritis increased by 207 percent between 1997 and 2009. Stays for treatment of a back problem remained relatively stable during this period.
- Mood disorders was a frequent cause of hospitalization among the privately insured, and increased by 26 percent between 1997 and 2009.
Uninsured:
- Although the uninsured stays comprised only 6 percent of total stays in 2009, they accounted for about one-quarter (23 percent) of all stays for alcohol-related conditions and over 10 percent of all stays for skin infections, mood disorders, and non-specific chest pain.
- Mood disorders was the second most common principal diagnosis among uninsured stays, making up 4 percent of all uninsured stays in 2009.
- Four of the most common conditions for uninsured hospital stays increased from 1997 to 2009: alcohol-related disorders (36 percent), mood disorders (64 percent), non-specific chest pain (99 percent), and skin and subcutaneous tissue infections (176 percent).
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