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HCUP Facts and Figures 2008
Statistics on Hospital-Based Care in the United States, 2008
 
TABLE OF CONTENTS

HIGHLIGHTS

INTRODUCTION

HCUP PARTNERS

1. OVERVIEW

2. DIAGNOSES

3. PROCEDURES

4. COSTS

5. MHSA

SOURCES/METHODS

DEFINITIONS

FOR MORE INFO

ACKNOWLEDGMENTS

CITATION

FACTS & FIGURES 2008 PDF
HIGHLIGHTS

HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2008 presents information from the 2008 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), with trend information as far back as 1993. The NIS consists of discharge records for all inpatients treated in a sample of approximately 1,000 hospitals. These discharges are weighted to represent all inpatient stays in community hospitals across the nation, so this report presents national estimates for the U.S.

In addition, this report contains information from the Nationwide Emergency Department Sample (NEDS) for 2007, constructed from data on emergency department (ED) visits from a 20-percent sample of community hospital EDs.

Community hospitals include all non-Federal, short-term, acute care hospitals. This excludes psychiatric and substance abuse facilities, short-term rehabilitation hospitals, and Federal hospitals (Department of Defense, Department of Veterans Affairs, and Indian Health Service).


OVERVIEW STATISTICS FOR INPATIENT HOSPITAL STAYS
EXHIBIT
The number of hospital discharges increased from 34.7 million in 1997 to 39.9 million in 2008, a 15-percent increase overall, or an average annual increase of 1.3 percent. 1.1
Between 1997 and 2008, the aggregate inflation-adjusted costs for hospitalizations—the actual costs of producing hospital services—increased 61 percent. Costs rose from $227.2 billion to $364.7 billion—an average annual increase of 4.4 percent. 1.1
The average length of stay (ALOS) in 2008 (4.6 days) was almost 20 percent shorter than in 1993 (5.7 days). The ALOS declined throughout most of the 1990s and has remained unchanged since 2000. 1.2
Circulatory conditions were the most frequent major cause of hospital stays in 2008, accounting for 5.9 million stays or 15 percent of all discharges. 1.3
Even when pregnancy and childbirth stays are excluded, females accounted for more stays than males—18.6 million stays for females compared to 16.5 million stays for males. 1.3
Pregnancy and childbirth was the reason for 1 out of every 5 female hospitalizations (4.7 million stays). 1.3
Medicare and Medicaid were the expected primary payers for more than half (55 percent) of all inpatient hospital discharges. 1.4
Between 1997 and 2008, Medicaid discharges (up 30 percent) grew at double the rate of all discharges, followed closely by uninsured discharges (up 27 percent). 1.4
The number of discharges billed to Medicare grew by 18 percent. 1.4
Growth in the number of discharges billed to private insurance remained relatively stable (5 percent). 1.4
The number of discharges to home health care grew by 69 percent (1.6 million discharges) between 1997 and 2008. 1.5
Uninsured and Medicaid stays accounted for nearly half (48 percent) of all stays discharged against medical advice, but only about one-quarter (23 percent) of all stays in 2008. 1.5
Persons residing in the poorest communities had a 21-percent higher rate of hospitalization in 2008 (148 discharges per 1,000 population) than those residing in all other communities (122 discharges per 1,000 population). 1.6


INPATIENT HOSPITAL STAYS BY DIAGNOSIS
EXHIBIT
Conditions related to pregnancy, childbirth, and liveborn infants were the most frequent reasons for hospitalization, accounting for nearly one in four discharges (23 percent) in 2008.
  • Stays with a principal diagnosis of previous C-section nearly doubled (up 96 percent) between 1997 and 2008.
  • Stays with a principal diagnosis of high blood pressure during pregnancy increased by 22 percent during this period.
2.1
Pneumonia (2.9 percent of all discharges) and congestive heart failure (2.6 percent) were the most common reasons for hospitalization. 2.1
Between 1997 and 2008, stays for osteoarthritis increased 118 percent and stays for septicemia increased by 91 percent. 2.1
Mood disorders was ranked as the fifth most common condition in 1997 and 2008, but increased nearly 30 percent over this time period. 2.1
Chronic obstructive pulmonary disease was the ninth ranked condition in 2008 and increased 30 percent since 1997. 2.1
Complication of device, implant or graft increased 39 percent from 1997 to 2008 and was the tenth ranked condition in 2008. 2.1
Hospital stays for acute myocardial infarction declined 12 percent and stays for acute cerebrovascular disease declined 8 percent from 1997 to 2008. 2.1
Asthma stays declined 35 percent among children 1-17 years between 1997 and 2008, while stays for skin and subcutaneous tissue infections increased 97 percent. 2.3
Mood disorders was the third most common diagnosis for children 1-17 and adults 18-44 years. 2.3
Among adults 85 and older, hospitalizations for septicemia (up 95 percent) and urinary tract infections (up 81 percent) increased at more than twice the rate of all hospitalizations for this age group between 1997 and 2008. 2.3
Osteoarthritis more than tripled among adults 45-64 and increased 73 percent among adults 65-84. 2.3
Spondylosis, intervertebral disc disorders, and other back problems increased 51 percent for 45-64 year olds between 1997 and 2008. 2.3
Medicaid accounted for 41 percent of all liveborn infant discharges in 2008. Three of the most common conditions with Medicaid as the primary payer were pregnancy and childbirth-related; altogether, stays for these conditions made up approximately 30 percent of all Medicaid stays. 2.5
Three of the most common conditions for uninsured hospital stays increased from 1997 to 2008: mood disorders (44 percent), non-specific chest pain (73 percent), and skin and subcutaneous tissue infections (138 percent). 2.5


INPATIENT HOSPITAL STAYS BY PROCEDURE
EXHIBIT
Blood transfusion occurred in over ten percent of all hospital stays that included a procedure and was the most frequently performed procedure in 2008. 3.1
Episiotomy fell from the list of top procedures, dropping in rank from eighth in 1997 to thirty-first in 2008, a 60-percent decrease. 3.1
C-section was the most frequent major operating room procedure—performed on 1.4 million women in 2008, up from 800,000 in 1997. 3.1
PTCA—a procedure involving the use of a balloon-tipped catheter to enlarge a narrowed artery—grew 56 percent from 1997 to 2006. Between 2006 and 2008, however, there was a 17-percent decline in discharges with this procedure. 3.1
Discharges with coronary artery bypass graft (CABG) procedures declined 38 percent between 1997 and 2008. 3.1
Respiratory intubation and mechanical ventilation grew rapidly from 1997 to 2008 among 45-64 year olds (123 percent), 65-84 year olds (45 percent), and seniors 85 years and older (89 percent). 3.2
Although hysterectomies and oophorectomies increased during the 5-year period from 1997-2002, these female-specific procedures declined in subsequent years. Over the 1997 to 2008 period, hysterectomies decreased by 13 percent and oophorectomies by 21 percent. 3.2


COSTS FOR INPATIENT HOSPITAL STAYS
EXHIBIT
The top three conditions with the highest aggregate costs—septicemia, coronary atherosclerosis, and osteoarthritis —accounted for more than 11 percent of all hospital costs in 2008. 4.1
Three of the twenty most expensive conditions were musculoskeletal: osteoarthritis, spondylosis, intervertebral disc disorders, and other back problems, and fracture of neck of femur (hip).
  • Costs for osteoarthritis and spondylosis grew at more than twice the pace of total hospital costs between 1997 and 2008.
4.1
Between 1997 and 2008, costs for acute renal failure, septicemia, and respiratory failure grew at two to three times the rate of total hospital costs. 4.1
Hospital stays for septicemia cost a total of $14.6 billion and accounted for 791,000 discharges. 4.1
Aggregate costs for stays in community hospitals grew 4.4 percent annually between 1997 and 2008. 4.2
Growth in intensity of services accounted for 71 percent of the growth in aggregate costs, while population growth was responsible for 24 percent and an increased number of discharges per population for only 5 percent of the growth in aggregate costs. 4.2
Non-elderly adult (45 to 64 years) discharges accounted for less than half (48 percent) of the aggregate cost of all inpatient stays, including maternal and neonatal stays. 4.3
Patients 65-84 years accounted for 35 percent of all hospital costs while they made up 27 percent of all discharges. 4.3
Medicare, the single largest expected payer for hospitalizations in 2008, accounted for 46 percent of aggregate inpatient costs and 37 percent of all discharges. 4.4 & 1.4
Medicaid stays accounted for 14 percent of in-hospital costs and 18 percent of all discharges. 4.4 & 1.4
Private insurance was responsible for 32 percent of aggregate costs and 35 percent of all discharges; the uninsured were responsible for 4 percent of costs and 5 percent of all discharges. 4.4 & 1.4
Five broad groups of conditions - circulatory, musculoskeletal system and connective tissue, respiratory, digestive, and maternal/neonatal stays accounted for more than half of total hospital costs in 2008. 4.5
Maternal and neonatal stays were responsible for the greatest portion of Medicaid hospitalization costs (27 percent) compared to only 14 percent of private payer costs. 4.5
Stays for musculoskeletal system and connective tissue conditions accounted for larger shares of hospital costs for Medicare (14 percent) and private insurance (15 percent) than for Medicaid (6 percent) and the uninsured (8 percent). 4.5


HOSPITAL CARE FOR MENTAL HEALTH AND SUBSTANCE ABUSE CONDITIONS
EXHIBIT
Of the 39.9 million community hospital discharges in 2008, about 5 percent had a principal diagnosis of a mental health (MH) or substance abuse (SA) disorder. 5.1
An additional 13.6 percent of all hospital discharges had a secondary MH diagnosis and 5.4 percent had a secondary SA diagnosis. 5.8
Depression was responsible for 24 percent of MHSA stays and bipolar disorders for another 20 percent of MHSA stays. 5.2
Non-elderly adults (18-64 years old) accounted for a disproportionate share of all MHSA hospitalizations (83 percent) relative to their share of the total population (63 percent) and all hospitalizations (49 percent). 5.5
Alcohol-related disorders accounted for 12 percent of MHSA stays among 18-44 year olds, 21 percent of MHSA stays among 45-64 year olds and 12 percent of MHSA stays for 65-84 year olds. 5.6
The number of hospital stays for drug-related conditions rose rapidly for all age groups over 45 years old (87-117-percent increase from 1997-2008), while remaining relatively stable (11-percent decline) among 18-44 year olds. The underlying causes of this increase were rapid growth in drug-induced delirium and in poisonings by opiate-based pain medications. 5.6
In 2008, the average cost for a MHSA hospital stay was $5,500, compared to an average of $9,100 for all stays and $6,700 for all stays without a major operating room procedure. 5.1 & 5.10
Hospital stays with MH and SA diagnoses were more commonly uninsured (12 percent) or insured by Medicaid (27 percent) than were hospital stays overall (5 percent uninsured and 18 percent insured by Medicaid). 5.9
In 2008, patients living in the poorest communities experienced MH hospitalization rates 44 percent higher than patients living in higher income communities—5.8 stays per 1,000 compared to 4.0 stays per 1,000 in higher income communities. 5.11
Hospitalizations for schizophrenia and other psychotic disorders for residents in the poorest communities (1.9 discharges per 1,000) occurred at twice the rate of all other communities (0.9 discharges per 1,000). 5.11
Patients residing in the poorest communities experienced similar overall rates of hospitalization for SA as patients residing in higher income communities. 5.11
In 2007, there were 122.3 million emergency department (ED) visits. Of those ED visits, 9.9 million had an all-listed MH diagnosis, 2.8 million had an all-listed alcohol-related diagnosis, and 2.2 million had an all-listed drug-related diagnosis. (All-listed diagnoses include all diagnoses listed on the discharge record.) 5.12
A diagnosis of depression was the most frequently noted MHSA diagnosis (4.2 million ED visits), and the second most frequent MHSA diagnosis was anxiety (3.3 million ED visits). 5.12
About one in five of all ED visits (20.4 million, or 17 percent of all ED visits) in 2007 resulted in inpatient hospital admission. In comparison, ED visits were much more likely to result in inpatient admission for MHSA conditions:
  • 42 percent of all MH ED visits resulted in hospitalization.
  • 44 percent of alcohol-related ED visits resulted in hospitalization.
  • 49 percent of all drug-related ED visits resulted in hospitalization.
5.12

Internet Citation: Facts and Figures 2008 - Highlights. Healthcare Cost and Utilization Project (HCUP). October 2010. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov//reports/factsandfigures/2008/highlights.jsp.
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