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Healthcare Cost and Utilization Project (HCUP). HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2009 [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011.

Cover of HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2009

HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2009 [Internet].

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HIGHLIGHTS

HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2009 presents information from the 2009 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.

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 STAYSEXHIBIT
  • The number of hospital stays increased from 34.7 million in 1997 to 39.4 million in 2009, a 14-percent increase overall, or an average annual increase of 1.1 percent. However, the rate of hospitalizations remained unchanged between 1997 and 2009: there were 1,278 hospital stays for every 10,000 persons in the United States in 1997 and 1,284 stays per 10,000 persons in 2009.
1.1
  • Between 1997 and 2009, the aggregate inflation-adjusted costs for hospitalizations—the actual costs of producing hospital services—increased 57 percent. Costs rose from $229.6 billion to $361.5 billion—an average annual increase of 3.9 percent.
1.1
  • The average length of stay (ALOS) in 2009 (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
  • In 2009, Medicare and Medicaid were the expected primary payers for more than half (57 percent) of all inpatient hospital stays (accounting for 14.7 and 8.0 million hospital stays, respectively).
1.3b
  • Between 1997 and 2009, uninsured and Medicaid stays (both up 42 percent) grew at three times the rate of all stays.
1.3c
  • The number of stays billed to Medicare grew by 17 percent from 1997 to 2009, while private insurance was unchanged.
1.3c
  • The number of discharges to home health care grew by 68 percent between 1997 and 2009.
1.4b
  • Uninsured and Medicaid stays accounted for over half (52 percent) of all stays discharged against medical advice, but only one-quarter (26 percent) of all other stays.
1.4c
  • Persons residing in the poorest communities had a 19-percent higher rate of hospitalization in 2009 (1,420 stays per 10,000 population) than those residing in all other communities (1,189 stays per 10,000 population).
1.5b
INPATIENT HOSPITAL STAYS BY DIAGNOSISEXHIBIT
  • Hospitalizations per 10,000 population for musculoskeletal conditions increased by 15 percent, from 95 stays per 10,000 population in 1997 to 110 stays per 10,000 population in 2009.
2.1
  • The rate of stays for circulatory conditions decreased by 13 percent over the 12-year period, falling from 217 stays per 10,000 population in 1997 to 189 stays per 10,000 population in 2009.
2.1
  • Liveborn (newborn infant) (4.2 million stays) was the most common diagnosis and accounted for more than 10 percent of all hospital stays. Since 1997, the rate of stays for newborn infants has remained stable (from 139 in 1997 to 135 in 2009 per 10,000 population).
2.2a
  • Pneumonia (3.0 percent of all stays) and congestive heart failure (2.6 percent) were the second and third most common reasons for hospitalization.
2.2a
  • The fourth and seventh most frequent principal diagnoses in 2009 (osteoarthritis and septicemia) were not among the most frequent diagnoses in 1997. Between 1997 and 2009, stays per 10,000 population for osteoarthritis increased 95 percent, and stays per 10,000 population for septicemia increased by 78 percent.
2.2a
  • Mood disorders was ranked seventh in 1997 and fifth in 2009, and increased nearly 20 percent per population over this time period, from 24 to 28 stays per 10,000.
2.2a
  • Three circulatory diseases—congestive heart failure, coronary atherosclerosis, and cardiac dysrhythmias—were among the top ten most frequent principal diagnoses in 2009.
2.2a
  • In 2009, acute renal failure was the most rapidly growing condition with an increase of 245 percent, from 3.6 to 12.4 stays per 10,000 population.
2.2b
  • Osteoarthritis was the most common condition for adults 45–64 with an increase of 151 percent in the rate of stays per 10,000 population. Between 1997 and 2009, osteoarthritis increased by 58 percent among adults aged 65–84 and was the second most common condition.
2.4
  • Spondylosis, intervertebral disc disorders, and other back problems—the fourth most common condition among 45–64 year olds—remained relatively stable from 1997 to 2009.
2.4
  • 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.
2.5
  • 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).
2.5
INPATIENT HOSPITAL STAYS BY PROCEDUREEXHIBIT
  • The rate of stays with procedures remained relatively stable at about 1,300 stays per 10,000 population from 1997 to 2009.
3.1a
  • Blood transfusion occurred in over ten percent of all hospital stays that included a procedure and was the most frequently performed procedure in 2009. The rate of blood transfusion more than doubled from 1997 to 2009.
3.1a
  • Cesarean section was the most frequent major operating room procedure—performed on 1.4 million females in 2009.
3.1a
  • The rate of stays with knee arthroplasty increased 84 percent from 12 per 10,000 population in 1997 to 22 per 10,000 population in 2009. Knee arthroplasty was the fourteenth most common inpatient procedure in 2009.
3.1a
  • The rate of respiratory intubation and mechanical ventilation grew rapidly from 1997 to 2009 among 45–64 year olds (69 percent), 65–84 year olds (33 percent), and seniors 85 years and older (28 percent).
3.2
  • Diagnostic cardiac catheterization and coronary arteriography was common for 45–64 year olds (638,000 procedures) and 65–84 year olds (664,000 procedures), but the rate of procedures declined about 20 percent from 1997 to 2009 in both age groups.
3.2
COSTS FOR INPATIENT HOSPITAL STAYSEXHIBIT
  • In 2009, the aggregate cost for all hospital stays was $361.5 billion.
4.1a
  • The top three conditions with the highest aggregate costs—septicemia, osteoarthritis, and coronary atherosclerosis—accounted for more than 11 percent of all hospital costs in 2009.
4.1a
  • When conditions were grouped by diagnostic category, the circulatory system accounted for the largest share of hospital costs (20 percent).
4.5a
  • Medicare, the single largest payer for hospitalizations in 2009, accounted for 46 percent of aggregate inpatient costs.
4.4a
  • Medicaid stays accounted for 15 percent of in-hospital costs.
4.4a
  • Private insurance was responsible for 30 percent of aggregate costs; the uninsured were responsible for 5 percent.
4.4a
  • The majority of costs for circulatory conditions (60 percent) were billed to Medicare. One-quarter of circulatory system costs (25 percent) were covered by private insurance.
4.5c
  • Between 1997 and 2009, inflation-adjusted aggregate costs for community hospital stays rose from $229.6 billion to $361.5 billion.
4.1a
  • Overall, growth in intensity of services accounted for 72 percent of the growth in aggregate costs, while population growth was responsible for 27 percent of total growth and an increased number of stays per population accounted for only 1.2 percent of growth.
4.2
WOMEN’S HEALTHEXHIBIT
  • In 2009, almost 6 out of every 10 hospital stays were for females. Specifically, 42 percent of all stays were for males, 12 percent were for females hospitalized for pregnancy and childbirth (maternal stays), and 46 percent were for females hospitalized for non-maternal conditions.
5.1a & 5.1b
  • Females were more likely than males to be hospitalized across all communities and all regions. For example, the rate of hospitalization for females in the lowest income communities was 34 percent higher than males and the female hospitalization rate in the highest income communities was 38 percent higher. Similarly, females were 20–41 percent more likely than males to be hospitalized across all regions in the U.S.
5.1a
  • Medicare was the primary payer for the largest percentage of male stays (39 percent) and non-maternal female stays (45 percent).
5.1c
  • Forty-five percent of maternal stays had Medicaid as the primary payer.
5.1c
  • The number of uninsured hospital stays was similar for males (1.2 million) and females (1.1 million).
5.1a
  • The average length of hospital stay declined for males and non-maternal females from 5.2 to 4.8–4.9 days from 1997 to 2009; however, the average length of hospital stay increased slightly for maternal females from 2.5 to 2.7 days.
5.1d
  • On average, hospital stays for non-maternal females cost less than stays for males ($9,400 versus $10,400).
5.1f
  • Stays for maternal females cost an average of $3,900, less than half of the cost of a non-maternal stay.
5.1f
  • The total cost for hospital care in the U.S. was $361.5 billion in 2009—47 percent for males, 48 percent for non-maternal females, and 5 percent for maternal females.
5.1g
  • Pregnancy and childbirth was the most common reason for hospitalizations of females – 295 hospital stays per 10,000 population.
5.2b
  • Circulatory conditions were less common reasons for hospital stays for females (176 per 10,000 population) than for males (202 per 10,000 population). On the other hand, respiratory system conditions were more common for females (135 per 10,000 population) than for males (123 per 10,000 population).
5.2b
  • Hospitalization for urinary tract infections in females was 2.5 times higher than in males.
5.2c
  • Biliary tract hospital stays were 67 percent higher in females than males.
5.2c
  • Osteoarthritis occurred at a 47-percent higher rate in females than males.
5.2c
  • Compared with females, males had higher rates of hospitalization for coronary atherosclerosis (77 percent higher) and acute myocardial infarction, or heart attack (62 percent higher).
5.2c
  • Average hospital costs were lower for females than males for congestive heart failure, acute cerebrovascular disease, coronary atherosclerosis, and acute myocardial infarction.
5.2d
  • Hospital costs were similar for females and males for stays involving complication of device, implant or graft; osteoarthritis; spondylosis; and complication of surgical procedures or medical care.
5.2d
  • Females accounted for a higher rate of hospital stays for mood disorders in 2009 than males (41 stays per 10,000 population for females and 34 stays per 10,000 population for males).
5.3a
  • The rate of mood disorders has been greater for females compared with males over the 12-year period from 1997 to 2009. Females had a 42-percent higher rate of hospitalization for mood disorders than males in 1997, a difference that narrowed to 21 percent in 2009.
5.3a
  • The rate of stays for mood disorders was consistently higher among females than males across all age groups in 2009, with the exception of adults age 85 and older, where the rates were similar for males and females.
5.3b
  • The highest rate of hospitalization among females for mood disorders was in the Midwest (50 stays per 10,000 population)—2.5 times higher than the lowest rate in the West (20 stays per 10,000).
5.3c
  • The largest male-to-female difference in hospitalizations for mood disorders was in the South, where the hospitalization rate for females (34 per 10,000 population) was 36 percent higher than for males (25 per 10,000 population).
5.3c
  • The rate of cholecystectomy was 71 percent higher for females than for males.
5.4a
  • The rate of knee arthroplasty for females was 57 percent higher than for males.
5.4a
  • The rate of knee arthroplasty increased by 69 percent for females 65 to 84 years old (from 72 stays per 10,000 population in 1997 to 122 stays per 10,000 population in 2009), while it increased by only 55 percent for males (from 58 stays per 10,000 population in 1997 to 90 stays per 10,000 population in 2009).
5.4b
  • The rate of hip replacement for females was 38 percent higher than for males.
5.4a
  • Hip replacements for females age 45 to 64 years old increased by 81 percent from 10 per 10,000 population in 1997 to 17 per 10,000 population in 2009. The rate for males in this period nearly doubled, from 10 per 10,000 population in 1997 to 19 per 10,000 population in 2009.
5.4c
  • Asthma was a common condition among children 1 to 2, 3 to 5, 6 to 9, and 10 to 14 years old. Among 1 to 9 year olds, males had 64- to 75-percent higher rates of stays for asthma compared to females.
5.5a
  • Mood disorders were common among 10 to 14 and 15 to 17 year olds. Females 15 to 17 years old had a 70-percent higher rate of hospitalization for mood disorders in 2009 than males (46 female stays per 10,000 population versus 27 male stays per 10,000 population).
5.5a
  • Diagnostic spinal tap was a top five procedure among children less than 1, 1 to 2, 6 to 9, and 10 to 14 years old. Among 6 to 9 year olds, males had a higher rate of diagnostic spinal tap in the hospital than females (3 male stays versus 2 female stays per 10,000 children). For all other age groups, the rate of diagnostic spinal tap was similar between males and females.
5.5b
  • Appendectomy was frequently performed in children 3 to 5, 6 to 9, 10 to 14, and 15 to 17 years old. With the exception of children 3 to 5 years, males had 36- to 50-percent higher rates of appendectomy than females.
5.5b
  • There were 4.6 million maternal stays in 2009, up from 4.3 million in 1997.
5.6b
  • The rate of stays for childbirth among 20 to 24 year olds remained stable from 1997 to 2007 and then declined 14 percent from 2007 to 2009 (from 1,082 to 951 stays per 10,000 population).
5.6a
  • The rate of stays for childbirth among 25–34 year olds increased 20 percent between 1997 to 2007 (from 950 to 1,141 stays per 10,000 population) and then declined 13 percent to 1,012 stays per 10,000 population.
5.6a
  • The rate of vaginal deliveries decreased 16 percent, from 79 percent of all deliveries in 1997 to 66 percent in 2009. The rate of Cesarean sections increased by 60 percent between 1997 and 2009, from 21 percent of all deliveries to 34 percent of all deliveries.
5.6d
  • The highest rate of C-sections was for females 35–44 years old—44 percent of all deliveries in this age group were via C-section in 2009, a 52-percent increase since 1997 (when the C- section rate was 29 percent in this age group).
5.6e
  • For teenage births (15–19 years old), 24 percent of all deliveries were via C-section in 2009, up 71 percent from 14 percent in 1997.
5.6e
  • The rate of vaginal delivery with episiotomy decreased 66 percent – from 23 percent of all deliveries in 1997 to 8 percent in 2009.
5.6f
  • The rate of vaginal birth following induction increased 24 percent (from 124 to 154 stays per 1,000 deliveries). However, the increase for C-section following induction was even higher—a 73-percent increase from 1997 to 2009 (from 22 to 38 stays per 1,000 deliveries).
5.6g
  • The rate of vaginal birth after C-section declined 67 percent from 1997 to 2009 (from 42 to 14 stays per 1,000 deliveries).
5.6h
  • During this same time period, the rate of repeat C-sections nearly doubled from 77 to 149 repeat C-sections per 1,000 deliveries.
5.6h
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