Slightly more than one-third (36%) of the hospital bill was paid by the patient and family with little variation between white (36.4%) and nonwhite (32.7%). The patient or family in the two older age groups pay a higher percentage of the total hospital bill than in the younger age groups. This is true for both whites and nonwhites. The percentage of the total hospital bill of all patients paid by Blue Cross was less than the percentage paid by commercial insurance in all age groups, white and nonwhite. The 65 and over age group has the lowest percentage of the total bill paid by insurance of any kind, 25.8% compared with 46.6% for all ages combined. The older age group has the highest percentage paid by governmental sources. The low percentage of the bill paid by insurance in the older group accounts for the higher percentage paid by patient or family (52.9%). Consideration must be given to the fact that only in recent years has insurance protection been available for persons 65 and older, therefore, a smaller percentage of these persons are covered by insurance. It can be expected that the percentage will increase within the next few years. The nonwhite group has a higher unpaid proportion of the total bill than does the white for all age groups. The lowest proportion unpaid for both whites and nonwhites is in the 45-64 age group. The highest proportion unpaid, for all patients, is in the under 25 age group.

The average charge per admission is somewhat higher among the whites and tends to increase with age for both whites and nonwhites (Figure VI.)

The percentage distribution of total hospital bill by source of payment by age group and by quarter is shown in Figure VII.

The total hospital bill by source of payment and by area is shown in Figure VIII.

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Figure VI. Average Charge Per Admission by (a) Age and Color, by (b) Bed Capacity and Color:

North Carolina Hospital Discharge Study, 1959-1960

Figure VIII. Percentage Distribution of Total Hospital Bill
by Source of Payment, and by Area:

North Carolina Hospital Discharge Study, 1959-1960

INSURANCE AS A FACTOR IN LENGTH OF STAY

Is the average length of stay of patients with Blue Cross insurance and other types of insurance longer than the length of stay of patients with no insurance whose total bill is borne by patient or family? In an effort to find an answer to this question, three distinct groups of patients were delineated: (1) All patients who had Blue Cross insurance, (2) All patients who had commercial insurance, and (3) Patients with no insurance whose total bill was borne by patient or family.

Since length of stay varies according to diagnosis, age, and color, it was considered desirable to compare the length of stay in each of the three groups of patients according to these factors. However, there were not enough nonwhites involved to permit computation of a meaningful average length of stay for this group. The comparison, therefore, is limited to whites. The age groups are not the same in all disease categories since the number of patients in some age groups was so few that it was necessary to combine them in order to compute length of stay. The six diagnostic categories with the largest number of patients were used in this phase of the study. For each diagnostic category, the average length of stay of white patients by age group is shown in Table 7.

For most of the diagnostic categories, the length of stay of patients with Blue Cross was slightly higher than the length of stay of patients with no insurance. The increase in length of stay ranged from 20% in obstetrical care patients to 1% in genito-urinary patients. Among respiratory patients, the length of stay was less in patients having Blue Cross (5.2) than in patients with no insurance (5.6). Differences in length of stay by age group within diagnostic category will be noted in Table 7, some of which are in the opposite direction to the length of stay of total patients in that category. For example, in circulatory diseases, the length of stay of all patients is higher among Blue Cross patients (10.6) than those with no insurance (9.6). Considering the patients under 45 years of age in this group, however, the length of stay among Blue Cross patients (7.9) is less than the length of stay in patients with no insurance (8.5).