TABLE 7. NUMBER AND AVERAGE LENGTH OF STAY OF WHITE PATIENTS WITH BLUE CROSS, WITH COMMERCIAL INSURANCE, AND WITH NO INSURANCE, BY DIAGNOSIS AND AGE, NORTH CAROLINA HOSPITAL DISCHARGE STUDY, 1959-1960 1 INCLUDES 512 PATIENTS WITH BOTH BLUE CROSS AND COMMERCIAL INSURANCE 2 INCLUDES ONLY THOSE CASES WHERE TOTAL BILL IS BORNE BY PATIENT OR FAMILY The average length of stay among commercial insurance patients was slightly higher than patients with no insurance and somewhat lower than patients with Blue Cross for the following diagnostic categories: Obstetrical care, circulatory, and digestive. Average length of stay was slightly higher among commercial insurance patients for genito-urinary and accidents-violence, than in the other two groups, and lower for respiratory causes. Differences in age groups within diagnostic category are also evident among patients with commercial insurance. In summary, the question of which group has the longest average length of stay among white patients depends, to some extent, on diagnostic category and age of the patient. The patients in these six combined diagnostic categories represent 70% of the total white patients in the study. The average length of stay for this group, ignoring age, was 6.6 days for patients with Blue Cross, 6.3 days for patients with commercial insurance and 6.1 days for patients with no insurance whose total bill was borne by patient or family. Of the six diagnostic groups studied, this difference is greatest among obstetrical care patients. It is realized that there are many factors other than age, race, and diagnosis which could influence length of stay. The data presented herein are, therefore, inadequate to warrant conclusions concerning over-utilization of hospital services by any of the groups studied. SUMMARY Discharge data from 27,906 patient records, covering one week in each seasonal quarter, and involving 183,152 patient days at a total charge of $4,296,355, have been tabulated and compiled to provide answers to the following questions: 1. What are the causes of hospitalization by age group and color, length of stay, per diem charge, and total hospital charge? 2. What are the sources of payment? 3. What was the unpaid balance by age group and color remaining at the end of the study? Of the 127 member general hospitals of the North Carolina Hospital Association, 72 participated in the study, representing 65.4% of the 13,000 beds in member general hospitals. Data recorded on discharged patients were submitted by the participating hospitals located in 53 counties, covering all geographical areas of the State. Principal causes of hospitalization were presented according to total patients, age groups, average number of days in the hospital, average charge per admission by age groups, and hospital bed capacity. The total hospital charge according to source of payment by age groups, color, and quarter has been shown. The mass of data presented cannot be briefly summarized, but certain important points, however, deserve emphasis: 1. Per diem charges of $23.46 approximates that reported by Lerner ($22.91). There was a slight difference between white ($23.87) and nonwhites ($20.73) as to per diem charge. 2. The average length of stay for all age groups and all patients was 6.6 days; for those under 25, it was 4.5 days, and for those 65 and over, 10.9 days. 3. The length of stay for nonwhite is slightly higher than for whites, with the exception of the 65 and over age group. Length of stay, however, increased with age, regardless of color. 4. In the 65 and over age group, the patient and family paid the highest percentage (52.9%) of total charge, whereas in the 25--44 age group, the lowest percentage (29.1%) was paid by this source. 5. Governmental sources paid a higher percentage of the total charge for the oldest age group (12.1%) as contrasted to the lowest percentage (4.6%) for the 25-44 age group. 6. Nonwhites had a higher proportion of unpaid balance for all age groups. The highest percentage for all patients was in the group under 25 years of age. 7. Percentage unpaid for all age groups and all patients was 7.5%; for those under 25 years, 9.2%; and for those 65 and over, 8.2%. 8. Health and welfare agencies paid 6.1% of the total charges for all patients. The percentage increased to 6.9% with inclusion of Medicare and Veterans Administration. 9. Length of stay was longest for circulatory diseases, followed by cancer, for whites; for nonwhites, the reverse was true. 10. Causes of hospitalization for all patients ranked as follows: (1) obstetrical care, (2) digestive system, (3) respiratory, (4) genito-urinary, and (5) circulatory diseases. 11. Total charges per admission for all patients were highest for cancer, followed by circulatory diseases. 12. Per diem charges were highest for the genito-urinary system, followed by cancer and obstetrical care for whites. For nonwhites, per diem charges were highest for cancer, followed by obstetrical care and diseases of the digestive system. 13. In comparing the average length of stay of white patients having Blue Cross, commercial insurance, and those having no insurance whose total bill was borne by patient or family, it was found that diagnostic category and age of patient had some influence. Taking all white patients in the six leading diagnostic categories, as a group and without reference to diagnosis and age, it was found that the average length of stay was one half day longer for patients with Blue Cross, and approximately one fifth day longer for patients with commercial insurance when compared with those having no insurance whose total bill was borne by patient or family. It is recognized that this study has some limitations, but the information contained herein is the most complete data of this type thus far compiled in North Carolina. It is hoped that the material presented will be of interest and value to various individuals and agencies concerned with the economics of present hospital care with respect to age groups, color, length of stay, cause of hospitalization, and the sources of payment. 76123 0-61-pt. 4-25 |