On behalf of the Committee on Chronic Illness of the Medical Society of the State of North Carolina, acknowledgement is made of the fine cooperation and support given this study by two other sponsoring organizations; namely, the North Carolina Hospital Association and the North Carolina State Board of Health. Special recognition is given to the Hospital Association, through the Executive Secretary, Marion J. Foster, and to Dr. J. W. R. Norton, State Health Officer and the Public Health Statistics Section of the State Board of Health for the time, effort, and financial support which made this study possible.

Special attention and appreciation is hereby given the administrators and the staffs of the participating hospitals for collecting and recording the data on discharged patients for four study periods. Without their full cooperation and support, the study would not and could not have been made. Appreciation is also expressed to Hospital Saving Association for making possible the attractive reproduction of this study material. The Medical Society is appreciative of the efforts of these groups in collaboration with its own staff in the achievements gained through this project.

Johuk Kemalle, MD

John R. Kernodle, M.D.
Chairman, Committee

on Chronic Illness

THE NORTH CAROLINA HOSPITAL DISCHARGE STUDY

1959-1960

INTRODUCTION

The marked increase in hospital costs and how such costs are met, with particular regard to certain age groups, has resulted in an increase in studies and evaluations of the status and needs of these groups. The absence of reliable data concerning the situation in North Carolina prompted the Committee on Chronic Illness of the Medical Society of the State of North Carolina to propose a survey to fill one of the gaps in the knowledge of hospital care in the State. Because of the importance of hospitalization to the older members of our society, the study of costs and causes of such care was felt to be of prime necessity. Accordingly, the survey was proposed to answer the following questions:

1. What are the causes of hospitalization by age group and color, the per diem charge, the length of stay, and the total charge of hospitalization?

2. What are the sources of payment (personal or family, insurance, official health or welfare fund, other govermental agencies, or voluntary)?

3. What was the unpaid balance by age group and color remaining at the end of the study?

The Committee realized that such data would have to be obtained from the hospitals and therefore solicited the cooperation and support of the North Carolina Hospital Association. Once the data had been recorded by the hospitals, there would be need for tabulating and compilation of the results. For this service, the North Carolina State Board of Health was contacted and it was agreed that the Public Health Statistics Section would punch and tabulate all questionnaries. The study thus became a voluntary, cooperative project of all three groups, with each sharing in the expense and responsibility.

THE STUDY PLAN

In planning the survey, it was suggested that quarterly study periods, of one week each, be utilized to overcome seasonal variations in ability to pay, as well as in causes of hospitalization.

A survey form was designed, as to content and format, to provide the necessary information for answering the above questions. (Appendix 1). The forms were prepared by the Medical Society of the State of North Carolina and distributed by the North Carolina Hospital Association.

Study periods, (beginning and ending at 6:00 a. m. .) lows:

were as fol

Fourth: January 25, 1960 ---- February 1, 1960

Two weeks prior to the beginning of each study period, the survey forms were sent to the general hospitals belonging to the North Carolina Hospital Association. The hospitals were requested to complete the forms, one for each patient discharged during the respective study period, and to return them to the State Board of Health three months after the end of the particular period. This threemonth period was to allow adequate time for settling the financial account with the hospital.

Upon receipt of the first study period report, a review of these forms was made. It was noted that many hospitals had returned the questionnaires immediately after discharge. As a result of the review, a few minor revisions were made in the form in an effort to increase the completeness of the information as to payments collected or expected.

To achieve a greater degree of accuracy as to financial payment, all questionnaires for all quarters were returned to the participating hospitals three months after the last study period for insertion of additional payments through April 30, 1960. It was recognized that there would be variations in the amount of time allowed for payments among the four study periods. However, it is a valid assumption that the financial status could be improved with additional time allowed for payments.

DESCRIPTION OF THE SAMPLE

At the time of this study, North Carolina had 154 general hospitals, of which 127 were members of the North Carolina Hospital Association. All general hospitals that were Association members were invited to participate in the study on a voluntary basis. The findings reported, however, are limited to the 72 hospitals completing all four study periods. A comparison of general hospitals in the State, in the Association, and in the study by bed capacity is shown in Table I.

TABLE I. General Hospitals in the State, in the Association, and in the Study by bed capacity: North Carolina Hospital Discharge Study, 1959-60.

SOURCES: • THE NORTH CAROLINA MEDICAL CARE COMMISSION 1959

.. THE NORTH CAROLINA HOSPITAL ASSOCIATION, APRIL 1, 1959

Of the member general hospitals, 56.7% participated in the study, representing 65.4% of the total beds of member general hospitals. There are 15,000 general hospital beds in North Carolina, 13,000 of which are in general hospitals belonging to the North Carolina Hospital Association. Of these, 8,500 are covered in the present study.