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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).

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.

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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.

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