are 14.6 discharges per year per 100 persons 65 and older living at the time of interview and not in institutions. 2/ Hospital stays of persons 65 and over averaged 14.9 days (compared to 14.7 days shown by the 1957-58 survey). The stays and the total days of hospitalization during the year for aged persons living at time of interview were distributed as follows by length of stay: Some persons are of course hospitalized more than once during a year, so that the number of discharges per person is larger than the number hospitalized. The National Health Survey found the following differences for persons over and under 65 discharged from short-stay general hospitals in 1958-60: This is substantially more than the 12.1 discharges per 100 aged persons shown by the first National Health Survey report on use of short-term general hospitals in the period July 1957-June 1958. Most of the difference is attributable to improved methods of data collection, the remainder to the fact that the data relate to a later period when utilization was somewhat higher. The July 1958-June 1960 reports are not yet published. The earlier figures are from U.S. Public Health Service Publication No. 584-87, Hospitalization: Patients Discharged from Short-Stay Hospitals, July 1957-June 1958. See also U.S. Public Health Service Publication No. 584-D4, Reporting of Hospitalization in the Health Interview Survey (May 1961). A national survey of old-age and survivors insurance beneficiaries conducted in late 1957 found somewhat more days of general hospital care per year than the National Health Survey for persons 65 and over--236 as compared with 218 per 100 aged persons. The difference stems in part from the fact that the National Health Survey includes aged persons in the labor force, who are less likely than the retired to be hospitalized, and in part from the fact that it is restricted to the noninstitutional population, whereas the beneficiary survey includes time spent in a general hospital by persons who were otherwise in an institution. One in nine of all aged beneficiaries was hospitalized during the course of a year. They are distributed as follows by number of days spent in a short-stay general hospital (regardless of number of hospital episodes within the year): About every fifth aged beneficiary who spent any time in a general hospital during the year had more than one hospital stay. In other words, there were 14 stays per 100 beneficiaries; and there were 21.2 days of care per hospitalized beneficiary. Corresponding data from other surveys conducted in 1956 and 1957 appear in the Report Submitted to the Committee on Ways and Means on April 3, 1959, Hospitalization Insurance for OASDI Beneficiaries. Factors affecting time spent in short-stay hospitals.--Age and sex affect the amount of time spent in hospitals. Household surveys show that aged men are usually admitted more frequently and stay longer in hospitals than aged women. The differences found are much greater in some surveys than in others and, perhaps because of sampling variations, are not consistent for all age and other subgroups. In general, the amount of time spent in the hospital for every 100 persons in the population increases with age. The latest data from the National Health Survey are summarized in table 4. Table 4.--Number of patients discharged per 100 (Noninstitutional population of the United States) The earlier data from the National Health Survey show some correlation between hospital utilization and amount of family income, but it is not clear to what extent this reflects the fact that aged persons needing hospitalization are more likely to share a home with relatives. The Bureau of Old-Age and Survivors Insurance survey data indicate that the probability of a beneficiary entering a hospital during the year bears no systematic relationship to his income (or, in the case of married beneficiaries, to the income of the couple). At each income level, however, those beneficiaries with some health insurance tend to have a higher hospital admission rate than beneficiaries with no insurance. The Persons who have health insurance enter hospitals more frequently, but have shorter average stays than those who are uninsured. following data from the National Health Survey for July-December 1959 show that regardless of sex or age older persons with health insurance are much more likely than other aged persons to have one or more shortstay hospital episodes in a year: Sex and age wo Percent with one or more hospital episodes 3 U.S. Public Health Service Publication No. 584-B25, Interim Report on Health Insurance, United States, July-December 1959. Matching information on length of stay, while not available from the National Health Survey, is provided by the 1957 survey of OASI beneficiaries. The frequency of hospital visits among the insured and uninsured OASI beneficiaries covered in that survey is in line with that found in the National Health Survey, as shown by the following figures: The average stay is less for the insured because persons with insurance are more likely to go to the hospital early in the course of an illness or for essentially diagnostic purposes and thus stay a relatively short time. The uninsured group includes a larger proportion of "impaired risks" who cannot purchase insurance, of older persons with more serious medical needs, and probably of persons who--because of fear of the costs--postpone getting medical and hospital care until the need is overwhelming. Utilization in last year of life.--Household surveys considerably understate the hospital utilization of aged persons because they generally exclude the hospitalization experience during the survey year of persons who had died prior to the interview. The mortality rate of the 65 and over group is of course high. A special National Health Survey report, Hospital Utilization in the Last Year of Life, based on data from surveys in the Middle Atlantic States, shows that the inclusion of hospitalization received by decedents during the survey year results in a substantial increase in the total volume of hospitalization reported, especially for persons 65 and over. In this region the days of care used by persons who died during 1957 would increase by about 40 percent the total estimated hospital days used by all the aged in the year, computed solely on the basis of the reported experience of persons alive at date of interview. However, inasmuch as the current statistics on hospital utilization by the population alive at date of interview are higher than formerly reported--as a consequence of the improved collection procedures now followed by the National Health Survey--the days used by decedents would raise the estimated days used by all the aged (derived from the experience of survivors) by no more than a third and possibly by as little as a fourth. U.S. Public Health Service Publication No. 584-D3 (January 1961). The 1957 survey of QASI beneficiaries also gives some indication of the heavy volume of hospitalization which may characterize a person's last illness. Although no data were obtained for nonmarried beneficiaries dying during the survey year, data were obtained for the small number of persons in the sample who died leaving a spouse drawing a retired worker's benefit. Among the couples where a spouse (usually the wife) had died, three times as many had one or both members hospitalized during the year as among those where both partners survived the year. (The average known medical cost for the year was 2 1/3 times as high for the couples with one member dying as when both lived through the entire year.) Long-stay institutions.--In addition to their high rate of general hospital use, aged persons are heavy users of nursing homes and other long-stay institutions. But relatively little is known about admission rates and length of stay in the chronic-care facilities because most household surveys exclude persons in institutions, as did the National Health Survey. The 1957 survey of OASI beneficiaries, however, did include beneficiaries in institutions. It found that only one-fifth as many spent time in a long-stay institution during the year as in a general hospital, but the average stay in such facilities was much longer. In the aggregate, for aged beneficiaries there were close to two days in a long-stay institution for every one day in a general hospital. It is not known for how many of the beneficiaries in nursing homes the care was primarily residential and custodial, and for how many it was skilled nursing and medical care. But it is known that nearly a third of those reporting nursing home care also spent some time in a general hospital--outside the nursing home--during the year. FINANCIAL RESOURCES Money Income As earnings decline or cease altogether, most persons 65 and over must get along on reduced resources. Just exactly how many have low incomes varies not only with the definition of "low" but also with the system of measurement, that is, the definition of the income unit and |