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Medicare News
Medicare, Medicaid Pay Most of 2005 Hospital Bill
that Jumped 90 Percent from 1997
Total bill is $873 billion in 2005 with Medicare
alone paying $411 billion
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Distribution of the national hospital bill by primary payer, 2005 |
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Dec. 12, 2007 While the presidential candidates
debate new ideas for universal health care, it is sneaking up behind us.
New numbers show U.S. hospitals charged $873 billion in 2005 almost a
90 percent increase from the $462 billion charged in 1997. The report
also shows that the majority - about two thirds - of this bill was paid
by Medicare and Medicaid, although other government programs also helped pay
the bill.
Medicare paid the bulk of the national hospital
bill ($411 billion), followed by private insurance ($272 billion) and
Medicaid ($124 billion). Uninsured hospital stays accounted for $38
billion in charges. The remaining $28 billion was for other insurers and
other government programs, including Workers Compensation, TRICARE
(military) and Title V. The portion paid by the government increased
substantially from 2004 - see story link in sidebar.
The 2005 bill, which is adjusted for inflation,
represents the total amount charged for 39 million hospital stays,
according to the latest News and Numbers from the Agency for Healthcare
Research. The hospital stays increased 13 percent from the 34.7 million
in 1997.
Hospital stays for coronary artery disease incurred
the highest charges ($46 billion); mothers pregnancy and delivery had
the second highest charges ($44 billion).
The average yearly rate of increase over the last
several years in the national hospital bill was 4.5 percent. At this
rate, researchers estimate that the annual national hospital bill may
reach $1 trillion by 2008.
The AHRQ report also found that:
● One fifth of the national hospital bill was for
treatment of just five conditions -
> coronary artery disease ($46 billion),
> pregnancy and childbirth ($44 billion),
> newborn infant care ($35 billion),
> heart attack ($32 billion), and
> congestive heart failure ($30 billion).
● The national bill for sepsis and nonspecific
chest pain grew twice as fast as the overall growth in hospital charges
- about a 180% increase from 1997 to 2005. Other expensive conditions
for which the national bill grew faster than overall included -
> respiratory failure (a 171 percent increase),
> back pain (170 percent), and
> osteoarthritis (165 percent).
● Among the 20 most expensive conditions in 2005,
ten increased faster than the overall 1997 to 2005 increase in the
national bill for all conditions (89 percent). For 10 conditions, the
growth was greater than the average of all hospital stays:
|
Hospital
Stays with Greater Than Average Billing Growth |
|
Condition |
%
Increase |
|
Sepsis |
189 |
|
Chest
pain |
181 |
|
Respiratory failure |
171 |
|
Back
pain |
170 |
|
Osteoarthritis |
165 |
|
Irregular heart beat |
131 |
|
Procedure complications |
120 |
|
Congestive heart failure |
117 |
|
Medical
device complications |
113 |
|
Diabetes |
97 |
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Table 1. Top 20 most expensive conditions treated in U.S.
hospitals, 2005 |
|
Rank |
Principal diagnosis |
Total national hospital bill (millions) |
Percentage of national hospital bill |
Number of hospital stays (thousands) |
|
1 |
Coronary artery disease |
$45,985 |
5.3% |
1,110 |
|
2 |
Mother's pregnancy and delivery |
$43,925 |
5.0% |
4,712 |
|
3 |
Newborn infants |
$35,316 |
4.0% |
4,429 |
|
4 |
Acute myocardial infarction (AMI, heart attack) |
$31,946 |
3.7% |
662 |
|
5 |
Congestive heart failure (CHF) |
$30,230 |
3.5% |
1,090 |
|
6 |
Pneumonia |
$29,535 |
3.4% |
1,355 |
|
7 |
Osteoarthritis |
$26,157 |
3.0% |
738 |
|
8 |
Complication of device, implant or graft |
$25,291 |
2.9% |
616 |
|
9 |
Sepsis |
$24,801 |
2.8% |
538 |
|
10 |
Back pain (spondylosis, intervertebral disc disorders, other
back problems) |
$20,327 |
2.3% |
647 |
|
11 |
Respiratory failure, insufficiency, arrest (adult)
|
$19,723 |
2.3% |
336 |
|
12 |
Cardiac dysrhythmias |
$17,224 |
2.0% |
697 |
|
13 |
Acute cerebrovascular disease (stroke) |
$17,060 |
2.0% |
526 |
|
14 |
Rehabilitation care, fitting of prostheses, and adjustment
of devices |
$13,848 |
1.6% |
517 |
|
15 |
Complications of surgical procedures or medical care
|
$13,316 |
1.5% |
463 |
|
16 |
Gall bladder disease |
$11,719 |
1.3% |
456 |
|
17 |
Chronic obstructive pulmonary disease (COPD) |
$11,506 |
1.3% |
630 |
|
18 |
Diabetes mellitus with complications |
$11,171 |
1.3% |
491 |
|
19 |
Hip fracture |
$10,869 |
1.2% |
317 |
|
20 |
Nonspecific chest pain |
$10,027 |
1.1% |
825 |
|
Total for top 20 conditions |
$449,976 |
51.5% |
21,155 |
|
Total for all hospitalizations |
$873,236 |
100.0% |
39,164 |
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Source: AHRQ, Center for Delivery, Organization, and
Markets, Healthcare Cost and Utilization Project, Nationwide
Inpatient Sample, 2005. |
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Table 2. Top 20 most expensive conditions billed to
Medicare, 2005 |
|
Rank |
Principal diagnosis |
Total hospital charges (millions) |
Percentage of Medicares hospital bill |
Number of hospital stays (thousands) |
|
1 |
Coronary artery disease |
$26,210 |
6.4% |
617 |
|
2 |
Congestive heart failure (CHF) |
$22,581 |
5.5% |
840 |
|
3 |
Pneumonia |
$18,879 |
4.6% |
816 |
|
4 |
Acute myocardial infarction (AMI, heart attack) |
$18,319 |
4.5% |
391 |
|
5 |
Sepsis |
$16,597 |
4.0% |
375 |
|
6 |
Osteoarthritis |
$15,353 |
3.7% |
438 |
|
7 |
Complication of device, implant or graft |
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