The Most Costly Hospital Stays

There is so much health care delivered in the United States at such a high total level of spending that it is sometimes hard to know where to start in trying to control it.  An Agency for Healthcare Research and Policy report examines the most expensive hospitalizations in 2008 to identify distinguishing characteristics.   (AHRQ Report) The report is based on data in the HCUP Nationwide Inpatient Sample. There were about 39.9 million hospital discharges in 2008.

Assuming our math is correct, all hospitalizations had charges (not what was paid necessarily) of $1.14 trillion associated with them.  The top 5% of cases accounted for about $375 billion, or one-third, of that and the top one-half percent of discharges were responsible for $111 billion, or almost 10%, of charges.  The mean charge for the top 5% was $191,984 and for the top .5% it was $568,040; compared to $20,804 for the  other 95% of discharges.  Mean length of stay was 48 days for the top one-half percent; 19 days for the top 5% and 4 days for the rest.

The principal diagnoses in the top .5% were blood infection; liveborn infants (premature births in all likelihood); respiratory failure, complication of device, implant or graft and stroke.  Looking at the top 5%, arteriosclerosis and heart attack replace liveborn infants and stroke.  Patients in these top groups tended to be severely ill, have more comorbidities and be more likely to die.  They were older, more likely to be male and to be in the western US.   The report adds to the evidence of concentration of spending on a few patients.  It is not clear how much could be avoided by better care management or people taking better care of their health, but anything that could be done to limit the number of expensive hospitalizations would obviously have a huge payoff.