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1 in 5 Hospital Patients Who Leave Against Medical Advice Are Uninsured

 |  By cclark@healthleadersmedia.com  
   November 13, 2013

Incidences of patients leaving the hospital against medical advice rose sharply between 1997 and 2011, particularly among patients financially responsible for their own care.

The number of patients who get up from their hospital beds and walk out the door before their doctors say they're well enough to go, is up 41% between 1997 and 2011.

These figures on patients said to leave AMA or against medical advice, come from a statistical brief from the Healthcare Cost and Utilization Project, a division of the federal Agency for Healthcare Research and Quality.

The brief says the number of AMA patients went from 264,000 in 1997 to 373,000 in 2011, with people between the ages of 45 and 64 accounting for most of the increase, 27% in 1997 to 41% in 2011. However, among patients between the ages of 18 and 44, such ill-advised departures went down, from 56% in 1997 to 44% in 2011.

Anne Elixhauser, the principal author for AHRQ, says that while the survey data doesn't provide insight into why this is happening, one clue may lie in who is paying the bill for patients who leave the hospital AMA, and what has happened to the economy between 1997 and 2011.

"We can very easily see that although only 5% of hospital stays are among patients who have no insurance, 19% of the people who leave against medical advice are uninsured," she said. "To me, that's the biggest finding here, and we wanted to draw attention to that."

"You can imagine the scenario," she added. "Once people start feeling better, they want to leave right away. And if someone is responsible financially for their [own] hospital stay, they're going to have a much different threshold for wanting to stick around, because they know everything that happens to them in the hospital they will be financially responsible for [themselves]."

Medicare and Medicaid Patients
Patients covered by Medicaid made up 20% of the inpatient stays but accounted for 31% of those who left against medical advice. Patients covered by Medicare made up 40% of the inpatient stays but only 29% of those who left against medical advice. And patients who had private insurance coverage made up 32% of the inpatient stays, but accounted for only 16% of those who left against medical advice.

According to published research, reasons other than fear of costs prompting patients to leave the hospital before they are ready for discharge include lack of home conveniences or lack of hospital room privacy or other amenities. Additionally, they may think they don't need to be in the hospital or don't want to wait for a physician to complete discharge orders.

An estimated 1% to 2% of all hospital admissions are said to leave against medical advice, although people with substance abuse history and who are younger are more likely to do so.

Finding on Costs, Hospitalizations
The HCUP statistical brief also highlighted findings on hospital costs and rates of hospitalization.

Inflation-adjusted aggregate hospital costs increased 63% between 1997 and 2011, to $387.3 billion. Costs per stay increased 47% to an average of $10,000. The charge per stay, or the amount hospitals billed for tests, nursing, procedures and other inpatient services, more than doubled to $35,400, which was adjusted for inflation, since 1997.

The rate of hospitalization for the U.S. population remained the same, at about 1,200 stays per 10,000 population, or 38.6 million hospital stays in 2011, although because population increased, the actual number of stays increased by 11%.

While the rate of stays-per-population was relatively similar in the Northeast, Midwest and South (between 1,276 and 1,354 stays per 10,000 population) it was much lower in the West, with 1,029 stays per 10,000 population.

  • 60% of all hospital stays were billed to Medicare and Medicaid, up from 52% in 1997
  • Stays billed to private insurance dropped from 39% to 32%
  • Patients living in areas with the lowest income levels had higher hospitalization rates

These statistics are obtained from the 2011 Nationwide Inpatient Sample of non-federal, short-term general hospitals, excluding long-term rehabilitation, psychiatric, and chemical dependency facilities.

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