Hospital Admissions Down, Costs Rise

Across all patient subgroups and payers, hospital stays decreased or held stable between 2005 and 2014, while the inflation-adjusted mean cost per inpatient stay increased by 12.7%, from $9,500 to $10,900.

Hospital inpatient stays dropped from 37.8 million in 2005, to 35.4 million in 2014, a decrease of 6.6%, according to a statistical brief from the Healthcare Cost and Utilization Project.

And the demographic trends show that more affluent people are spending 15%-20% less time in the hospital, while people living in poorer communities experienced the smallest decrease in hospitalization rates. Medicaid-covered inpatient stays increased by 15.7%, while the proportion paid by private insurance and that were uninsured decreased by 12.5% and 13%, respectively.

The decreased held for several patient demographic subgroups, including patients younger than 45 years and older than 74 years, patients with private insurance or no insurance, and patients in the two highest income quartiles. For patients aged 45-64 and 65-74 years, the number of hospital stays did not change substantially during the 10-year time period, HCUP’s analysis found.  

The only hospitalization type that changed substantially from 2005 to 2014 was mental health/substance use. Between 2005 and 2014, the proportion of inpatient stays for mental health/substance use increased from 4.9% to 5.9% of all hospital stays, a 20% increase. The proportion of stays for other hospitalization types held steady. 

The HCUP analysis also found that:

• The overall average cost per hospital stay increased by 12.7% from 2005 to 2014, adjusting for inflation. Inflation-adjusted cost per stay for patients covered by private insurance or Medicaid increased 16%-18%. Cost per stay for Medicare-covered patients and the uninsured changed minimally. Other subgroups with large increases in mean cost per stay were patients aged 0-17 years (up 15.3%) and patients hospitalized for neonatal care (up 19.2%), injuries (up 17%), and surgery (up 16.4%).
   
• In both 2005 and 2014, medical hospitalizations constituted the highest proportion of stays (46%), followed by surgical (20%), maternal (12%), neonatal (11%), mental health/substance use (6%), and injury (5%).
   
• Medicare was the most common expected payer for hospital care and together with Medicaid paid for 61.6% of all hospital stays in 2014.
   
• The proportion of Medicaid-covered inpatient stays increased by 15.7%, whereas the proportion paid by private insurance and that were uninsured decreased by 12.5% and 13%, respectively.
   
• Between 2005 and 2014, septicemia and osteoarthritis became two of the five most common reasons for inpatient stays. Septicemia hospital stays almost tripled. Septicemia and complication of device/implant/graft rose to top 10 conditions in 2014 but were not on the top 10 list a decade earlier. Nonspecific chest pain and coronary atherosclerosis decreased by more than 60% from 2005 to 2014, falling off the list of top 10 reasons for hospitalization.