Healthcare News & Insights

Most costly inpatient hospital conditions to treat

NurseAndPatientFor policymakers, hospitals are a major concern because they represent the single largest portion of healthcare spending. And unfortunately, as has been the case for years now, healthcare costs are growing faster than the economy. That’s why most hospitals are focused on doing everything they can to provide better, more effective care at a lower cost.

The healthcare share of the Gross Domestic Product (GDP) in 2011 was 17.9%, according to the most recent statistical brief from the Agency for Healthcare Research and Quality (AHRQ). This is placing a big burden on consumers, insurers and the government.

Top 10 most expensive conditions

To see where a big portion of the spending is going, the AHRQ looked at data from the Healthcare Cost and Utilization Project (HCUP) on the costs of U. S. inpatient hospital stays in 2011. Here’s what Agency found for the top 10 most expensive conditions treated in U.S. hospitals for all payors:

  1. Septicemia, except in labor ($20.3 million)
  2. Osteoarthritis ($14.8 million)
  3. Complication of device, implant or graft ($12.9 million)
  4. Liveborn ($12.4 million)
  5. Acute myocardial infarction ($11.5 million)
  6. Spondylosis, intervertebral disc disorders, other back problems ($11.2 million)
  7. Pneumonia, except caused by tuberculosis and sexually transmitted diseases ($10.6 million)
  8. Congestive heart failure, nonhypertensive ($10.5 million)
  9. Coronary atherosclerosis ($10.4 million)
  10. Respiratory failure, insufficiency, arrest, adult ($8.7 million)

Costs by payor

In 2011, Medicare and Medicaid were responsible for 63% of national inpatient hospital costs,  which totaled $387.2 billion.

While Medicare had the bulk of the costs (47%) in 2011 for 15.3 million hospital stays totaling $182.87 billion, Medicaid incurred approximately $60.2 billion (16%) for 7.6 million hospital stays.

The other portions were picked up by private insurance (29%), uninsured (4%) and other/missing (4%).

As far as which conditions cost which payor the most, the breakdown goes like this:

Medicare’s top 5 most expensive conditions

  1. Septicemia, except in labor ($12.7 million)
  2. Osteoarthritis ($8 million)
  3. Congestive heart failure, nonhypertensive ($7.6 million)
  4. Complication of device, implant or graft ($7.5 million)
  5. Pneumonia, except caused by tuberculosis and sexually transmitted diseases ($6.7 million)

Medicaid’s top 5 most expensive conditions

  1. Liveborn ($5.9 million)
  2. Septicemia, except in labor ($2.7 million)
  3. Complication of device, implant or graft ($1.4 million)
  4. Mood disorders ($1.4 million)
  5. Pneumonia, except caused by tuberculosis and sexually transmitted diseases ($1.3 million)

Private insurance’s top 5 most expensive conditions

  1. Liveborn ($5.8 million)
  2. Osteoarthritis ($5.7 million)
  3. Spondylosis, intervertebral disc disorders, other back problems ($4.7 million)
  4. Septicemia, except in labor ($3.7 million)
  5. Complication of device, implant or graft ($3.2 million)

Uninsured’s top 5 most expensive conditions

  1. Acute myocardial infarction ($0.819 million)
  2. Septicemia, except in labor ($0.774 million)
  3. Acute cerebrovascular disease ($0.538 million)
  4. Biliary tract disease ($0.441)
  5. Diabetes mellitus with complications ($0.440 million)

Of course the top five conditions varied among payors due to demographic mix and service coverage.

Some other interesting findings from the statistical brief are:

  • Schizophrenia was the only condition that appeared in the top 20 list only for Medicaid
  • Conditions seen only in the top 20 for the uninsured were alcohol-related disorders, pancreatic disorders and unspecified chest pain, and
  • Rehabilitation, urinary tract infections, intestinal obstruction without hernia were among the conditions only seen in Medicare’s top 20.

 

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