Hospital charges increase for uninsured

Over a 10-year period, the number of uninsured hospitalizations increased by 34% and the number of Medicaid hospitalizations increased by 36%, but the number of privately insured hospitalizations remained about the same, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ).

According to the report, hospital charges increased for the uninsured faster than for overall hospital charges (76% for compared with 69% for all hospital stays). The average hospital charge for an uninsured stay in 2006 was $19,400 compared to $11,000 in 1997 (after adjusting for inflation). The average length of stay for the uninsured remained the same at about 4 days per hospital visit.

Other findings included:
• Compared to all hospital stays, uninsured hospitalizations begin in the emergency department much more frequently (60% for the uninsured compared to 44% for all hospital stays).

• The number of uninsured hospitalizations for skin infections rose sharply over the 10-year period, increasing from about 28,000 stays in 1997 to about 75,000 stays in 2006. Early appropriate outpatient treatment for skin infections can usually prevent the need for hospitalization.

• There was a 36% increase in hospitalizations billed to Medicaid during the 10-year period.“In theory, as Medicaid spending goes up, the number of uninsured hospitalizations should go down-adjusting for population increases,” says Carol Stocks, RN, MHSA, AHRQ’s Center for Delivery, Organization, and Markets. “We find that is not the case, but explaining the reasons for this will require more study.”

Lack of health insurance has serious consequences on an individual and societal level, according to Stocks. The uninsured may be more likely to delay or forgo necessary medical care until hospitalization is inevitable and care is much more expensive, she says.

According to AHRQ, on average the costs (not charges) to provide hospital care to the uninsured are about $1,500 less expensive ($6,800 vs. $8,400 per hospital stay) than costs for all other hospital stays.

Stocks suggests broader adoption of the fundamental principles of managed care, such as a focus on primary and preventive care-may help curb the number of uninsured hospital stays for potentially preventable conditions, such as, uninsured stays for skin infections.