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Hospital charges are defined
as the amount the hospital bills for the entire stay (excluding
most physician fees). Charges may not reflect the actual
cost of hospital care or how much is reimbursed. Examining
charges over time can provide insight into the relative
growth in various areas.
Total Charges and Average Charge per Day:
Statewide, total charges for hospitalization in 2006 were
approximately $2.7 billion. The average charge of $22,319
per discharge was similar to the U.S. average charge (U.S.:
$22,299).1 Between 1995 and 2006, total hospital
charges increased from $1.4 billion to about $2.7 billion,
an annual growth rate of 7.7 percent. The average charge
per day of $4,108 (2006) represents a 36 percent increase
(adjusted for inflation) from 1995. The increase in the
average charge per day reflects Hawai'i's increasing total
charges and decreasing average length of stay (see "Hospital
Length of Stay and Occupancy"). However, Hawai'i's average
charge per day remains below the U.S. average charge per
day (Hawai'i: $4,108; U.S.: $4,847). Five of the top ten
conditions with the highest average charge per hospitalization
were related to infants.2
County Average Charge: In 2006, patients
hospitalized on O'ahu had the highest average charge per
discharge at $25,309. The higher average charge on O'ahu
is attributed to the concentration of tertiary care services
in Honolulu. These services are necessary for treating
sicker and often high-risk patients.
Payers: Private insurance is billed
for 39 percent of all hospital stays, Medicare for 33
percent, and Medicaid/QUEST for 22 percent; 3 percent
of stays are uninsured.2 Between 1995 and 2006,
the largest increase in charges was experienced within
the Medicaid/QUEST program while hospital charges billed
to the uninsured decreased.3
- Medicare: Medicare, the federally
sponsored health care program for the elderly and
disabled, serves an estimated 174,633 individuals
in Hawai'i, most of whom are 65 years of age and older.4
In 1995 Medicare was billed for 42 percent of hospital charges in Hawaii. In 2006, Medicare was billed for
47 percent of Hawai'i's hospital charges,
while only 33 percent of hospital stays are for Medicare
patients and only 14 percent of the Hawai'i population
is 65 or older. The most common reason for hospitalization
among stays billed to Medicare is congestive heart
failure, followed by pneumonia and respiratory infections.5
In 2006, Medicare hospital charges totaled $1.2 billion.
- Medicaid/QUEST: Medicaid/QUEST,
the federal- and state-government-sponsored health
care program for low-income people, serves about 200,000
individuals in Hawai'i. Approximately 16 percent of
the Hawai'i population is covered by Medicaid/QUEST.
This program is billed for 22 percent of all stays;
17 percent of hospital charges. Women and children
continue to comprise a large portion of Medicaid enrollment,
which results in Medicaid/QUEST being billed for a
larger share of certain conditions. One in four newborn
stays and stays for obstetrics/delivery are billed
to Medicaid/QUEST. This program is also billed for
a large portion of mental health condition, including
39 percent of all stays for depression. In 2006, Medicaid/QUEST
hospital charges totaled $440 million.
- Private: Nearly 900,000 individuals
have private health insurance through private insurance
plans in Hawai'i.6 These plans include
employer-sponsored health plans and self-purchased
plans. In 2006, private plans were billed for
31 percent of hospital charges in Hawai'i, down from 38 percent in 1995; 40 percent of hospital stays are for private patients(2006). The most
common conditions for hospitalizations under commercial
plans are pregnancy and childbirth. In 2006, hospital
charges to private insurers totaled $850 million.
- Uninsured: About 117,000 individuals,
or approximately 10 percent of Hawai'i's population,
have no health insurance.7 Top reasons
for hospitalization of the uninsured include depression,
cellulitis, and pregnancy and childbirth. In 2006,
hospital charges for the uninsured totaled $75 million.
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Source: Hawaii Health Information Corporation, Inpatient Database.; Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample.
Note: Based on county of discharging facility. Non-federal hospitals only. Includes newborns.
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Source: Hawaii Health Information Corporation, Inpatient Database.; Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample.
Note: Based on county of discharging facility. Non-federal hospitals only. Includes newborns.
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Source: Hawaii Health Information Corporation, Inpatient Database.
Note: Non-federal hospitals only.
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