The Top Five Most Costly Inpatient Conditions

Megan Brooks

June 14, 2016

Septicemia was the most expensive condition treated in US hospitals in 2013, followed by osteoarthritis; care for newborn infants; complication of device, implant, or graft; and acute myocardial infarction (MI), according to a statistical brief from the Agency for Healthcare Research and Quality.

In 2013, aggregate hospital costs for 35.6 million hospital stays totaled $381.4 billion. The five most expensive conditions accounted for 20.5% of total hospital costs in 2013.

The hospital costs represent the hospital's costs to produce the services, not the amount paid for services by payers. They do not include the physician fees associated with the hospitalization, the agency notes.

Coming in at number one, septicemia accounted for $23.7 billion (6.2%) of the total costs for all hospitalizations in 2013, followed by osteoarthritis, at $16.5 billion (4.3%), newborn infant care, at $13.3 billion (3.5%), complication of device, implant or graft, at a cost of $12.4 billion (3.3%), and acute MI, at $12.1 billion (3.2%).

Rounding out the top 20 most expensive inpatient conditions (in order) were congestive heart failure; spondylosis, intervertebral disc disorders and other back problems; pneumonia; coronary atherosclerosis; acute cerebrovascular disease; cardiac dysrhythmias; respiratory failure, insufficiency, arrest (adult); complications of surgery or medical care; rehabilitation care, fitting and adjustment of prostheses; mood disorders; chronic obstructive pulmonary disease and bronchiectasis; heart valve disorders; diabetes with complications; fracture of neck or femur; and biliary track disease.

Together, the 20 most expensive conditions accounted for nearly half (47.7%) of aggregate hospital costs. They accounted for 43.7% of all hospital stays.

By Payer

The primary payer shares of total hospital costs were 63% for Medicare and Medicaid, 28% for private insurance, and 5% for uninsured hospitalizations, according to the brief.

With regard to payer, osteoarthritis and back problems were the most expensive conditions for Medicare and private insurance. Pregnancy and childbirth were the most costly for Medicaid and private insurance, and skin infections were the most costly for Medicaid and the uninsured.

Nine of the 20 most expensive conditions for hospital stays billed to Medicare involved the cardiovascular or respiratory system, as did seven of the 20 most expensive conditions billed to Medicaid.

Authors Celeste M. Torio, PhD, MPH, and Brian J. Moore, PhD, also note in their brief that healthcare expenditures have maintained a "relatively stable share" of the gross domestic product since 2009, reaching 17.5% in 2014. Hospital care expenditures in particular, which make up the largest single component of healthcare spending, grew 4.1% in 2014. Although this is up from 3.5% in 2013, annual hospital care expenditure growth averaged 5.5% from 2008 through 2012.

The authors note that although only 7.2% of the US population had a hospital inpatient stay in 2012, the average expense per stay associated with those hospitalizations was more than $18,000, making hospitalization one of the most expensive types of healthcare treatment.

Healthcare Cost and Utilization Project. Statistical Brief 204, May 2016. Full text


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