From Vital and Health Statlstlcs of the National Center for Health Statlstlcs ‘“~.!&~~~~, 1982 

PuBi{cATtoNc ,, trl,”ui 

‘HMTORIAL
I’BWRY


Expected Principal Source of Payment for Hospital Discharges: 

United States, 1979 

by Edmund Graves and Robert Pokras, 

Introduction 

This report presents statistics on data collected 

through the National Hospital Discharge Survey. The 

National Center for Health Statistics has continuously 

conducted this survey since 1965. In 1979 data were 

abstracted from the face sheets of medical records of 

approximately 215,000 patients discharged from 416 

non-Federal short-stay hospitals. These data were 

used to produce estimates of hospital utilization by 

an estimated 36.7 million inpatients (excluding 

newborn infants) in the United States. 

From 1968 through 1970 information on hospital 

charges and sources of payment from a subsample of 

the National Hospital Discharge Survey sample was 

collected. I No information on charges or sources of 

payment was collected from 1971 through 1976. 

However, during 1977-79 data on a patient’s expected principal source of payment and other expected sources of payment were collected from the 

face sheets of all medicaI records in the NationaI 

Hospital Discharge Survey sample. A report on the 

1977 data has been published.z Statistics in that 

report as well as those in this one reflect only the 

patient’s principal source of payment. The 1977 

report presents estimates of source of payment by 

age and sex of patients as well as estimates for leading 

diagnostic and surgical categories. This report updates 

the basic estimates by age and sex of patients and 

provides new analysis by discharge status and surgical 

status of patients as well as by hospital location and 

ownership. The survey form used to collect these 

data is reproduced in another publication of the 

o

National Center for Health Statistics.s 

Within NCHS, there are two other sources of 

information on health care costs: the NationaI Medical 

Care Expenditures Survey (NMCES) and the National 

Health Interview Survey (NHIS). These surveys 

provide data on the number of ~ersons in the general 

�population covered under the’ different pri;ate or 

Division of Health Care Statistics 

public health p]ans,q+ and the National Hospital 

Discharge Survey (NHDS) provides data on the 

hospital population only. Acco;ding to the NHDS, 

approximately 6 percent of all patients discharged 

from short-stay hospitak had no heaIth insurance. 

On the other hand, data from NHIS and NMCES 

indicate that 11.0 and 12.6 percent, respectively, of 

the noninstitutionalized population had no health 

insurance coverage. This would seem to indicate that 

a proportionately smaller number of the uninsured 

rather than of the insured are hospitalized. This may 

be true. Moreover. many individual who claim they 

have no health insurance coverage may find on being 

hospitalized that they are covered under such public 

health programs as Medicaid, Welfare, Veterans 

Administration health benefits, and the like. 

According to the National Hospital Discharge 

Survey, the percent of hospitalized individuals 

covered by private insurance was 52.5 percent. This 

is much lower than the estimated 77.7 percent of 

individuals covered by private insurance found in 

the 1978 National Health Interview Survey.G This 

difference is not unexpected since public health 

programs are often billed first for hospital charges, 

and individuals citing private insurance coverage may 

be using it as a seconda~ insurance source. 

It should be noted that the expected source of 

payment recorded on the face sheet of the medical 

record may not have been the actual source of payment. For example, a patient admitted to a hospital 

following an automobile accident may have cited 

Blue Cross as the expected source of payment when, 

in fact, an automobile insurance company ultimately 

made restitution. Also, because of the manner in 

which this variable was collected, there is no way to 

determine the charge for the hospital stay or what 

proportions of the hospital stay and medical services 

were covered by the principal source of payment 

indicated. 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Office of Health Research. Statistics, and Technology 
2 ackincedata 

Data highlights 

Of the 36.7 million patients discharged from 

non-Federal short-stay hospitals in the United States 

during 1979, 52.5 percent expected to pay for 

their hospital stay through private insurance, 27.0 

percent expected Medicare to pay for the hospitalization, 8.8 percent expected Medicaid to pay for the 

hospitalization, 5.9 percent expected to pay their 

own hospital bills, and the remaining 5.9 percent 

expected to have their hospital bills paid through 

other sources or not to be charged. 

A typical person who was hospitalized in nonFederal short-stay hospitals in the United States 

during 1979 was female, white, about 44 years of 

age, was hospitalized in the South, was a patient in 

a nonprofit hospital, and expected to pay for the 

hospitalization through private insurance. 

Discussion 

Private Insurance 

Private health insurance is the major type of 

health insurance in the United States. In studies done 

in 1976 and 1978 it was estimated that over 70 

percent of all persons in the United States were 

covered by private insurance.l,s In the National 

Hospital Discharge Survey of 1979 it was the expected source of payment for about 50 percent of 

all hospital patients. The use of private insurance to 

pay hospital costs is a rather unusual method of 

payment since a study of 10 of the more developed 

countries pointed out that only the United States and 

Australia utilized private health insurance plans to a 

large extent.7 Another interesting finding of that 

study was that the United States and Australia also 

had the shortest average lengths of stay of the 10 

countries. 

Private health insurance consists of Blue Cross 

and other private or commercial insurance. It was the 

expected source of payment for approximately 19.3 

million discharges from non-Federal short-stay 

hospitals in 1979, about half of all discharges (table 

1). Of these 19.3 million discharges, 19.0 million 

(98.7 percent) were under 65 years of age. The 

remaining 0.3 million (1.3 percent) were 65 years 

and over. 

The numbers of males and females discharged 

were relatively similar for all age groups except 

15-44 years (table 1). Of the discharges in this age 

group, females outnumbered males by about 5 to 2. 

This was due to the large number of females admitted 

for delivery and female-specific surgery.z However, 

the percent of males using private insurance and the 

percent of females using private insurance was about 

the same in each age group. 

The average length of stay for patients with private insurance as an expected source of payment was 

5.9 days (table 2). This was 1.3 days less than th 

average of 7.2 days for all patients discharged frome 

short-stay hospitals. This difference is partially a 

function of age since average length of stay increases 

with age, and the average age of patients using private 

insurance was 34.4 years compared with an average 

age of 43.7 years for all patients (table 3). The shorter 

average length of stay means that a proportionately 

smaller number of days of care were used by the 

patients. Whereas approximately 52 percent of all 

discharges were expected to be covered by private 

insurance, only about 43 percent of the total days 

of care in non-Federal short-stay hospitals were 

used by these patients. 

Table 4 provides data on the number and percent 

of patients discharged from non-Federal short-stay 

hospitals who had one or more surgical or nonsurgical procedures performed during 1979. A total 

of 18.9 million or 51.4 percent of all patients discharged during 1979 had one or more procedures 

performed. 

Of the 19.3 million patients who expected to 

pay for their hospitalization through private insurance, 58.5 percent had one or more procedures 

performed (table 5). Women 15-44 years of age had 

three times more surgical procedures than men of th 

same age had because of the large number of obstet 9 

rical procedures.2 Approximately 69.4 percent of 

all women 15-44 years expecting to pay for their 

hospitalization through private insurance had one 

or more procedures performed, whereas only 53.1 

percent of the men 15-44 years with the same characteristic had one or more procedures performed. 

Table 5 provides data on the discharge status for 

all patients under 65 years and 65 years and over. Of 

the 19.3 million patients covered by private insurance 

programs, 18.0 million (93.5 percent) were discharged alive and 184,000 (1.0 percent) were discharged dead; the discharge status of 1.1 million 

(5.6 percent) were unknown. A total of 17.8 million 

(98.8 percent) of the 18.0 million patients discharged 

alive were under 65 years. The remaining 223,000 

patients (1.2 percent) were 65 years and over. 

Table 6 shows the number and percent distribution 

of patients discharged from non-Federal short-stay 

hospitals by source of payment, race, region, and 

hospital ownership. Approximately 14.8 million 

(76.8 percent) of the 19.3 million patients discharged 

from short-stay hospitals who expected to pay for 

their hospitalization through private insurance were 

white. Of the remaining 4.5 million, 1.9 million 

(9.8 percent) were of other races and 2.6 mini 

(13.3 percent) did not have race stated on ths 

medical record. 

Estimates of the number of discharges by region 

showed that the South Region, with 6.4 million 
aduancedata 3 

Table 1. Number and percent distribution of patients discharged from non-Federal short-stay hospitals 

payment, according to age and sex: United States, 1979 

All expected Private Workmen ? Medi- Medic- Other 

Age and sex sources of insurance Compenpayment sation 

Both sexes 

Alleges . . . . . . . . . . 

Under 15 years . . . . . . . 

15-44 years . . . . . . . . . 

45-64 years . . . . . . . . . 

65 years and over . . . . . . 

Alleges . . . . . . . . . . 

Under 15years . . . . . . . 

15-44 yeara . . . . . . . . . 

45-64 years . . . . . . . . . 

65 years and over . . . . . . 

Female 

Alleges . . . . . . . . . . 

Under 15years . . . . . . . 

15-44 years . . . . . . . . . 

45-64 years . . . . . . . . . 

65 years and over . . . . . . 

Both sexes 

Alleges . . . . . . . . . . 

Under 15 years . . . . . . . 

e15-44 years . . . . . . . . . 

5-64years . . . . . . . . . 

5 years and over . . . . . . 

Male 

Alleges . . . . . . . . . . 

Under 15years . . . . . . . 

1544 years . . . . . . . . . 

45-64 years . . . . . . . . . 

65 years and over . . . . . . 

Female 

Alleges . . . . . . . . . . 

Under 15years . . . . . . . 

15-44 years . . . . . . . . . 

45-64 years . . . . . . . . . 

65 years and over . . . . . . 

36,747 19,289 643 

3,641 2,437 . . . 

15,4B8 10,574 447 

8,532 6,017 182 

9,086 260 14 

14,705 7,399 528 

2,053 1,381 

4,680 3,122 3;6 

4,017 2,765 143 

3,955 131 10 

22,042 11,889 115 

1,588 1,056 . . . 

10,808 7,452 72 

4,515 3,252 39 

5,131 129 4 

100.0 52.5 1.8 

100.0 66.9 

100.0 68.3 2:9 

100.0 70.5 2.1 

100.0 2.9 0.2 

100.0 50.3 3.6 

100.0 67.3 . . . 

100.0 66.7 8.0 

100.0 68.8 3.6 

100.0 3.3 0.2 

100.0 53.9 0.5 

100.0 66.5 . . . 

100.0 68.9 0.7 

100.0 72.0 0.9 

100.0 2.5 0.1 

aid government care payments 

Number in thousands 

9,925 3,227 918 

43 675 163 

288 1,820 507 

1,019 592 228 

8,576 139 21 

4,437 974 353 

19 381 87 

148 329 152 

554 210 105 

3,716 54 10 

5,488 2,253 565 

23 294 76 

140 1,491 355 

465 382 123 

4,860 85 11 

Percant distribution 

27.0 8.8 2.5 

1.2 18.5 4.5 

1.9 11.8 3.3 

11.9 6.9 2.7 

94.4 1.5 0.2 

30.2 6.6 2.4 

0.9 18.6 4.2 

3.2 7.0 3.2 

13.8 5.2 2.6 

94.0 1.4 0.2 

24.9 10.2 2.6 

1.5 18.5 4.8 

1.3 13.8 3.3 

10.3 8.5 2.7 

94.7 1.7 0.2 

by principal expected source of 

No Other 

Self-pay charge payments 

2,168 30 546 

235 5 83 

1,500 15 337 

372 7 116 

61 4 11 

773 11 230 

136 2 46 

431 3 120 

179 3 58 

27 2 5 

1,395 20 316 

99 2 37 

1,069 12 216 

193 3 58 

34 2 6 

5.9 0.1 1.5 

6.5 0.1 2.3 

9.7 0.1 2.2 

4.4 0.1 1.4 

0.7 0.0 0.1 

5.3 0.1 1.6 

6.6 0.1 2.3 

9.2 0.1 2.6 

4.5 0.1 1.4 

0.7 0.0 0.1 

6.3 0.1 1.4 

6.2 0.1 2.3 

9.9 0.1 2.0 

4.3 0.1 1.3 

0.7 0.0 0.1 

(33.2 percent), and the North Central, with 6.0 Public health programs


million (3 1.3 percent), had the largest numbers of


discharged patients covered by private insurance. Public health programs
 include Medicare, Medic- The West, with 2.’7 million (14.1 percent) had the aid, Workmen’s Compensation, and other gover­ smallest number of discharges. 

Patients discharged from nonprofit hospitals nment programs. Together these programs were the 

principal expected source of payment for 14.7 accounted for 14.2 million (73.6 percent) of the 19.3 million or 40.0 percent of all discharges (table 1). million patients covered by private insurance dis- Of these 14.7 million, 9.9 million (67.5 percent) were harged from non-Federal short-stay hospitals. Of Medicare patients, 3.2 million (21.9 percent) were 

e remaining 5.1 million patients, 3.5 million (18.0 Medicaid patients, 0.6 million (4.4 percent) were 

e	 percent) were discharged from State and local gover- covered under Workmen’s Compensation, and the 

nment hospitals and 1.6 million (8.4 percent) were remaining 0.9 million (6.2 percent) were covered discharged from profitmaking (proprietary) hospitals. 
4 achncedata 

Table 2. Number and percent distribution of days of care and average length of stay for patients discharged from non-Federal short-stay hospitals 

by principal expected source of payment, according to age: United States, 1979 

A II expected Private Workmen’s Medi- Medic- Other nf - 71.L. ”. 

Age 

Alleges . . . . . . . . . . 

Under 15 years . . . . . . . 

15-44 years . . . . . . . . . 

45-64 years . . . . . . . . . 

65 years and over . . . . 

All ages . . . . . . . . . . 

Under 15 years . . . . . . . 

15-44 years . . . . . . . . . 

45-64 years . . . . . . . . . 

65 years and over . . . . . 

Allege s . . . . . . . . . 

Under 15 years . . . . . . 

15-44 years . . . . . . . . . 

45-64 years . . . . . . . . . 

65 years and over . . . . . . 

sources of ‘“” insurance Compen- care aid government Self-pay ,.A..wa “.,,U ‘“C’ w m.n+c 

payment sation payments 

Days of care in thousands 

264,173 113,329 4300 105,319 20,433 5,401 11,595 242 3,555 

15,765 9,808 . . . 346 3,230 724 1,175 55 426 

80,913 54,205 2,760 2,719 9,806 2,663 6,797 67 1,895 

69,755 46,738 1,391 9,904 5,800 1,846 2,951 57 1,067 

97,740 2,578 149 92,350 1,596 167 671 63 166 

Percent distribution of days of care 

100.0 42.9 1.6 39.9 7.7 2.0 4.4 0.1 1.3 

100.0 62.2 2.2 20.5 4.6 7.5 0.3 2.7 

100.0 67.0 3:4 3.4 12.1 3.3 8.4 0.1 2.3 

100.0 67.0 2.0 14.2 8.3 2.6 4.2 0.1 1.5 

100.0 2.6 0.2 94.5 1.6 0.2 0.7 0.1 0.2 

Average length of stay in days 

7.2 5.9 6.7 10.6 6.3 5.9 5.3 7.9 6.5 

4.3 4.0 8.1 4.8 4.5 5.0 11.6 5.1 

5.2 5.1 6:2 9.4 5.4 5.3 4.5 4.4 5.6 

8.2 7.8 7.6 9.7 9.8 8.1 7.9 8.7 9.2 

10.8 9.9 10.9 10.8 11.5 8.0 11.0 15.7 15.7 

Table 3. Number of discharges, days of care, average length of stay, and 

average age of patients discharged from non-Federal short-stay 

hospitals, by principal expected source of payment: United States, 

1979 

Expected sources of paymen t 

All expected 

I tern sources of Self-pay, no 

payment Private Public charge, and 

other 

Total number of 

discharges in 

millions. . . . . . 36.7 19.3 14.7 2.7 

Total days of care 

in millions . . . . 264.2 113.3 135.5 15.4 

Average length of 

stay in days . . 7.2 5.9 9.2 5.7 

Average age of 

patients in years 43.7 34.4 58.5 29.9 

by other forms of government health payment 

programs. 

Forty percent of all discharges expected to pay 

for their hospitalization through public health programs, and they accounted for 51.3 percent of the 

total days of care. As stated earlier, 52.5 percent of 

the discharges in the NHDS were covered by private 

insurance, but they accounted for only 42.9 percent 

of the total days of care (table 2). This resulted in 

longer average length of stay for patients covered 

by public health programs than for those covered by 

private insurance–9.2 days compared with 5.9 days. 

In addition, 86.4 percent of the Medicare patients 

were 65 years and over, and the average length o 

_stay for patients of this age group was 10.8 days. 

The average age of patients expecting to pay foB 

their hospitalization through public programs was 

58.5 years (table 3). This was 70 percent higher than 

the average of 34.4 years for patients expecting to 

pay hospital bills through private insurance. The 

higher average age for patients covered by public 

health insurance was because of the high proportion 

of Medicare patients. 

In the age-by-sex distributions of table 1, the 

most prominent sex difference in the number of 

discharges was in the age group 15-44 years. For 

Medicaid and other government payments there 

were more than twice as many female as male discharges in this age group. For Medicare the number 

of females and males 15-44 years of age were quite 

similar (140,000 and 148,000, respectively), but for 

Workmen’s Compensation the number of males outnumbered the number of females discharged by more 

than 5 to 1 (375,000 and 72,000, respectively). 

Medicare is a government-sponsored program 

primarily designed to help older people defray the 

costs of hospitalization. Medicare patients accounted 

for 9.9 million patients (27.0 percent) discharged 

from short-stay hospitals (table 1). Of these 9.9 

million, 8.6 million (86.4 percent) were 65 years an 

over. Table 4 shows that a total of 3.9 million (38. 

percent) of the Medicare patients had one or morB 

procedures performed. This was considerably lower 

than the 56.1 percent of patients with one or more 

procedures performed who were covered under all 
aciwncedata 5 

Table 4. Number and percent of patients with procedures discharged from non-Federal short-stay hospitals by sex, age, and principal expected 

source of payment: United States, 1979 

* Sex and age of patients All expected Private Workmen k Medi- Medic- 0 ther No Other 

with procedures sources of insurance Compen - care aid government Self-pay charge payments payment sation payments 

Both sexes Number in thousands 

Alleges . . . . . . . . . . 18,896 11,284 380 3,862 1,491 460 1,117 17 285 

Under 15years . . . . . . . 1,575 1,142 14 225 75 82 2 36 

15-44 years . . . . . . . . . 9,514 6,825 263 109 993 277 849 10 188 

45-64 years . . . . . . . . . 4,207 3,194 109 365 219 98 163 4 55 

65 years and over . . . . . . 3,601 124 9 3,374 53 11 23 2 5 

Male 

All ages . . . . . . . . . . 6,839 3,786 320 1,824 344 147 307 5 105 

Under 15years . . . . . . . 899 661 7 123 38 48 1 20 

15-44 years . . . . . . . . . 2,357 1,656 226 50 126 62 180 1 54 

45-64 years . . . . . . . . . 1,894 1,404 87 191 71 43 68 1 28 

65 years and over . . . . . . 1,690 64 7 1,575 25 4 11 1 2 

Female 

All ages . . . . . . . . . . 12,057 7,498 60 2,039 1,146 313 809 12 179 

Under 15years . . . . . . . 676 480 7 102 36 33 1 16 

15-44 years . . . . . . . . . 7,157 5,168 “36 58 867 216 669 8 134 

45-64 years . . . . . . . . . 2,313 1,790 22 174 149 55 95 2 27 

65 years and over . . . . . . 1,911 60 2 1,799 28 6 12 1 3 

Both sexes Percent 

Alleges . . . . . . . . . . 51.4 58.5 59.1 38.9 46.2 50.1 51.5 55.9 52.1 

Under 15 years . . . . . . . 43.2 46.8 33.8 33.3 45.8 34.7 39.2 43.0 

15-44 years . . . . . . . . . 61.4 64.5 58.+ 37.8 54.6 54.7 56.6 64.0 56.0 

45-64 years . . . . . . . . . 49.3 53.1 59.9 35.8 37.1 43.0 43.9 57.4 47.5 

— 65 years and over . . . . . . 39.6 47.7 63.1 39.3 38.0 51.3 37.5 42.4 51.9 

Male 

All ages . . . . . . . . . . 46.5 51.2 60.6 41.1 35.4 41.8 39.8 44.3 45.7 

Under 15 years , . . . . . . 43.8 47.9 . . . 36.4 32.2 44.0 35.5 53.2 42.9 

15-44 years . . . . . . . . . 50.4 53.1 60.3 34.0 38.5 40.6 41.8 41.0 45.2 

45-64 years . . . . . . . . . 47.1 50.8 60.7 34.5 33.7 41.3 38.0 42.5 48.8 

65 years and over . . . . . . 42.7 49.1 70.3 42.4 45.6 45.4 40.2 41.0 50.7 

Female 

Alleges . . . . . . . . . . 54.7 63.1 52.4 37.1 50.8 55.4 58.0 62.0 56.8 

Under 15 years . . . . . . . 42.6 45.5 . . . 31.7 34.8 47.9 33.5 24.9 43.0 

15-44 years . . . . . . . . . 66.2 69.4 50.4 41.8 58.1 60.7 62.5 69.6 62.0 

45-64 years . . . . . . . . . 51.2 55.0 56.8 37.4 38.9 44.5 49.4 72.0 46.2 

65 years and over . . . . . . 37.3 46.3 45.5 37.0 33.3 56.5 35.3 43.6 53.0 

other sources of payment. One reason for this 

difference may be that Medicare patients, who 

are primarily elderly people, may be more likely to 

be hospitalized for chronic nonoperable conditions. 

As shown in table 5 patients covered under the 

Medicare program were also more likely to have a 

higher mortality rate than patients covered under 

other sources of payment. Medicare patients constituted 70.7 percent of all patients discharged dead 

even though they constituted only 27.0 percent 

)f all patients discharged from short-stay hospitals. 

— Again, this is because of the substantially older

average age of Medicare patients. 

Approximately 10.6 million (72.3 percent) of 

the 14.7 million patients expecting to pay for their 

hospitalization through public insurance were white 

(table 6). Of the remaining 4.1 million, 2.2 million 

(15.0 percent) were of other races, and race was not 

stated for 1.9 million (12.6 percent). 

An estimated 24.8 percent of other than white 

patients discharged from short-stay hospitals had 

Medicaid entitlement whereas only 6.2 percent of 

white patients discharged from short-stay hospitals 

had Medicaid entitlement. An explanation of this 

may be that Medicaid is primarily a program to provide medical benefits to certain low income people 

in need of medical care and that people of other 

races have proportionately more low income families 

than white people. Specifically, in 1979 the actual 

poverty level was determined to be $7,412 for a 

family of four. In that year 13.3 percent of all 

families were below an income level of $7,500. For 
T 

6 

Table 5. Number and percent distribution of patients discharged from non-Federal short-stay hospitals by age and discharge status, according tO 

principal expected source of payment: United States, 1979 

f’ 

Age and All expected Private Workmen’s Medi- Medic- 0 ther No Other 

discharge status	 sources of insurance Compen - care aid government Self-pay charge payments 

payment sation payments 

Number in thousands 

Alleges . . . . . . . . . . 36,747 19,289 643 9,925 3,227 918 2,168 30 546 

Alive . . . . . . . . . . . . . 33,812 18,034 610 8,743 3,024 837 2,031 29 504 

Dead . . . . . . . . . . . . . 924 184 2 653 40 12 23 1 8 

Not stated . . . . . . . . . . 2,011 1,071 31 528 162 69 114 1 34 

Under 65 years . . . . . 27,661 19,028 630 1,349 3,087 897 2,107 26 535 

A live . . . . . . . . . . . . . 25,845 17,811 598 1,223 2,896 821 1,977 25 495 

Dead . . . . . . . . . . . . . 287 165 2 51 33 10 20 z 7 

Not stated, . . . . . . . . . 1,528 1,053 30 75 158 67 111 1 34 

65 years and over. . . . 9,086 260 14 8,576 139 21 61 4 11 

Alive . . . . . . . . . . . . . 7,967 223 12 7,520 128 16 54 3 10 

Dead . . . . . . . . . . . . . 636 19 1 603 7 2 4 1 1 

Not stated . . . . . . . . . . 483 18 1 454 4 2 3 z 

Percent distribution 

Alleges. .,....... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

Alive . . . . . . . . . . . . . 92.0 93.5 94.9 88.1 93.7 91.2 93.7 94.2 92.4 

Dead . . . . . . . . . . . . . 2.5 1.0 0.4 6.6 1.2 1.3 1.1 3.8 1.4 

Not stated . . . . . . . . . . 5.5 5.6 4.8 5.3 5.0 7.5 5.3 2.0 6.2 

Under65years . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

Alive . . . . . . . . . . . . . 93.4 93.6 94.9 90.7 93.8 91.5 93.8 96.3 92.4 

Dead . . . . . . . . . . . . . 1.0 0.9 0.3 3.8 1.1 1.1 0.9 1.4 1.3 

Not stated . . . . . . . . . . 5.5 5.5 4.8 5.6 5.1 7.5 5.3 2.3 6.3 f65 years and over. . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

Alive . . . . . . . . . . . . . 87.7 85.8 90.7 87.7 92.1 79.1 88.5 80.3 90.5 

Dead . . . . . . . . . . . . . 7.0 7.3 4.8 7.0 4.8 10.0 6.2 19.7 5.9 

Not stated . . . . . . . . . . 5.3 6.9 4.5 5.3 3.1 10.9 5.3 3,6 

white families this figure was 11.0 percent while for 

all others it was 30.0 percent.8 

Estimates of the number of discharges by region 

showed that the South Region, with about 5. Omillion 

discharges, had the largest number of patients expecting to pay for their hospitalization through 

public insurance programs. This was followed by the 

North Central Region with 4.1 million, the Northeast 

with 3.2 million, and the West with 2.5 million 

discharges. Even though the number of discharges 

varied by region, patients with public insurance 

represented approximately 40 percent of all discharges 

in each region. 

Nonprofit hospitals accounted for 10.2 million 

(69.4 percent) of the 14.7 million patients discharged 

from non-Federal short-stay hospitals covered under 

public programs. Of the remaining 4.5 million 

patients, 3.3 million (22.4 percent) were discharged 

from government operated hospitals, and 1.2 million 

(8.2 percent) were discharged from profitmaking 

hospitals. The percent of patients with public health 

coverage discharged from nonprofit hospitals (69.4 

percent) was lower than the percent of patients 

covered by private insurance discharged from the 

same hospitals (73.6 percent). This is not unexpected 

since patients covered by public health programs may 

be referred to State or local government-owned 

hospitals. This is especially true of Medicaid patients 

of whom 29.7 percent were discharged from State 

or local government-owned hospitals compared with 

only 18.0 percent for patients covered by private 

insurance. 

Self-pay 

Approximately 2.2 million patients (5.9 percent) 

expected to pay for their hospitalization principally 

by themselves (table 1). Of these, 1.1 million (49.3 

percent) were females 15-44 years of age. This was 

1.4 times greater than the total number of males 

expecting to pay for their hospitalization by themselves. 

The length of stay for self-pay patients was 

days (table 2). This was almost 4 days less than t. 

length of stay for patients covered by public health 

programs and almost 2 days less than the 7.2 days for 

all patients (table 3). Lack of financial resources 

coupled with the age and reason for hospitalizat~on 
dwlce&a7 

-P Table 6. Number and percent distribution of patients discharged from non-Federal short-stay hospitals by race and region and type of ownership of 

hospital, according to principal expected source of PaYment: United States, 1979 

I 

I	 Race, region, and All expected Private Workmen “s Medi- Medic- Other No Other 

type of ownership sources of insurance Compen - aid government Self-pay charge payment sation 

Total . . . . . . . . . . . 

Race 

Vvlllte . . . . . . . . . . . . . 

Another . . . . . . . . . . . 

Not stated . . . . . . . . . . 

Hospital region 

Northeast . . . . . . . . . . 

North Central . . . . . . 

South . . . . . . . . . . . . . 

West . . . . . . . . . . . . . 

Hospital ownership 

Nonprofit . . . . . . . . . . 

Profit . . . . . . . . . . . . . 

State or local 

government. . . . . . 

Total . . . . . . . . . . . 

Race 

White . . . . . . . . . . . . . 

Another . . . . . . . . . . . 

Not stated . . . . . . . . . . 

Hospital region 

Northeast . . . . . . . . . . 

North Central . . . . . . 

South . . . . . . . . . . . . . 

West . . . . . . . . . . . . . 

Hospital ownership 

Nonprofit . . . . . . . . . . 

Profit . . . . . . . . . . . . . 

State or local 

government. . . . . 

36,747 19,289 643 

27,451 14,819 453 

4,572 1,900 79 

4,724 2,570 111 

7,786 4,125 91 

10,647 6,041 163 

12,425 6,402 252 

5,889 2,720 137 

26,105 14,188 444 

2,956 1,621 87 

7,686 3,480 113 

100.0 100.0 100.0 

74.7 76.8 70.5 

12.4 9.8 12.3 

12.9 13,3 17.3 

21.2 21.4 14.2 

29.0 31.3 25.3 

33.8 33.2 39.2 

16.0 14.1 21.3 

71.0 73.6 69.1 

8.0 8.4 13.5 

20.9 18.0 17.6 

care payments 

Number in thousands 

9,925 3,227 918 

7,881 1,689 617 

800 1,136 198 

1,244 401 103 

2,154 819 151 

2,761 902 229 

3,464 989 268 

1,546 517 269 

7,085 2,065 623 

878 202 39 

1,962 960 256 

Percent distribution 

100.0 100.0 100.0 

79.4 52.3 67.2 

8.1 35.2 21.6 

12.5 12.4 11.2 

21.7 25.4 16.4 

27.8 28.0 24.9 

34.9 30.6 29.2 

15.6 ?6.0 29.3 

71.4 64.0 67.9 

8.8 6.3 4.2 

19.8 29.7 27.9 

payments 

2,168 30 546 

1,592 24 375 

331 5 123 

245 1 48 

334 1 110 

441 2 108 

865 3 180 

528 24 147 

1,334 4 362 

106 z 23 

728 26 161 

100,0 100.0 100.0 

73.4 80.0 68.7 

15.3 16.7 22.5 

11.3 3.3 8.8 

15.4 3.3 20.1 

20.3 6.7 19.8 

39.9 10.0 33.0 

24.4 80.0 26.9 

61.5 13.3 66.3 

4.9 0.0 4.2 

33.6 86.7 29.5 

associated with these patients are some of the 

principal reasons for the shorter length of stay. 

According to the National Health Interview Survey 

data, 54.2 percent of all reasons given for no health 

insurance were that insurance costs were too high.b 

In NHDS data, approximately one-half of all 

self-insurers are females aged 15-44 years, a period 

of life when cost of insurance may be a critical factor. 

A type of hospital utilization related both to self-pay 

status and short average length of stay are obstetrical 

conditions,2 conditions which are very common for 

the age and sex of half of the self-pay patients. 

An estimated 1.1 million (5 1.5 percent) selfinsurers had at least one surgical or nonsurgical 

procedure performed (table 4). The majority of 

these (59.9 percent) were for females 15-44 years of 

age. Females composed about 70 percent of all 

self-insurers who had one or more procedures performed. 

Approximately 1.6 million (73.4 percent) of the 

2.2 million self-insurers discharged from non-Federal 

short-stay hospitals were white. of the remaining 

0.6 million, 0.3 million (15.3 percent) were of other 

races, and 0.2 million ( 11.3 percent) did not have 

their race stated in the medical record. 

The South Region, with 0.9 million (39.9 

percent), had the largest number and percent of selfinsurers discharged from non-Federal short-stay 

hospitals. The number and percent of self-insurers 

discharged from these hospitals in the other three 

regions were 0.5 million (24.4 percent) for the West, 

0.4 million (20.3 percent) for the North Central, 

and 0.3 million ( 15.4 percent) for the Northeast. 

About 1.3 million (6 1.5 percent) of the selfinsurers were hospitalized in nonprofit hospitals. Of 

the remaining 0.9 million self-insurers, 0.7 million 

(33.6 percent) were hospitalized in a State or local 
--

8 dmcdata 

hospital, and 0.1 million (4.9 percent) were hospitalized in a proprietary hospital. 

No charge 

In 1979 an estimated 30,000 patients (table 1) 

were not charged for approximately 242,000 days of 

care (table 2). This was only about 0.1 percent of all 

References 

1National Center for Health Statistics: Patient charges in 

short-stay hospitals, United States, 1968-1970, by M. Moien. 

Vital and Health Statistics. Series 13-No. 15. DHEW Pub. No. 

(HRA) 74-1766., Public Health Service. Washington. U.S. 

Government Printing Office, May 1974. 

2National Center for Health Statistics: Expected principal 

source of payment for hospital discharges, United States, 

1977, by R. Pokras and G. Gardocki. Advance Data From 

Vital and Health Statistics, No. 62. DHHS Pub. No. (PHS) 

81-1250, Public Health Service. Hyattsville, Md. Oct. 31, 

1980. 

3 National Center for Health Statistics: Utilization of shortstay hospitals, Annual summary for the United States, 1979, 

by B. J. Haupt.. Vital and Health Care Statistics. Series, 13-No. 

60. DHHS Pub. No. (PHS) 82-1721. Public Health Service. 

Washington. U.S. Government Printing Office. In press. 

4 National Center for Health Statistics: Health care coverage: 

United States, 1976, by L. S. Corder, Ph.D. Advance Data 

From _Vital and Health Statistics, No. 44. DHEW Pub. No. 

(PHS) 79-1250. Public Health Service. Hyattsville, Md. Sep~ 

70 1979 

discharges and days of care in short-stay hospitals. 

Females in the 15-44 years of age group composed = 

40.0 percent of all no-charge discharges (table 1) and -

49.7 percent of all no-charge discharges for which one 

or more procedures were performed. In addition, 

80.0 percent of the discharges were from the West, 

and 86.7 percent were discharged from State or local 

govcn-mrnenthospitals. 

5 National Center for Health Services Research: National 

Health Care Expenditures Study, Who are the Uninsured, Data 

Preview 1, by J. A. Kasper, D. C. Walden, and G. R. Wilensky. 

Office of Health Research, Statistics, and Technology. Public 

Health Service. Hyattsville, Md. 1980. 

6 National Center for Health Statistics: Health care coverage 

under private health insurance, Medicare, Medicaid, and 

military or veterans administration health benefits, United 

States, 1978. Advance Data From Vital and Health Statistics, 

No. 71. DHHS Pub. No. (PHS) 81-1250. Public Health Service. 

Hyattsville, Md. June 29, 1981. 

7National Center for Health Statistics: Health, United States, 

1980. DHHS Pub. No. (PHS) 81-1232. Public Health Service. 

Washington. U.S. Government Printing Office, Dec. 1980. — 

8U. S. Bureau of the Census: Statistical A bstract of the Unite$~~ 

States, 1980. Washington. U.S. Government Printing Office, 

1980. .0 
------

admcwMa9 

_, Technicalnotes 

I “ 

1 Source of data 

The National Hospital Discharge Survey encompasses patients discharged from short-stay noninstitutionahzed hospitals, exclusive of military and 

Veterans Administration hospitals, located in the 

50 States and the District of Columbia. Only 

hospitals with six beds or more and an average 

length of stay less than 30 days for all patients 

are included in the survey. Discharges of newborn 

infants are excluded from this report. 

The universe of the survey consisted of 6,965 

short-stay hospitals contained in the 1963 Master 

Facility Inventory of Hospitals and Institutions. 

New hospitals were sampled for inclusion into the 

survey in 1972, 1975, and 1977, In all, 544 hospitals 

were sampled in 1979. Of these hospitals, 80 refused 

to participate, and 48 were out of scope. The 416 

Participating hospitals provided approximately 

215,000 medical records, 

Sample design 

All hospitals with 1,000 beds or more in the 

r universe of short-stay hospitals were selected with 

certainty in the sample. All hospitals with fewer than 

1,000 beds were stratified, the primary strata being 

24 size-by-region classes. Within each of these 24 

primary strata, the allocation of the hospitals was 

made through a controlled selection technique so 

that hospitals in the sample would be properly 

distributed with regard to type of ownership and 

geographic division. Sample hospitals were drawn 

with probabilities ranging from certainty for the 

largest hospitals to 1 in 40 for the smallest hospitals. 

Sample discharges were selected within the 

hospitals using the daily listing sheet of discharges 

as the sampling frame. These discharges were selected 

by a random technique, usually on the basis of the 

terminal digit or digits of the patient’s medical 

record number, a number assigned when the patient 

was admitted to the hospital. The within-hospital 

sampling ratio for selecting sample discharges varied 

inversely with the probability of selection of the 

hospital. 

Sampling errors, nonresponse, and 

data edits 

I Since the estimates for this report are based 

on a sample rather than the entire universe, they 

are subject to sampling variability. The relative 

standard errors presented in table I are obtained by 

dividing the standard error of the estimate by the 

estimate itself and are expressed as a percent of the 

estimate. 

About 7.7 percent of the discharges sampled for 

the 1977 NHDS did not have information concerning 

source of payment on the face sheet of the medical 

record. An expected source of payment was imputed 

for these discharges based on the sex and age of the 

patient. 

There were several edits performed on the raw 

data. When a principal expected source of payment 

was not indicated, but a single expected source of 

payment was listed as a secondary source of payment, 

the indicated secondary source of payment was 

assumed to be the principal expected source of payment. When Workmen’s Compensation was listed in 

conjunction with other insurance sources, Workmen’s 

Compensation was taken as the principal expected 

source of payment; and when Medicare was listed 

in conjunction with other insurance sources (except 

Workmen’s Compensation), Medicare was taken as 

the principal expected source of payment. 

Table 1, Relative standard errors of estimates, by all principal expected 

sources of payment 

Size of estimates Number of discharges Days of care 

10,000. . . . . . . . . . 27.0 

100,000......... 12.1 1’5.5 

1,000,000 . .. . 9.4 9.4 

10,000,000 . .. .. 9.1 6.0

100,000,000., . . . . 4.2 

Definitions 

Private insurance. –Health insurance provided by 

nongovemment sources including consumers, insurance companies, private industry, and philanthropic 

organizations. 

Workinerz’s Compensation. –A program in all 

states under which employees injured on the job 

receive financial compensation without regard to 

fault. 

Medicare (Title XVIII). –A nationwide health 

insurance program providing health insurance protection to people 65 years of age and over, people 

eligible for social security disability payments for 

more than 2 years, and people with end-stage renal 

disease, regardless of income. 

Medicaid. –A joint federal-state welfare program 

available in virtually all states that provide medicaid 

benefits for low income persons, including the aged. 

In order to qualify for this program, a person must 

meet each State’s definition of “low income. ” 

Other governmeril payments. –Government payments in which the expected source of payment 
10 

cannot be classified in one of the other three government categories. These include payments made under 

the Title V Program, Champus (a program designed 

to provide medical coverage for defendants of 

military personnel), no fault (casualty coverage, 

vocational rehabilition, Federal or State research 

grant (medical research), or legal hold (prisoner in 

medical detention). 

Self-pay. –The major share of the total costs for 

this hospitalization is expected to be paid by the 

patient, spouse, family, or next of kin. 

No charge. –There is no charge for hospital costs 

for patients admitted with the understanding that 

payment would not be expected because the medical 

services are provided free of charge bY th<--’ 

hospital. This category includes hospital sponsorea 

welfare, staff services donated, and hospital-sponsored 

special research or “teaching” patients. 

Other payments, –This includes all other nonprofit sources of payment such as church welfare, 

United Way (United Appeal), or Shriner’s Crippled 

Children Services. 

Definitions of other terms are available in Appendix II of another reports 

Symbols 

. . . Data not available 

. . . Category not applicable 

Quantity zero 

0.0 Quantity more than zero but less than 

0.05 

z	 Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

* 

Figure does not meet standards of 

reliability or precision 

#	 Figure suppressed to comply with 

confidentiality requirements 
aduancedata 11 

Recent lssUes of Adyance Data From vi~al and Health Statistics aNo. 74. Visits to Family Planning Clinics: United States, 1979 No. 71. Health Care Coverage Under Private Health Insurance, 

(Issued: September 4, 1981) Medicare, Medicaid, and Military or Veterans Administration 

No. 73. Patient Profile. National Re~ortin~ Svst em for Familv Health Benefits: United States, 1978 (Issued: June 29, 1981 ) 

Planning Services: United States, 19;8 (Iss;e~: June 24, 198 ~) No. 70. Utilization of Short-Stay Hospitals in the Treatment 

No. 72. Visits to Family Planning Service Sites: United States, of Mental Disorders: 1974-1978 (Issued: May 22, 1981) 

1978 (Issued: June 29, 1981)