FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH . Public Health Serwce


AND HUMAN SERVICES Office of Health Research, Statistics,and Technology MmiJer 62 � octotH31,19so


Expected Principal Source of Payment for Hosp-italD-kcharges: 

United States, 1977a 

a 

0 

INTRODUCTION 

This report presents statistics based on data 

collected through the National Hospital Discharge Survey, a continuous survey conducted 

by the National Center for Health Statistics 

since 1965. In 1977 data were abstracted from 

the face sheets of medical records of approximately 224,000 patients discharged from 423 

hort-stay non-Federal hospitals. These data 

ere used to produce estimates of hospital utilization by an estimated 35.9 million inpatients 

(excIuding newborn infants) in the United 

States. 

From 1968 through 1970, information on 

hospital charges from a subsampIe of the National HospitaI Discharge Survey (NHDS) sample 

was coIlected. 1 No information on charges or 

source of payment was colIected from 1971 

through 1976. In 1977, however, data on a 

patient’s expected (in contrast with actual) 

principal source of payment and other expected sources of payment were colIected from 

the face sheets of zdl medical records in the 

NHDS sample. Statistics in this report reflect 

only the patient’s principal expected source of 

payment. The survey form used to collect these 

aThis report was prepared by Robert Pokras and 

Gloria Gardocki, Division of Health Resources Utilization Statistics. 

1National Center for Health Statistics: Patient 

charges in short-stay hospitals, United States, 1968-

970, by M. Moien. Vital and Health Statzkics. Series 

3-No. 15. DHEW Pub. No. (HRA) 741766. Public 

Health Service. Washington. U.S. Government Printing 

Office, May 1974. 

data is reproduced m a previous pubkation of 

we National Center for Health Statistics.2 

There is an obvious but important limitation 

to these datz the expected payment source recorded on the face sheet of the medical record 

may not have been the actual source of paymen~ For exampI~ a patient admitted to a hospital following an zrutomobiIeaccident may have 

cited Blue Cross as the c%pected source of 

payment whc+ m fax an automobile insurance company uhimately made restitution AIso, 

because of the manner in which this variable was 

coIIected, there is no way to determine the 

charge for the hospitid stay or what proportions 

of the hospital stay and medical services provided were covered by the principal expected 

source of payment indicated. 

HIGHLIGHTS 

Private Insurance 

Private health insurancq consisting of Blue 

Cross and other private or commercial insurance, 

was the principal expected source of payment 

for approximately 19.3 million discharges in 

1977, or about 54 percent of all discharges 

(tabIe 1). The averagelength of stay for patients 

using private insurance was 6.0 days compared 

2Natio~ cater for Hdth Stitisties: fnpatient 

utilization of short-stay hospita& annual summary of 

the United States, 1977, by B. J. EIaII@ VitaZ and 

Health Stat&&s. series 13-No- 41. DHEW Pub- No. 

(PHS) 79-1792. PubJic HealtlI Service. Waabington. 

U.S. GovernrnentPrintingOffice, Mar- 1979. 
Table 1, Number and percent distribution of patients discharged from non-Federal short-stay hospitals by principal expected source of


payment, age and sex of patient: United States, 1977


, 

dI expecte( private Workmen’s Medi- Medic- Other Other Sax and ags mu rces of insurance COmpen- care aid government payments payment setion payments 

Both sexes 

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

Under 15 years................. 

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

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

65 years and over............. 

VmIe 

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

Under 15 years................. 

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

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

65 years and refer ............ 

Female 

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

Under 15 years.................


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


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


65 years and over............. I


Both sexes 

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

Under 15 years................. 

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

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

65 years and over............. 

Male 

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

Undar 15 years................ 

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

45.64 years...................... 

65 years and over............. 

Female 

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

Undar 15 years................ 

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

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

65 years and over............. 

Number in thousands 

35,902 19,325 663 1.110 

- 486 

+ 

3,775 2,549 45 635 213 2501 13 71 

15,180 10,334 446 238 1,636 607 1,574 56 289 

8,604 6,135 195 863 546 266 452 14 113 I 

8,344 307 22 7,788 119 24 62 8 13 

14,385 r7,497 527 4,031 901 415 789
 -L31 195


2,137 1,444 23 362 124 139 8 37


4,553 3,081 362 124 306 160 405 11 95 I


4,042 2,807 153 499 184 120 216 7 56


3,653 155 12 3,385 49 11 29 5 7


21,518 11,828 136 4,923 I 2,035 695 1,549 60 

1,638 1,105 22 273 89 111 5 

10,627 7,243 84 114 1,330 447 1,169 45 194 

4,562 3,328 42 384 362 146 236 7 57 

4,690 152 10 4,403 70 13 33 3 6 

Percent 

100.0 53.8 1.8 24.9 8.2 3.1 6.5 0.3 1.4 

100.0 67.5 1.2 16.8 5.6 6.6 0.3 1,9 

100.0 68.1 2.9 1.6 10.8 4.0 10.4 0.4 1.9 

100.0 71.3 2.3 10.3 6.3 3.1 5.3 0.2 1.3 

100.0 3.7 0.3 93.3 1.4 0.3 0.7 0.1 0.2 

100.0 52.1 3.7 28.0 6.3 2.9 5.5 0.2 1.4 

100.0 67.6 1.1 16.9 5.8 6.5 0.4 1.7 

100.0 67.9 7.9 2.7 6.7 3.5 8.9 0.2 2.1 

100.0 69.4 3.8 12.4 4.6 3.0 5.3 0.2 1.4 

100.0 4.2 0.3 92.7 1.3 0.3 0.8 0.1 0.2 

100.0 55.0 0.6 22.9 9.5 3.2 7.2 0.3 1.4 

100.0 67.4 1.3 16.7 5.4 6.7 0.3 2.1 

100.0 68.2 0.8 1.1 12.5 4.2 11.0 0.4 1.8 

100.0 73.0 0.9 8.4 7.9 3.2 5.2 0.2 1.2 

100.0 3.2 0.2 93.9 1.5 0.3 0.7 0.1 0.1 
� a&medaa3 

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 Unitad States, 1977 

Principal expected source of payment 

All expected 

sources of Blue Cross Days of care payment and other Workmen’s Medi- Medic- Other Other 

private COmpen- care aid government self-pay ~h:ge payments 

insurance sation payments 

Number in thousands . ....... 262,407 115,616 4,742 100,354 19,261 6,662 12,087 610 3,065 

Percent distribution .......... 100.0 44.1 1.8 38.2 7.3 2.5 4.6 0.2 1.2 

Average length of stay ...... 7.3 6.0 7.3 10.9 6.6 6.1 5.2 6.8 6.4 

with 7.3 days for dl patients (table 2). This difference is partially a function of the age of these 

patients. That is, average Iength of stay increases with age, and the average age of patients 

using private insurance was 35.5 years, whiIe the 

average age of all patients was just over 40 years 

(table 3). The shorter average length of stay 

means that a proportionateIy smaller number of 

days of care were used by these patients: while 

54 percent of alI discharges were covered by 

private insurance, only 45 percent of the total 

days of care in short-stay non-Federal hospitals 

were used by these patients. 

�

The five most frequent first-listed diagnoses 

for patients using private insurance (table 4) 

were deIivery (with or without mention of comTable 3. Private, public, and other expected scurces of payment 

for patients discharged from non-Federal short-stay hospitals 

by total number of discharges, days of care, average length of 

stay, and age: United States, 1977 

I All Expected source of payment 

expected 

Item sources of self-pay, 

Private Public 10 charge, payment other m 

2.9 

Total days of care 

in millions .. .... .. .. . . 262.4 115.6 131.0 15.8 

Average length of 

stay in days . .... ... . . 7.3 6.0 9.$4 5.5 

Average age of o patients in years... 40.6 35.5 58.8 31.8 

placation), mzdignant neoplasms, benign neoplasms, hypertrophy of tonsils and adenoids, 

and chronic ischemic heart disease. The diagnostic categories used to determine this ranking are 

discussed in the Technical Notes. Of the 3.33 

milIion patients hospitalized for deliveries in the 

United States in 1977, 2.05 million (62 percent) 

listed Blue Cross or another private insurance 

pkm as the principal expected source of payment. This large proportion of deliveries contributed in part to the shorter average Iength of stay 

of patients using private insurance, because 

a delivery generally results in a relatively short 

Iength of stay-from about 3 to 5 days. 

TabIe 5 provides data on all-listed surgeries 

for inpatients, with a maximum of three procedures recorded on the NHDS survey form. The 

five most frequent surgical procedures (see 

Technical Notes for a discussion of surgical 

categories) performed for patients using private 

health insurance were diagnostic dilation and 

curettage of uterus, hysterectomy, tonsillectomy 

with or without adenoidectomy, bilateral 

ligation and division of faUopian tubes, and 

oophorectomy or salpingo-oophorectomy. Of 

these five procedures, four axe female specific, 

and private insurance was the principzd expected 

source of payment for more than 75 percent of 

each of them. 

The numbers of males and females discharged were relatively sirniIar in all age groups 

except 15-44 years (table 1). Of the discharges 

in this age group Iisting Blue Cross or other 

private insurance as the expected source of payment, more than twice as many were females as 

males. This was due to the large number of 
4 � 

Table 4. Nurrber of dischargesfor the 5 most frequent diagnostic categories for patients discha~ed from non-Fedeml short-stay hospitals


for each principal expected source of payment, and percent of all dischargeswith the diagnosis: United States, 1977


— 

Number of d ischarges Most frequent diagnostic categoriesand ICDA codes 

Private insurance 

Delivery with or withcut mention of mmpli=tion ....................................65Hl


Malignant neoplasm ..................................................................................l 40-208


Benign neoplasms and neoplasrnsof uns~ified neture.............................2l O-239


Hypertrophy of tonsils and %enoids ................................................................ 500


Chronic ischemic heart di.= ....................................... ..................................4l 2


Medicem 

Meligmnt neoplasm .................................................................................. 140-209


Chronic ischemic heart di.= ..........................................................................4l 2


Cerebrovesculardiwaw ..............................................................................@H8


Pneumonia, all forms ................................................................................. 480-486


Qtarati ......................................................................................... .................. 374


Medicaid 

Delivery with or without mention of compli~tion ....................................65ml


Abortion (induced or Wontineous) ........................................................... 640-645


Malignant neoplasrrrs................................................ .................................140-209


Pneumonia, all form ................................................................................. 480-436


Hypertrophy of tonsils and adenotis ................................................................ 500


Workmen’s Compensation 

Displacement of intervertebral diw ...................................................................7~ 

sprains and strainsof back and neck......................................................... 646-647


lacerations and open wound (excluding eye, ear, and head)..................... 674-907


Inguinal hernia...........................................................................................550,552


Dislocation without fracture......................................................................830-839


Other governnwnt payments 

Delivery with or without rrs?ntionof mmpfi@tion ....................................~~6l


Alcohol ism........................................................................................................3O3


Hypertrophy of tonsils and adenoids ............................................................... 500


Malignant ne~lasm ... ............................... .............................................. 140-208


Rychows ............. ............................................................. .......................~ng


self-pay 

Delivery with or without mention of mmpl.~tion ....................................65M6l


Abortion (induced or s~nti~s) ........................................................... 640-645


Alcoholism ........................................................................................................3o3


Malignant neoplasm .................................................................................. 10209


Complications of ~mn~ ...................................................................... 630-634


Other payments 

Delivery with or without mention of competition ....................................65@66l


Malignant neoplasrns...... ............... ........................................................... 140-208


Alcohol ism............................~..........................................................................3O3


lnttacraniel injury (including skull fr~m) .............................................. 850-854


Benign neoplasms and neoplasms of unspecified neture .............................2l O-239


No charge 

Delivery with or w“tiout mention of compli~tion ....................................~~l


pneumonia, all forms ......................................... .................................. .... 480-436


Abortion (induced or spontaneous) ............................................... ...... ....~5


Cholelithmsis...................................................... ..... ........................................s4


Rycho~s .......................................................... ............................ ........... ~0-~


in thousands 

2,049


708


593


492


410


827


766


456


258


245


411


93


83


80


76


74


66


37


36


32


139


46


33


33


33


613


78


76


56


56


80


16


17


12


11


26


‘4


*3


*2


*2


i


Percent of 

al I discharges 

61.5 

41.0 

72.2 

77.6 

32.1 

47.8 

59.9 

71.4 

35.7 

70.4 

12.3 I

19.9 

4.8 

11.1 

12.0 � 

18.7 

18.3 

15.7 , 7.2 

15.2 

4.2 

9.8 

5.2 

1.9 

8.0 

18.4 

16.7 

16.1 

3.2 

16.2 

2.4 

0.9


3.6


3.1


1.3


0.8


0.6


0.60


0.4


0.5

� atkmdab5 

Table 5. Number of all-listed surgeries for the 5 most frequent surgical categories for patients dischar~d from non-Fedeml short-stay 

hospitals for each principal expected source of payment, and percent of all such surgeriesperformed Unitad States, 1977 

Most frequent surgical categories and ICDA codes Number of all-listed Percent of aIl 

surgeries in thousands such surgeries 

Private insurance 

Dilation and curettage of uterus, diagnosis . .... . . ... .. .. ... .. . .... .. . ... .. . .. . ... . ... . ... . .. 70s 76E 77.0 

HySeremomy ... ..... ... ... . .. .... .. .. .. .. . ... ... .... . . ... .. . ... .. .. ... ... ... .. .. .... . .. ... .. ... ... . ..~.l~.5 554 78.6 

Tonsillectomy with or without adenoidectomy .. .. .. .. .. ... .. . .... . .. ... .. .. ... .. . . 21.1 -21.2 479 77.6 

Ligation and division of fcdlopian tubes, bilateral . .... .. ..... ... ... ... ... . ...-..............68.5 44C 75.2 

Oophorectomy; wlpingmophorectomy . . .. .. . .. . ... . . .... .. . .. .. ... ... . .. ... .. .. ... . ..~.2~~ 353 77.1 

Extraction of lens . ... .. . ... .. . .. .. .. .. .. .. . ... ... . .. ... .... ... ... . . ... .. ... ... .. .. .. .. .. ... .. . ... ..14.4-14.6 249 70.1 

Prostetectomy . .. . .. ... ... . ... .. . .... .. . ... .. . .... .. .... . .. ... . . ... .. . ..... .. ... ... . ... .. . .... . .. ... . 58.1 -58.3 214 71.6 

Reduction of fracture with fixation .. . .. .. .. .. ... . . .... .. .. .. .. .. .. .. .. ... .. .. ... .. . .... . . ... .. . 82.2 16a 47.9 

Choiecystectomy .. .. ... . .. ... .. . .... . . .... . .. ... .. . ... . .. ... . .. ... . .. ... .. .. ... .. .. .. .. .. .... .. . ... .. . ... . . 115 25.8 

Repair of inguinal hernia .. .. .. .. .. . ... ... . ... . . .... . . .... . .. ... .. . ... . ... .... . . .... . .. ... . .. ....%.2.?2 lla 20.6 

Medicaid 

� 

Dilation and curettage of uterus, diagno~ic .. .. .. .. .. ... ..... . . .... . .. ... .. .. ... . . .... . .. ....7o.3 88 8.8 

Tonsillectomy with or without adenoidectomy . .. . ... . .. ... .. .. ... .. .. .. .. . ... .. . . 21.1 .21.2 73 11.8 

tigetion and divisio+s of fallopian tubes, bila~rel .. .. .. .. .... . .. ... . .. .. ... . ... .. .. ... . .. ...68.5 a 11.6 

Cesarean setiion . .. ... .. ... .. .. ... . .. ... . .. .... .. . .. .. .. ... . . .... . .. ... .. . .... . .. ... .. .. ... . .. .... . . ... .. . .... ..~ 52 11.4 

Hywerectomy . .. ... .. .. .. ... .. . .... . ... .. .. . ... ... . ... . .. ... .. . .... . .. .. .. . .... . ... .. .. .. .. ... . .... ..~.f@.5 45 6.4 

Workmen’s Compensation 

Repair of inguinal hernia .. .. .. .. .. ... . .. .... . .. ... . . .... . . .... . .. ... . ... ... .. ..... .. . ... . .. .....~Q.38.3 37 6.9 

Neurosurgery .. ... . .... .. .. .... .. .... .. . ... .. .. ... . .. ... .. . .. ... . .... .. ... .. ... .. .. . .. .. .. .. ... .. . .... . . .....ola 37 9.5 

@rations on muscles, tendons, facia, and bur~ ......................................... 35 9.4 

Excision of intervertebral cartilage (pro lapsed disc) .. .. .. .. ... .. .. .... ... ... . ... .. .. .. ....8&4 34 20.5 

&ItUre of Skin or mucous metimne .... .. ... .. .... .. . ... . .. .... .. . ..... .. .... ... ... . .. ... ... . ... 92.5 19 9.8 

Other mwernment oawnents 

Tonsi Ilectomy with or without adenoidectomy . . .. .. ... . ... .. .. .... . .. ... ... . .. . .. 21.1.21.2 33 5.3 

Dilation and curettage of uterus, diaW@ic . . ... . .. ... .. . .... .. .. ... . ... ... . .. ..a . .. ... . .. ..7O.3 28 2.8 

L@tion and division of fallopian tubes, Mlawral . .. . ... .. .. .. ... .. .. .. .... .. . ... . . .... .. .. 68.5 20 3.4 

Hy~erectomy .. .. ... .. .. .... .. . ... .. . ... ... . ... .. .. .. .. . .... .. . .. .. .. .. ... . .... .. . .... .. . .... . ... .. . 6g.I+gs 18 2.6 

Cesarean section . ... ... . .... . . .... . .. .... .. . .... . .. ... .. ... . .. ... .. .. ... .. . .... . ... .. ... . ... . .. ... . .. .... .. . ...77 17 3.7 

self-PeY 

Ceserean section . .. ... .. . .... .. .. ... .. . ... . .. .... .. .. .. .. .... . . ..... . . .... .. .. .... . . ..... .. ... .. .. ... .. . ... ... . .77 70 15.4 

Repair of laceration, obstetrical . .. ... . ... .. .. ... .. .... .. ... .. .. .... . . ... .. .. .... . .. ... .. . ... 78.2-78.3 50 18.4 

Dilation and curettage of uterus, dia~oSic . . ... .. . ... . . ...... .. .... . .. ... . ... ... .. .. .. . .. ...7O.3 46 4.6 

L@ation and division of fallopian tubes, bilateral ... .. . . .... .. . ... . ... .. ... .. .. .. .. ... .. . ...68.5 45 7.7 

Dilation and curettage after delivery or abo~ion . . ... .. . .... . .. .... .. .... ... . .. . . .... .. .. . 78.1 43 14.8 

Other payments 

Repair of laceration, obstetrical .. .. .. ... .. . ... . .. ... .. .... . . .... ... .. . ... . ... .. .. .. .. . . .....78.2.78.3 12 4.4 

Dilation and curettage of uterus, dia~o=ic . ... . .. .. ... . ... .. .. ... .. . .... . . .... .. . .. .. .. ... ...7O.3 11 1.1 

Hy~eretiomy . ..... . .. ... .. .. .. .. ... .. ... ... .. . .... . .. ... . . .... ... .. .. .. ... . .. . ... . .. .... . .. ... . .. ...@.l@~ la 1.4 

Ceserean section ... . .. ... .. .. .. .. ... .. .. . ... . .. .... .. . ... . . ... .. . .... .. . ... .. .. .... . . .... . .. .. .. .. ... . .. ... .. ...77 la 2.2 

Ligation and division of fallopian tub=, bilate~l . .. .. . .... .. . .... . .. ... . ... .. .. .. ... . .. ....68.5 8 “1.4 

No charge 

Cesarean section . . .... .. . .... . .. ... .. .. ... .. ... ... . .. .. . ... .. . ... .. . ... .. .. ... . .. ... .. .. .. .. ... .. . . ... .. . .... ..77 *4 0.9 

Hysterectomy ... . .. .... ... . ... . .. ... .. . ... .. .. .. ... .... .. . . .... .... . . .... . .. ... . .. .... .. . ... . .. .... ..m.le.5 *2 0.2 

Ligation and division of fallopian tubes ... .. .... . .. ... . . .... .. .. ... .. . ... .. . .... . .. ... .. . .. . . .. 68.5 ‘2 0.3 

holecystectomy .. ..... . .. ... . .. . ... . .. ... . . .... . .. .. .. . ... .. .. ... .. . .. .. .. ... .. .. ... .. . .... . . ... . .. .... . .. 43.5 *2 0.4 

ilation and curettage after delivery or abomion .. .. . ... ... . ... . .. .. ... . .... .. .... .. . ... . .. 78.1 *2 0.7 e 
� 6 Zdwncedata 

females admitted for delivery and femalespecific surgery. 

Public Programs 

Public programs for hospital care payments 

include Medicare, Medicaid, Workmen’s Compensation, and other forms of government payments. Together these programs were listed as 

the principal expected source of payment for 

13.7 million, or 38 percent, of all discharges 

(table 1). Of these, 66 percent were Medicare 

patients, 21 percent were Medicaid patients, 5 

percent benefited from Workmen’s Compensation, and 8 percent received other forms of 

government payments. While private insurance 

accounted for 54 percent of all discharges and 

only 45 percent of the total days of care, public 

health programs accounted for 38 percent of the 

total discharges and 49 percent of the total days 

of care. This disparity resulted from a greater 

average length of stay, 9.4 days, for patients 

covered by public programs. The longer average 

length of stay was itself due in great part to the 

fact that Medicare was the expected source of 

payment for 93 percent of all patients 65 years 

of age or over (table 1); as a result, the average 

age of patients covered by public programs was 

almost 59 years. 

Because of their specific characteristics, 

the public programs showed considerable 

variability among the most frequent diagnoses 

and surgical procedures. The most obvious case 

was Workmen’s Compensation, in which the five 

most frequent principal diagnostic conditions 

reflected kjuries, accidents, and physical ailments related to the work environment (table 

4). Likewise, the five most frequent surgical 

procedures covered by Workmen’s Compensation reflected medical care provided for accidents and kjuries (table 5). For Medicare, 3 of 

the 5 most frequent principal diagnoses reflected 

the age of the population using this program: 

chronic ischemic heart disease, cerebrovascular 

disease, and cataract. Medicare was the principal 

expected source of payment for 60, 71, and 70 

percent, respectively, of all patients with these 

conditions. Also, 2 of the 5 most frequently 

performed surgical procedures, extraction of 

lens and prostatectomy, reflected the age of the 

Medicare population. 

The most frequent diagnoses and surgical 

procedm’es for Medicaid and other government 

payments did not reflect as specific a class of 

patients as Workmen’s Compensation and Medicare did. Rather, those patients covered by Medicaid and other government payments were more 

similar to patients covered by private insurance. 

Of the 5 most frequent diagnoses for Medicaid 

and other government payments, 3 (delivery, 

malignant neoplasms, and hypertrophy of 

tonsils and adenoids) were also among the 5


most frequent diagnoses for both Blue Cross


and other commercial insurance (table 4). Also,


of the 5 most frequent surgical procedures for


Medicaid and other government payments, 4


were among the 5 most frequent surgeries per-


formed for patients using private insurance.


These were diagnostic dilation and curettage of


uterus, bilateral ligation and division of fallopian [

tubes, tonsillectomy with or without adenoidec­


tomy, and hysterectomy (table 5).


In the age bv sex distribution in table 1, the 

most prom~en~ sex difference in number of 

discharges was in the 15-44 years category. For 

each expected source of payment except � 

Workme/s Compensation and Medicare the~e 

were more than twice 

discharges in this age 

care class, the number 

and males was quite 

124,000, respectively), 

as many female as male 

category. In the Mediof discharges for females 

similar (1 14,000 and\ 

and, not unexpectedly, 

in the Workmen’s Compensation class the sex 

difference was the reverse of that for other 

insurance sources: there were 362,000 males and 

84,000 females discharged who were in the 

1544 years age group. 

Self-Pay 

More than 6 percent (2.3 million) of all patients expected to pay for their hospital care 

principally by themselves. Delivery, the leading 

diagnosis for this group (table 4), was the firstlisted dia~osis for 26 percent of }hese patients. 

No other diagnosis accounted for more than 14 

percent of the total number of discharges in any 

source of payment category except for no 

chm-ge (as discussed below). The large proportion of self-pay patients admitted for delivery 

largely accounts for two other characteristics of 

the self-pay group: 67 percent were between the � 
o dwmeckw7 

ages 15-44 years, and the average length of stay gory are broken down into most frequent diagfor them was only 5.2 days (table 2).	 noses and surgical procedures, the frequencies have relative standard errors greater than 

30 percent and consequently are too small to No Charge be considered reliable estimates. The only 

In 1977, an estimated 91,000 discharges exception was the most frequent diagnosis— 

(table 1) were not charged for approximately delivery vvith or without mention of com610,000 days of care (table 2); this was only plication-for which there were 26,000 no 

about two-tenths of 1 percent of all days of care charge deliveries in 1977 that accounted for 

in short-stay hospitals. When data in this cate- 29 percent of all no charge patients. 
8 achancedata 

TECHNICAL NOTES 

SOURCE OF DATA 

The National Hospital Discharge Survey encompasses patients discharged from short-stay 

noninstitutional 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 excIuded 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, 535 hospitals were sampled in 1977. Of 

these hospitals, 68 refused to participate, and 

44 were out of scope. The 423 participating 

hospitals provided approximately 224,000 medical records. 

SAMPLE DESIGN 

All hospitals with 1,000 beds or more in the 

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 aUocation 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 smaUest 

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 medicaI 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 

Since the estimates for this report are based 

on a sample rather than the entire universe, they 

are subject to sampling variability. The reIative 

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 8.5 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. Therefore, all frequency 

estimates in this report have been adjusted for 

nonresponse by assuming that nonresponses are 

distributed among the principal expected 

sources of payment in the same proportions 

as re.menses are. However, the ratio estimates , 

of average length of stay and average age in 

tables 1 and 5 do not incorporate nonresponse 

data. � 

There were severaI 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 

principaI expected source of payment. When 

Workmen’s Compensation was listed in conjunction with other insurance sources, Workmen’s 

Compensation was taken as the pnncipaI 

expected source of payment; and when Medicare 

was listed in conjunction with other insurance 

sources (except Workmen’s Compensation), 

Table 1. Relative standard errors of estimates, by source of data 

First-listed diagnosis and 

number of discharges 

A1l-listac lays of 

ielf-pay surgeries care 

of payment ex- only 

cept self-pay 

1,000............... 35.0 

10,000 ............. 19.5 27.4 21.8 . . . 

100,000 ........... 1,000,000 ........ 10,000,000 ...... 

9.2 

6.2 

3.6 

15.2 

13.6 

8.1 

4.0 

16.9 

10.1 

6.3 � 

100,000,000 .... . . . . . . . . . 4.0 

150,000,000.... . . . . . . . . . 3.7 

i 
� achmdaa9 

Medicare was taken as the principal expected grouping scheme were made: 1. deliveries withsource of payment.	 out mention of complication (ICDA-8 code 

650) and deliveries with mention of complication (ICDA-8 codes 651-661) were combined; 

DIAGNOSTIC AND SURGICAL CATEGORIES and 2. neopksms were categorized as malignant 

or benign without regard to site. For surgical 

The most frequent dia~ostic and surgical procedures the categories used are subsets of the 

categories in this report come from a grouping first 16 major surgical cksses in ICDA-8 

scheme devised by NHDS for reporting pur- (biopsies are excluded). These surgicaI groups 

poses.3 J4 For diagnoses, these categories are sub- represent single surgical procedures or groups of 

sets of the 17 major diagnostic classes of the associated surgical procedures that are performed 

Eighth Revision International Classification of frequently. In both diagnostic and surgical 

D&eases, Adapted for Use in the United States~ recoding schemes there are “other” categories 

(ICDA-8) and were developed to reduce the de- that group dia~oses or surgeries into catch-aU 

tail of ICDA-8 while retaining specificity of con- groups (e.g., “other abdomimd surgery”). These 

ditions. For this report, two changes in this	 categories were not used in determining the five 

most frequent diagnoses or surgeries. 

3 National Center for Health Statistics: Inpatient utilization of shoti-stay hospitals by diagnosis, United 

States, 1974, by L. S. Glickman. Vital and Health Statb DEFINITIONS 

tics. Series 13-No. 30. DHEW Pub. No. [HRA) 77-1783. 

Public Health Service. Washington. U.’S. G~vemment First-listed diagnoszk.-The coded diagnosis 

m 

nnting Office, July 1977. 

4National Center for Health Statistics: Surgical Operations in short-stay hospitals, United States, 1975, by A. 

identified as the principal diagnosis or else listed 

first on the face sheet of the medical record. The 

L. Ranofsky. Vital and Health Statistics. Series 13.:No. number of first-listed diagnoses is equivzdent to 

34. DHEW Pub. No. (PHS) 78-1785. Public Health the number of discharges. 

Service. Washington. U.S. Government Printing Office, All-listed operations.–AlI coded operations 

July 1977. listed in positions 1-3 on the face sheet of the 

5National Center for Health Statistics: Eighth Re- medicaI record exclusive of certain obstetrical 

vision International Classification of Diseases, Adapted 

for Use in the United States. (PHS) Pub. No. 1693. procedures, diagnostic- endoscopy and radiograPublic Health Service. Washington. U.S. Government phy, radiotherapy, and certain other treatments 

Printing Office, 1967. not generzdly considered as surgery. 
---

--------------------------------

-----

------------------------------

10 ackimecklta 

Data not 

Category 

Quantity 

Quantity 

SYMBOLS 

available --------------------------------------

not applicable 

zero ------------------------------------------­

more.than Obut less than 0.05 

Figure does not meet standards of 

reliability or precision 

I 

e 

. . . 

-

0.0 

* 

I 
? 

akmdata 11 

Recent Issues of Advance Data From Vital and Health Statistics 

No. 61.	 Selected Demographic Characteristics of Teen- No. 58. Remarriages of Women 15-44 Years of Age 

age Wives and Mothers (Issued: September Whose First Marriage Ended in Divorce: 

26, 1980) United States, 1976 (Issued: February 14, 

1980) 

No. 60.1978 Summary: National Ambulatory Medical 

Care Survey (Issued: April 23, 1980) No. 57. Office Vkits for Diabetes “hfellitus, National 

Ambulatory Medical Care Survey: United 

No. 59. Trends in Breast Feeding (Issued: March States, 1977 (Issued: January 25, 1980) 

28, 1980) 

A complete list of Advance Data From Vital and Health Statktics is available from the Scientific and Technical 

Information Branch. I