From Vital and Health Statistics of the National Center for Health Statistics Number 144 � December 7, 1987 

Expected Principal Source of Payment for Hospital 

Discharges: United States, 1985 

by Edmund J. Graves, Division of Health Care Statistics 

Introduction 

This report presents statistics on data collected through the 

National Hospital Discharge Survey. The National Center for 

Health Statistics has conducted this survey continuously since 

1965, In 1985 data were abstracted from the face sheets of 

medical records of approximately 194,800 patients discharged 

from 414 non-Federal short-stay hospitals. These data were 

used to produce estimates of hospital utilization by an estimated 35.1 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 (NHDS) sample was collected (NCHS, 

1974). No information on charges or sources of payment was 

collected from 1971through 1976.However, beginning in 1977 

data on patients’ principal expected sources of payment and 

other expected sources of payment were collected from the 

face sheets of all medical records in the NHDS sample. Reports 

on the 1977 and 1979 data have been published (NCHS, 1980 

and 1982), In addition, summary data for 1982–85 have been 

published (NCHS, 1984, 1985, 1986, and 1987a). Statistics 

in these reports, as well as in this one, reflect only the patients’ 

principal source of payment. The 1977 report presented estimates of source of payment by age and sex of patients as well 

as estimates for leading diagnostic and surgical categories. The 

1979 report updated the basic estimates by age and sex of patient and provided analysis by discharge status and surgical 

status of the patient as well as by hospital location and ownership. This report updates the data from both reports; however, 

the data are analyzed from a different point of view. Expected 

sources of payment are not analyzed separately, but are analyzed for all the different sources of payment by sex and age of 

patient, by hospital characteristics, and by diagnostic and procedural categories. The survey form used to collect these data 

is reproduced in another publication of the National Center for 

Health Statistics (NCHS, 1987a). 

According to the NHDS, approximately 7 percent of all 

patients discharged from short-stay hospitals had no health insurance (NCHS, 1987a). On the other hand, data horn the National 

Health Interview Survey indicate that 13 percent of the noninstitutionalized population had no coverage (NCHS, 1987 b). This 

would seem to indicate that a proportionally smaller number of 

the uninsured rather than the insured are hospitalized. This 

may be true. However, many individuals who claim they have 

no health insurance may find on being hospitalized that they 

are covered under such programs as medicaid, welfare, and 

Veterans Administration health benefits. 

According to the NHDS, the percent of hospitalized individuals covered by private insurance was 44.9 percent (NCHS, 

1987 a). This is much lower than the estimated 66.5 percent of 

individuals covered by private insurance found in the 1984 

NHIS (NCHS, 1987b). This is not unexpected because public 

health programs are often billed first for hospital charges, and 

indhiduals citing private coverage may be using it as a secondq 

insurance source. It should be noted that in some cases 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 folIowing an automobile accident may have cited B1ue 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 � Centers for Disease Control 
2 duancedata 

Highlights 

The percent of patients who expected private insurance to 

pay for their hospitalization decreased significantly tlom 1977 

to 1985 (53 and 45 percent, respectively). 

There was a significant increase in the percent of discharges 

expecting public insurance to pay for their stay. 

The average length of stay for patients expecting private 

insurance to pay for their hospitalization was 5.3 days, which 

was 1.2 days less than the average of 6.5 days for all patients 

discharged from shofi-stay hospitals. 

The average age of patients expecting private insurance to 

pay for their hospitalization was 35.9 year% for those expecting 

public insurance to pay for their hospitalization, it was 60.2 

years. 

Only 7 percent of white patients expected medicaid to pay 

for their hospitalization about 25 percent of black patients expected medicaid to pay for their hospitalization. 

Sixty percent of all females with deliveries expected private 

insurance to pay for their hospitalization. 

About two-thirds of all patients under 65 years of age who 

had one procedure or more performed expected private insurance to pay for their hospitalization. 

Overview 

There are three basic types of payment used in the payment 

of hospital bills. These are private insurance, public insurance, 

and other types of hospital bill payment including self-pay and 

no charge. Private insurance consists of Blue Cross and other 

private or commercial insurance, and public insurance consists 

of medicare, medicaid, workmen’s compensation, and other government insurance programs. 

Private insurance traditionally has been the source of payment used by most hospitalized patients as their expected source 

of payment. However, in recent years, the percent of patients 

expecting to pay their hospital bills through some form of private insurance has been on the decline. The percent of patients 

expecting to pay their hospital bills by private insurance declined from 52.5 percent in 1979 (NCHS, 1982) to 44.9 percent in 1985. 

Expected source of payment through public insurance programs has been on the increase in recent years. In 1979 approximately 40.0 percent of all hospitalized patients expected to pay 

their hospital bills through some form of public insurance. In 

1985 this increased to 46.3 percent. 

Patient characteristics 

In 1985 there were 35.1 million discharges from shoti-stay 

hospitals. Of the patients discharged, 15.7 million expected 

private insurance to pay for their hospital stay, 16.2 million 

expected a government program to pay for their hospital stay, 

and 3.1 million expected to pay for their hospital stay through 

other means (table 1). 

Even though the number of patients expecting private insurance to pay for their hospital stay was similar to the number of 

patients expecting a public insurance program to pay for their 

hospital stay, the number of days of care and average length of 

Table 1. Number of discharges, deys of care, avarage length of 

stay, and avarage age of patients discharged from non- Federel 

short-stay hospitals, by principal expected sourca of paymerm 

Unitad States, 1985 

[Excludes newborn infants] 

Expected sources of payment 

All expected Self-pa y, 

sources of no charge, 

Item payment Private Public and other 

Total number of 

discharges in 

millions . . . . . . . . 35.1 15.7 16.2 3.1 

Total days of care 

in millions . . . . . . 226.2 83.0 126.9 16.3 

Average length of 

stay in days . . . . . 6.5 5.3 8.2 5.3 

Average age of 

patients in 

years . . . . . . . . . . . 46.7 35.9 60.2 30.7 

stay for those expecting public insurance to pay for their hospital stay was much larger. This is primarily because the medicare program is designed to help older people defray the cost of 

their medical bills. Older people tend to have more chronic 

aihnents and longer hospital stays. The number of days of care 

and average length of stay for those expecting public insurance 

to pay for their hospital stay was 126.9 million days of care 

and an average length of stay of 8.2 days; for those expecting 

private insurance to pay for their hospital stay the figures were 

83 million days of care and an average length of stay of 5.3 

days. The average age of those expecting public insurance to 

pay for their hospital bills was 60.2 years; for those expecting 

private insurance to pay for their hospital stay the average age 

was 35.9 years. 

The number and percent distribution of patients discharged 

from short-stay hospitals by expected source of payment according to age and sex are provided in table 2. With the exception 

of workmen’s compensation, the number of females was greater 

than the number of males in each expected source of payment. 

Over 50 percent of all patients discharged from short-stay 

hospitals in each age group, with the exception of those 65 

years of age and over, expected to pay their hospital bills through 

some form of private insurance. Medicare is the expected source 

of payment for most of those over 65 years of age. 

White patients tended to utilize private insurance and medicare as an expected source of payment more often than black 

patients while black patients tended to use medicaid as an expected source of payment more often than white patients (table 3), 

About 46 percent of white patients expected private insurance 

to pay for their hospitrdizatiom only 35 percent of black patients 

expected private insurance to pay for their hospitalization. Medicare as an expected source of payment was utilized by 35 percent of the white patients but only about 21 percent of the black 

patients. On the other hand, only 7 percent of white patients 

used medicaid as an expected source of payment and about 

one-quarter of black patients used medicaid. These differences 

are partially explained by the younger age distribution of hospitalized black persons. 
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Table 2. Number and percent distribution of patients discharged from non-Federal short-stay hospitals by principal expected source of 

payment, according to sex and age: United States, 1985 

[Excludes newborn !nfants] 

All expected Workmen’s Other 

sources of Private compen- government No Other 

Sex and age payment insurance Medicare Medicaid sation payments Self-pay charge payments 

Both sexes Number in thousands 

Alleges, . . . . . . . . . . . . . . . . 35,056 15,726 11,341 3,344 756 790 2,346 221 531 

Under 15 yeara . . . . . . . . . . . 2,972 1,727 35 712 .-. 113 316 24 46 

15-44 years . . . . . . . . . . . . . 13,966 8,691 332 1,985 464 446 1,569 131 349 

45-64 years . . . . . . . . . . . . . 7,610 5,064 1,014 551 197 196 402 65 122 * 65ycmrs and over . . . . . . . . . 10,508 244 9.961 96 96 36 59 15 

Male 

All LIges . . . . . . . . . . . . . . . . . 14,160 5,985 5,064 967 569 332 941 79 223 

Under 15 years . . . . . . . . . . . 1,698 985 13 403 73 185 13 26 

15-44 years . . . . . . . . . . . . . 4,153 2,421 183 350 374 146 521 35 123 

45-64 years . . . . . . . . . . . . . 3,776 2,460 586 1 BO 152 92 208 30 66 * 65years imd over. ,. .,.... 4,533 118 4,282 34 43 21 27 “7 

Female 

Allciges . . . . . . . . . . . . . . . . . 20,896 9,741 6,277 2,377 187 459 1,405 142 308 

Undar15 years ., .,..,.... 1,274 742 22 

15-44 years . . . . . . . . . . . . . 9,813 6,270 149 

45-64 y~ars . . . . . . . . . . . . . 3,834 2,604 428 

65 years And over . . . . . . . . . 5,975 126 5,679 

Both sexes 

Alleges . . . . . . . . . . . . . . . . . 100.0 44.9 32.4 

Under 15 years . . . . . . . . . . . 100.0 58.1 1.2 

15-44 years . . . . . . . . . . . . . 100.0 62.2 2.4 

45-64 years . . . . . . . . . . . . . 100.0 66.6 13.3 

65 years And over . . . . . . . . . 100.0 2.3 94.8 

Male 

Alleges . . . . . . . . . . . . . . . . . 100.0 42.3 35.8 

Under 15 years . . . . . . . . . . . 100.0 58.0 0.8 

15-44 years . . . . . . . . . . . . . 700.0 58.3 4.4 

45-64 years . . . . . . . . . . . . . 100.0 65.2 15.5 

65 years And over . . . . . . . . . 100.0 2.6 94.5 

Female 

Alleges, . . . . . . . . . . . . . . . . 100.0 46.6 30.0 

Under 15 years . . . . . . . . . . . 100.0 58.2 1.7 

15-44 years . . . . . . . . . . . . . 100,0 63.9 1.5 

45-64 years 100.0 67.9 11.2 

65 years And over. .,...... 100.0 2.1 95.0 

Hospital characteristics 

The percent of patients expecting private insurance to pay 

for their hospitalization was lowest in the West Region (39.9 percent) but similar in all other regions. The percent of patients 

expecting medicare to pay for their hospitalization was higher 

in the Northeast Region when compared with the South Region 

(35.0 versus 30.2 percent) (table 3). There were no differences 

by region in the percent of patients expecting medicaid to pay 

for their hospital stay. 

For patients of profit, nonprofit, and State and local government hospitals, differences occurred in distribution of patients by source of payment. About 37 percent of all patients in 

State and local government hospitals expected private insurance 

309 40 131 11 20 

1,635 91 300 1,049 95 225 

371 44 104 193 35 55 * 62 52 15 32 *8 

Percent distribution 

9.5 2.2 2.3 6.7 0.6 1.5 

24.0 . . . 3.8 10.6 0.8 1.5 

14.2 3.3 3.3 11.2 0.9 2.5 

7.2 2.6 2.6 5.3 0.8 1.6 * 0.9 0.9 0.3 0.6 0.1 

6.8 4.0 2.3 6.6 0.6 1.6 

23.7 4.3 10.9 0.8 1.5 

8.4 9.0 3.5 12.5 0.8 3.0 

4.8 4.0 2.4 5.5 0.8 1.8 * 0.8 1.0 0.3 0.6 “0.2 

11.4 0.9 2.2 6.7 0.7 1.5 

24.2 3.2 10.3 0.8 1.5 

16.7 0.9 3.1 10.7 1.0 2.3 

9.7 1.2 2.7 5.0 0.9 1.4 * 1.0 0.9 0.2 0.5 “0.1 

to pay for their hospitalizatio~ about 10 percent of them expected to pay for their own hospitalization. On the other hand, 

close to 50 percent of patients in profit and nonprofit hospitals 

expected private insurance to pay for their hospitalization, but 

only 6 percent or less of the inpatients expected to pay for their 

own hospitalization. In addition, the percent of patients using 

medicaid in the government hospitals was twice that of the 

profit hospitals (12.9 and 5.6 percent, respectively). 

Utilization by diagnosis 

Table 4 provides the number and percent of discharges for 

selected diagnostic categories for patients discharged from short-
4 &ncedata 

Table 3. Number and percent distribution of patients discharged from non-Federal short-stay hospitals by principal expected source of 

payment, according to race, geographic region, and type of hospital ownership: United States, 1985 

[Excludes newborn infants] 

Race, region, and All expected Workmen’s Other 

type of hospital sources of Private compen- government No Other 

ownership payment insurance Medicare Medicaid sation payments Self-pa y charge payments 

Number in thousands 

Al[ ages . . . . . . . . . . . . . . . . . 35,056 15,726 11,341 3,344 756 790 2,346 221 531 

Rata 

White . . . . . . . . . . . . . . . . . . . 26,379 12,219 9,315 1,751 557 520 1,546 114 357 

Black . . . . . . . . . . . . . . . . . . . 5,181 1,819 1,078 1,266 112 182 534 76 114 

Another . . . . . . . . . . . . . . . . . 3,497 1,688 948 328 88 88 266 31 60 

Geographic region 

Northeast . . . . . . . . . . . . . . . . 7,168 3,174 2,508 784 106 87 395 *8 107 

Midwest . . . . . . . . . . . . . . . . . 9,111 4,234 3,003 889 225 172 471 11 108 

South . . . . . . . . . . . . . . . . . . . 12,274 5,726 3,707 1,140 270 257 966 27 181 

West . . . . . . . . . . . . . . . . . . . 6,502 2,592 2,123 532 156 275 513 175 135 

Type of 

hospital ownership 

Nonprofit . . . . . . . . . . . . . . . . 23,984 11,152 7,921 2,154 536 390 1,411 152 267 * Profit . . . . . . . . . . . . . . . . . . . 3,296 1,671 1,085 

State or local 

government . . . . . . . . . . . . . 7,776 2,903 2,335 

Total . . . . . . . . . . . . . . . . . . . . 00.0 44.9 32.4 

Race 

White . . . . . . . . . . . . . . . . . . . 00.0 46.3 35.3 

Black . . . . . . . . . . . . . . . . . . . 00.0 35.1 20.8 

All other . . . . . . . . . . . . . . . . . 00.0 48.3 27.1 

Geographic ragion 

Northeast . . . . . . . . . . . . . . . . 100.0 44.3 35.0 

Midwest. . . . . . . . . . . . . . . . . 100.0 46.5 33.0 

South . . . . . . . . . . . . . . . . . . . 100.0 46.7 30.2 

West . . . . . . . . . . . . . . . . . . . 100.0 39.9 32.7 

Type of 

hospital ownership 

Nonprofit . . . . . . . . . . . . . . . . 100.0 46.5 33.0 

Profit . . . . . . . . . . . . . . . . . . . 100.0 50.7 32.9 

State or local 

government . . . . . . . . . . . . . 100.0 37.3 30.0 

stay hospitals by expected source of payment. Heart disease 

was the only first-listed diagnosis that was among the leading 

diagnoses in each of the expected sources of payment. Medicare and private insurance were the expected sources of payment for about 90 percent of all heart disease discharges with 

medicare accounting for about 62 percent of them. Except for 

workmen’s compensation and medicare, females with deliveries 

was also among the leading first-listed diagnoses for each 

expected source of payment. Private insurance, medicaid, and 

self-pay accounted for about 90 percent of all the discharges 

for females with deliveries, with private insurance accounting 

for about 61 percent of them, 

Other leading first-listed diagnoses in most of the expected 

sources of payment were fractures, all sites, and malignant neo185 102 75 142 33 

1,006 118 325 793 65 231 

Parcent distribution 

9.5 2.2 2.3 6.7 0.6 1.5 

6.6 2,1 2.0 5.9 0.4 1.4 

24.4 2.2 3.5 10.3 1.5 2.2 

9.4 2,5 2.5 7.6 0.9 1.7 

0.9 1,5 1.2 5.5 “0.1 1.5 

9.8 2.5 1.9 5.2 0.1 1.2 

9.3 2.2 2.1 7.9 0.2 1.5 

8.2 2.4 4.2 7.9 2.7 2.1 

9.0 2.2 1.6 5.9 0.6 1.1 

5.6 3.1 2.3 4.3 * 1.0 

12.9 1.5 4.2 10.2 0.8 3.0 

plasms. Fractures, all sites, was among the leading first-listed 

diagnoses in each of the expected sources of payment with the 

exception of medicaid and other government payments; malignant neoplasms was among the leading first-iisted diagnoses in 

each of the expected sources of payment with the exception of 

medicaid, workmen’s compensation, and self-pay. 

Workmen’s compensation, as would be expected, had leading diagnoses different from the other sources, Four of the five 

diagnoses were injury related intervertebral disc disorders; fractures, all sites; sprains and strains of back; and inguinal hernia. 

In fact, even though workmen’s compensation accounted for 

only 2 percentof all expectedsourcesofpayment,it accounted 

for one-fourth of all intervertebral disc disorders and one-fifth 

of all sprains and strains of back (including neck). 
adwancedata 5 

Table 4. Number and percent of discharges for selected diagnostic categories for patients discharged from non-Federal short-stay hospitals for 

each principal expected source of payment United States, 1985 

[Excludes newborn infants] 

Number of 

discharges 

Diagnostic category and ICD-9-CM code in thousands Percernl 

Private insurance 

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27 2,366 61.4 

He@rt disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391-392.0, 393-398, 402, 404, 41 0–416, 420-429 1,025 28.6 

Otharischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...411-413.414.1-414.9 455 35.1 

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410 235 31.1 

Malignant naoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140 –208. 230–234 890 36.1 

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800–829 419 37.1 

Benign neoplasms andneoplasms ofuncertain behavior and 

unspecified nature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210-229,235-239 324 64.8 

Medicare 

Heart disease ... ..,.’, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391 –392.0, 393-398, 402, 404, 41 0–416, 420-429 2,220 61.9 

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..411 -413. 414.1 –414.9 715 55.2 

Congestive heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428.0 460 82.6 

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410 450 59.6 

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427 332 65.0 

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208.230-234 1,020 53.4 

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438 689 75.2 

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800–82g 423 37.4 

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600 177 72.1 

Medicaid 

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27 673 17.5 

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..290–299 126 18.0 

Heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391 –392.0, 393–398, 402, 404, 410-416, 420-429 117 3.3 

Pneumonia, ell forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 480-486 104 12.2 

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493 98 21.2 

Workmen’s compensation 

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...722 117 23.0 

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800–829 61 5.4 

Sprains andstrains of back (including neck) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..846–847 52 21.9 

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550 32 8.4 

Heart diaease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391-392.0,393–398, 402,404,410–41 6,420-429 30 0.8 

Other government payments 

Femalea with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27 126 3.3 

Heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391 –392.0, 393-398, 402, 404, 41 0–416, 420-429 47 1.3 

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..290–299 40 5.8 

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...303 31 7.9 

Malignant naoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140-208 .230–234 26 1.4 

Self-pay 

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27 510 13.2 

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-829 120 10.6 

Heart disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391–392.0,393–398, 402,404.410–41 6,420-429 112 3.1 

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299 72 10.3 

Abortions andectopic and molar pregnancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...630-639 68 17.9 

No charge 

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27 52 1.3 

Heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391-392.0, 393-398,402,404,41 0–416, 420-429 10 0.3 

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208.230-234 *9 ‘0.4 

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800–82g *6 *0.5 

Other payments 

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27 99 2.6 

Haart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391-392.0,393–398, 402,404.410–41 6,420-429 23 0.6 

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..290–299 19 2.8 

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-829 18 1.6 

Malignant neoplasms . . . . . .. i....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208.230-234 17 0.9 

1percant of ~11discharges in this diagnostic categoty with this expected PrkCiPal source of PaYment. 
---

---

---

---

---

---

6 

Utilization by procedures 

Approximately two-thirds of all patients under 65 years of 

age who had one procedure or more performed expected private 

insurance to pay for their hospitalization. For those 65 years of 

age and over, medlcare was the expected source of payment for 

95 percent of these patients. 

About 50 percent of all patients who had one procedure or 

more performed expected private insurance to pay for their 

hospitalization (table 5). Of these almost half were women between the ages of 15–44 years. For some of the other sources 

of payment, the percent of women in this age group with one 

procedure or more performed is even higher. For example, 58 

percent of patients with one procedure or more performed who 

expected medicaid to pay for their hospitalization and 53 percent who expected to pay for their own hospital bills were females between the ages of 15–44 years. 

Table 6 provides the number and percent of all-listed surgeries for patients discharged from short-stay hospitals for each 

expected source of payment. In each category, with the excep 

tion of medicare and workmen’s compensation, the leading surgical procedures performed were female sex specific. These 

included procedures to assist delivery, cesarean section, hysterectomy, and oophorectomy and salpingeoophorectomy. In addition, for patients with medicaid as a source of payment, bilateral 

destruction or occlusion of fallopian tubes was a leading procedure. The only two surgical procedures performed that were 

not sex specific were biopsy and open reduction of fracture, 

except face and jaw. 

Table 5. Number and percent distribution of patients with procedures discharged from non-Fadaral short-stay hospitals by principal expectad 

source of payment, according to sax and age: United States, 1985 

[Excludes newborn infants] 

All expected Workmen’s Other 

sources of Private compen- government No Other 

Sex and age payment insurance Medicare Medicaid setion payments Self-pay charge payments 

Both sexes 

Alleges . . . . . . . . . . . . . . . . . 

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

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

45-64 yeara . . . . . . . . . . . . . 

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

Male 

Alleges . . . . . . . . . . . . . . . . . 

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

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

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

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

Female 

Alleges . . . . . . . . . . . . . . . . . 

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

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

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

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

Both sexes 

Alleges . . . . . . . . . . . . . . . . . 

Under 15 yeara . . . . . . . . . . . 

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

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

65 yeara and over . . . . . . . . . 

Male 

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

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

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

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

65 years And over . . . . . . . . . 

Female 

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

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

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

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

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

20,651 10,136 6,053 

1,283 799 15 

9,104 5,955 174 

4,605 3,240 517 

5,658 142 5,347 

7,900 3,484 2,831 

747 462 *6 

2,309 1,408 94 

2,259 1,541 297 

2,585 72 2,434 

12,751 6,652 3,221 

537 337 *9 

6,795 4,547 80 

2,346 1,698 220 

3,073 70 2,913 

100.0 49.1 29.3 

100.0 62.3 1.2 

100.0 65.4 1.9 

100.0 70.4 11.2 

100.0 2.5 94.5 

100.0 44,1 35.8 

100,0 61.9 *0.8 

100.0 61.0 4.1 

100.0 68.2 13.1 

100.0 2,8 94.2 

100.0 52.2 25.3 

100.0 62.8 “1.6 

100.0 66.9 1.2 

100.0 72.4 9.4 

100.0 2.3 94.8 

Number in thousands 

1,695 533 

256 

1,134 323 

260 148 

45 63 

391 413 

149 

143 266 

82 118 

18 29 

1,304 121 

107 

991 56 

178 30 

28 34 

Percent distribution 

8.2 2.6 

19.9 

12.5 3.5 

5.6 3.2 

0.8 1.1 

5.0 5.2 

19.9 

6.2 11.5 

3.6 5.2 

0.7 1.1 

10.2 0.9 

20.0 

14.6 0.8 

7.6 1,3 

0.9 1.1 

436 1,315 148 335 

51 129 10 24 

252 946 95 226 

111 211 43 76 * 22 29 *9 

159 450 45 128 

33 77 *5 14 

60 252 20 66 

52 109 19 42 * 14 13 *5 

277 865 104 207 

18 52 *5 *9 

192 694 75 160 

59 103 24 34 * * *8 16 

2,1 6.4 0.7 1.6 

4.0 10.0 0.8 1.8 

2.8 10.4 1.0 2.5 

2.4 4.6 0.9 1.7 * 0.4 0.5 ‘0.2 

2.0 5.7 0.6 1.6 

4.4 10.3 “0.7 1.9 

2.6 10.9 0.9 2.9 

2.3 4.8 0.8 1.9 * 0.5 0.5 “0.2 

2.2 6.8 0.8 1.6 

3.4 9.7 “0.9 *1.7 

2.8 10.2 1,1 2.4 

2.5 4.4 1.0 1.4 * * ‘0.3 0.5 
I 

advancedata 7 

Table 6. Number and percent of all-listed procedures for selected surgical categories for patients discharged from non-Federal short-stay 

hospitels for each principal expected source of peyment Unitad States, 1985 

[Excludes nowborn infants] 

Number 

in 

Surgical procedure category and ICD-9-CM code thousands Percentl 

Private insurance 

Procodumst oassistd elivery.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-73 1,597 64.1 

Cesarean aection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74.0–74.2, 74.4, 74.99 583 66.5 

Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549 38.2 

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.3 -68.7 515 76.8 

Oophorectomy andsalpingo-oophorectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65.3-65.6 397 75.7 

Medicare 

Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 708 49.3 

Prostatectomy, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...60.2-60.6 283 77.1 

Arthroplrmtyo fjoints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...81.3-81.8 239 47.2 

Pmmmakeri nsertion,r eplacement,r emoval, and repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...37.7-37.8 168 75.0 

Opcmroduction of fracture (except face and jaw) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79.2 -79.3. 79.5 -79.6 157 34.8 

Medicaid 

Pracodures toassist dalive,ry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-73 375 15.0 

Casarean section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74.0–74.2, 74.4, 74.99 135 15.4 

Repair occurrent obstetric laceration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75.5-75.6 95 17.3 

Bilateral destruction orocclusion of fallopian tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.2–66.3 88 19.0 

Biopsy, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 5.5 

Workmen’s compensation 

Excmion ordestruction of intervertebral disc and spinal fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80.5,81.0 66 20.3 

Operations onmuscles, tendons, fascia, and bursa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82-83.1. 83.3–83.9 42 12.3 

Repair ofinguinal hernia ..,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...53.0-53.1 32 7.8 

Oponreduction of fracture (except face and jaw) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...79.2-79.3.79.5-79.6 30 6.7 

Arthroplasty of joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...81.3-81.8 28 5.4 

Other government payments 

Pmcndurest oassistd elivery.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-73 83 3.3 

t%arean section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74.0–74.2, 74.4, 74.99 24 2.7 

Ropoirof current obstetric laceration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75.5-75.6 19 3.4 

Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.1 

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.3 -68.7 15 2,3 

Self-pay 

Procedures to assist delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-73 327 13.1 

Cosurean section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74.0 –74.2. 74.4,74.99 99 11.3 

Repair occurrent obstetric laceration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75.5-75.6 80 14.7 

Oponreduction of fracture (except face and jaw) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...79.2-79.3.79.5-79.6 48 10.6 

Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 3.5 

No charge 

Procedures to assist delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-73 34 1.4 

Cesarean section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74.0–74.2. 74.4,74.99 12 1.3 

Repair occurrent obstetric laceration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..75.5 –75.6 10 1.8 

Bilateral destruction orocclusion of fallopian tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.2 -66.3 *6 *1.4 

Other payments 

Procedurcm to assist delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..72–73 59 2.4 

Ropairof current obstetric laceration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.5–75.6 20 3.6 

Cesamans action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74.0–74.2, 74.4, 74.99 18 2.0 

Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.1 

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...68.3-68.7 *lo *1.5 

‘ Percent of all surgical procaduras in this catego~ with this expectsd principal source of payment 

Over 60 percent of all procedures to assist delivery, cesarerm as an expected source of payment was biopsy. In fact, one-half 

secticms, hysterectomies, and oophorectomies and salping~ of all biopsies performed were on patients with medicare. Seventyoophorectomies were performed on patients expecting private seven percent of all prostatectomies and 75 percent of all paceinsurance to pay for these surgeries. maker insertions, replacements, removals, and repairs were perThe leading surgical procedure for patients with medicare formed on patients using medicare as a source of payment. All 
8 ZKhEincedata 

Table 7. Number and percant of all-listed procedures for selected nonsurgical categories for petients discharged from non-Federal short-stay 

hospitals for aach principal expacted source of paymant Unitad Statas, 1985 

[Excludes newborn infanta] 

Number 

in 

Nonsurgical procedure category and ICD-9-CA4 code thousands Percent’ 

Private insurance 

Endoscopies of the digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . ...42.21-42.23. 

44.11-44.13,45.11-45.13, 45.21-45.24,48.21-48.22, 51.11-51.21 658 42.7 

Arteriography and angiocardiography using contrast material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..88.4-88.5 502 44.9 

Computerized axial tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...87.03.87.41.87.71.88.01. 88.38 440 31.9 

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 431 34.9 

Cardiac catheterization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37.21 -37.23 351 51.6 

Medicare 

Endoscopies of the digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.21-42.23, 

44.11-44,13, 45.11-45.13, 45.21-45.24, 48.21-48.22, 51.11-51.21 675 43.8 

Computerized axial tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...87.03.87.41.87.71.88.01. 88.38 672 48.8 

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 536 43.4 

Arteriography and angiocardiography using contrast material. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88.4–88.5 496 44.4 

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0-92.1 446 53.2 

Medicaid 

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 108 8.7 

Endoscopiea of the digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.21-42.23, 

44.11-44.13, 45.11-45.13,45.21-45.24, 48.21-48.22, 51.1 1–51 .21 90 5.9 

Computerized axial tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...87.03.87.41.87.71.88.01. 88.38 77 5.6 

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0-92.1 45 5.4 

Arteriography and angiocardiography using contraat material. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88.4–88.5 35 3.2 

Workmen’s compensation 

Contrast myelogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...87.21 113 25.9 

Computerized axial tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...87.03.87.41.87.71.88.01. 88.38 59 4.2 

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..92.0–92.1 22 2.6 

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 16 1.3 

Endoscopies of the digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.21-42.23, 

44.11-44.13,45.11-45.13, 45.21-45.24,48.21-48.22, 51.11-51.21 14 0.9 

Other government payments 

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 27 2.2 

Computerized axial tomography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87.03 . 87.41 . 87.71 . 88.01 .88.38 26 1.9 

Arteriography and angiocardiography using contrast material. ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88.4-88.5 22 1.9 

Endoscopies of thedigestivesyatem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.21-42.23, 

44.11-44.13, 45.11-45.13, 45.21-45.24, 48.21-48.22, 51.11 –51 .21 21 1.4 

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0-92.1 11 1.4 

Self-pay 

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 83 6.7 

Computerized axial tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87.03, 87.41, 87.71, 88.01, 88.38 73 5.3 

Endoscopies oftha digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...42.21-42.23. 

44.11-44.13, 45.11-45.13, 45.21-45.24, 48.21-48.22, 51.11-51.21 56 3.6 

Arteriography and angiocardiography using contrast material. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88.4-88.5 39 3.5 

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0-92.1 32 3.9 

No charge 

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 13 1.1 

Endoscopies of the digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...42.21-42.23. 

44.11-44.13, 45.11-45.13, 45.21–45.24, 48.21-48.22, 51.11-51.21 *7 “0.5 

Computerized axial tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...87.03.87.41.87.71.88.01. 88.38 *7 “0.5 

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.0-92.1 “6 “0.7 

Other payments 

Computerized axial tomography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...87.03.87.41.87.71.88.01. 88.38 25 1.6 

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7 20 1.7 

Endoscopiea of the digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...42.21-42.23. 

44.11-44,13, 45.11-45.13, 45.21-45.24,48.21-48.22, 51.11-51.21 20 1.3 

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0-92.1 14 1.7 

Pyelogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87.73 -87.74 11 2.4 

1Percsnt of all diagnostic procedures in this nonsurgical category with this expscted principal source of payment. 
achiancedata 9 

of the leading procedures for which workmen’s compensation 

was the expected source of payment were for work-related injuries, These included excision or destruction of intervertebral 

disc and spinal fusiow operations on muscles, tendons, fascia, 

and bursrq repair of inguinal herni~ open reduction of fracture, 

except face and jaw, and arthroplasty of joints. 

Table 7 provides the number and percent of all-listed diagnostic procedures for each expected source of payment. Endoscopics of the digestive system, computerized axial tomography 

(CAT scan), and diagnostic ultrasound were among the leading 

diagnostic procedures in each of the source of payment cateReferences 

Amcricm Hospital Association. Unpublished data from The American Hospital Association 1984 Annual Survey. Chicago. 

National Center for Health Statistics, M. G. Sirken. 1967a. Utilization of short-stay hospitals, summary of nonmedical statistics: United 

States, 1965. Vital and Health Statistics. Series 13, No. 2. PHS Pub. 

No. 1000. Public Health Service. Washington: U.S. Government 

Printing Office. 

National Center for Health Statistics, M. J. Witkin. 1967b. Utilization of short-stay hospitals by characteristics of discharged patients 

United States, 1965. Vital and Health Statistics. Series 13, No. 3. 

PHS Pub. No. 1000. Public Health Service. Washington U.S. Govemmcnt Printing OffIce. 

National Center for Health Statistics, M. Moien. 1974. Patient charges 

in short-stay hospitals: United States, 1968–70. Vital and Health 

Sfatisfics. Series 13, No. 15. DHEW Pub. No. (HRA) 74-1766. 

Hdlr Resources Administration. Washington U.S. Government Printing OffIce. 

National Center for Health Statistics, R Pokras and G. Gardocki. 

1980. Expected principal source of payment for hospital discharges: 

United States, 1977. Advance Data From Vital and Health Statistics. No. 62. DHHS Pub. No. (PHS) 81-1250. Public Health Service, Hyattsville, Md. 

National Center for Health Statistics, E. Graves and R Pokras. 1982. 

Expected principal source of payment for hospital discharges: United 

States, 1979. Adwance Data From Vital and Health Statistics. No. 

75, DHHS Pub, No, (PHS) 82-1250. Public Health Service. Hyattsville, Md. 

gories. Approximately 87 percent of the endoscopies of the digestive system, 81 percent of the computerized axial topographies, and 78 percent of the diagnostic ultrasound procedures 

were performed on patients using private insurance or medicare 

as the expected source of payment. 

Radioisotope scan was also among the leading diagnostic 

procedures in each of the different expected source of payment 

categories with the exception of those using private insurance 

as the expected source of payment. Over 50 percent of the radioisotope scans were performed on patients using medicare as the 

expected source of payment. 

National Center for Health Statistics, E. J. Graves. 1984. Utilization 

of shofi-stay hospitals, United States: 1982 annual summary. Vital 

and Health Statistics. Series 13, No. 78. DHHS Pub. No. (PHS) 84-

1739. PuMic Health Service. Washington U.S. Government Printing 

Office. 

National Center for Health Statistics, E. J. Graves. 1985. Utilization 

of short-stay hospitals Annual summary for the United States, 1983. 

Vital and Health Statistics. Series 13, No. 83. DHHS Pub. No. (PHS) 

85-1744. Public Health Service. Washington U.S. Government PrintingOffIce. 

National Center for Health Statistics, E. J. Graves. 1986. Utilization 

of short-stay hospitals Annual summary for the United States, 1984. 

Vital and Health Statistics. Series 13, No. 84. DHHS Pub. No. (PHS) 

86–1 745. Public Health Service. Washington U.S. Government Printing OffIce. 

National Center for Health Statistics, E. J. Graves. 1987a. Utilization 

of shoti-stay hospitals: Annual summary for the United States, 1985. 

Vital and Health Statistics. Series 13, No. 91. DHHS Pub. No. (PHS) 

87-1752. Public Health Service. Washington U.S. Government Printing OffIce. 

National Center for Health Statistics, P. Ries. 1987b. Health care 

coverage by sociodemographic and health characteristics: United 

States, 1984. Vital and Health Statistics. Series 10, No. 162. DHHS 

Pub. No. (PHS) 87– 1590. Public Health Service. Washington U.S. 

Government Printing Oflice. 
10 achncedata 

Technical notes 

Survey methodology 

Source of data 

The National Hospital Discharge Survey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive 

of military and Veterans Administration hospitals, located in 

50 States and the District of Columbia. Only hospitals with six 

beds or more and an average length of stay of less than 30 days 

for all patients are included in the survey. Discharges of newborn infants are excluded from this report. 

The original universe for the survey consisted of 6,965 

hospitals contained in the 1963 National Master Facility Inventory. New hospitals were sampled for inclusion in the survey in 1972, 1975, 1977, 1979, 1981, 1983, and 1985. In all, 

558 hospitals were sampled in 1985. Data on the universe of 

short-stay non-Federal hospitals are now obtained from the 

American Hospital Association (unpublished). 

Of the 558 hospitals in the 1985 sample, 82 refused to 

participate and 62 were out of scope either because the hospital had gone out of business or because it failed to meet the 

definition of a shoti-stay hospital. Thus, 414 hospitals participated in the survey during 1985 and provided approximately 

194,800 abstracts of medical records. 

Sample design and data collection 

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 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. The within-hospital sampling ratio for selecting sample discharges varied inversely with the probability of selection of the hospital. In 1985, 

for the fwst time, there were two data collection procedures 

used for the survey. The first was the traditional manual system of sample selection and data abstraction. The second was 

an automated method used in approximately 17 percent of the 

sample hospitals; it involved the purchase of data tapes from 

commercial abstracting services. 

In hospitals using the manual procedure, sample discharges were selected 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. The sample selection and abstraction of data from the face sheet and discharge 

summary of the medical records were performed by the hospital staff or by representatives of the National Center for Health 

Statistics. The completed forms were forwarded to NCHS for 

coding, editing, and weighting procedures. 

For hospitals using the automated procedure, tapes containing machine-readable medical record data are purchased 

from commercial abstracting services. These tapes are subject 

to National Center for Health Statistics sampling, editing, and 

weighting procedures. A detailed description of the automated 

process is to be published. 

The medical abstract form and the abstract service data 

tapes contain items relating to the personal characteristics of 

the patient, including birth date, sex, race, and marital status 

but not name and address; administrative information, including admission and discharge status and medical record numben 

and medical information, including diagnoses and surgical and 

nonsurgical operations or procedures, Since 1977, patient zip 

code, expected source of payment, and dates of surgery have 

also been collected. (The medical record number and patient 

zip code are considered confidential information and are not 

available to the public.) 

Presentation of estimates 

Statistics produced by the NHDS are derived by a complex estimating procedure. The basic unit of estimation is the 

sample inpatient discharge abstract. The estimating procedure 

used to produce essentially unbiased national estimates in the 

NHDS has three principal components: inflation by recip 

rocals of the probabilities of sample selection, adjustment for 

nonresponse, and ratio adjustment to fixed totals. These components of estimation are described in appendix I of two earlier 

publications (NCHS, 1967a and 1967b). Based on consideration of the complex sample design of the NHDS, the following 

guidelines are used for presenting NHDS estimates in this 

repoti 

1. If the sample size is less than 30, the value of the estimate is not reported. Only an asterisk (*) is shown in 

the tables. 

2.	If the sample size is 30–59, the value of the estimate is 

reported but should be used with caution. The estimate 

is preceded by an asterisk (*) in the tables. 

Sampling errors and rounding of numbers 

Because 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 tables I 

and II are obtained by dividing the standard error of the estimate 

by the estimate itself and are expressed as a percent of the 

estimate. 

About 3.1 percent of the discharges sampled for the 1985 

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 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 
adwncedata 11


Tabla 1. Approximate relativa standard errors of estimatad numbers 

of diachargee: Unitad Statas, 1985 

Number of discharges 

Region, proprietary, 

or State and local All other 

Size of estimate government hospitals characteristics 

5,000 . . . . . . . . . . . . . . . . . .


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


50,000 . . . . . . . . . . . . . . . . .


100,000.............!!


500,000 . . . . . . . . . . . . . . .


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


3,000,000, . . . . . . . . . . . . .


5,000,000 . . . . . . . . . . . . . .


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


20,000,000 . . . . . . . . . . . . .


30,000,000 . . . . . . . . . . . . .


40,000,000 . . . . . . . . . . . . .


22.4 13.2 

18.3 10.6 

12.0 6.7 

10.3 5.7 

7.5 4.0 

6.6 3.5 

5.6 2.9 

5.2 2.7 

4.8 2.4 

4.4 2.2 

4.2 2.1 

4.1 2.1 

Table i 1. Approximate relative standard errors of estimated 

numbars of all-listad procaduras: Unitad Stetes, 1985 

All-1isted 

Size of estimate procedures 

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ! . . . . . . . . . . 18.2 

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.1 

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.3 

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.9 

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 

1,000,000 . . . . . . . . . . . . . ! . . . . . . . . . . . . . . . . ...!!... 6.0 

3,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 

5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 

10,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 

20,000,000, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 

30,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 

insurance sources, workmen’s compensation was taken as the 

principal expected source of paymen~ when medicare was listed 

in conjunction with other insurance sources (except workmen’s 

compensation), medicare was taken as the principal expected 

source of payment. Estimates have been rounded to the nearest 

thousand. For this reason detailed figures within tables do not 

always add to the totals. 

Tests of significance 

In this report, the determination of statistical inference is 

based on the two-tailed Bonferroni test for multiple comparisons. Terms relating to differences such as “higher” and 

“less” indicate that the differences are statistically significant. 

Terms such as “similar” or “no difference” mean that no statistically significant diRerence exists between the estimates being 

compared. A lack of comment on the difference between any 

two estimates does not mean that the difference was tested and 

found to be not significant. 

Definition of terms 

Private insurance—Private insurance is health insurance 

provided by nongovemment sources including consumers, insurance companies, private industry, and philanthropic organizations. 

Workmen’s compensation—Workmen’s, compensation is 

a program in all States under which employees injured on the 

job receive financial compensation without regard to fault. 

Medicare (Title XVIII)—Medicare is a nationwide health 

program providing health insurance protection, regardless of 

income, 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. 

Medicaid—Medicaid is a joint Federal-State welfare pre 

gram, available in virtually all States, that provides benefits for 

low-income persons, including the aged. To qualify for this 

program, a person must meet each State’s definition of “low 

income.” 

Other govemmentpayments—Other government payments 

refers to government payments in which the expected source of 

payment cannot be classified in one of the other three governmentcategories. These include payments made under the Title 

V Program, Champus (a program designed to provide medical 

coverage for dependents of military persomel), no-fault casualty coverage, vocational rehabilitation, Federal or State research grant (medical research), or legal hold (prisoner in medical detention). 

Sel~pay—Self-pay is a form of hospital payment in which 

the major share of the total cost is paid by the patient, spouse, 

family, or next of kin. 

No charge—There is no charge to a patient when a patient 

is admitted to a hospital with the understanding that payment 

will not be expected because the medical services are provided 

free of charge by the hospital. This category includes hospitalsponsored welfare, donated staff services, hospital-sponsored 

special research, and patients in “teaching” hospitals. 

Other payments—Other payments 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 report (NCHS, 1987a). 
---

12 akmedaa


Symbols 

. . . 

0.0 

z 

* 

# 

Suggested citation 

National Center for Health Statistics, E. J. Graves. 

1987. Expected principal source of payment for 

hospital discharges: United States, 1985. Advance 

Data From Vital and Health Statistics. No. 144. 

DHHS Pub. No. (PHS) 88-1250. Public Health 

Service. Hyattsville, Md. 

U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Publlc Health Serv!ce 

Centers for Disease Control 

National Canter for Health Statistics 

3700 East-West Highway


Hyattsvllle, Maryland 20782


OFFICIAL BUSINESS


PENALTY FOR PRIVATE USE, $300


To rece[ve this publication regularly, contact the


Nattonal Center for Health Statlstlcs by calling


301436-8500


DHliS Publication No. (PHS) 88-T250


Data not available


Categoy not applicable


Quantity zero


Quantity more than zero but less than


0.05 

Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

Figure does not meet standard of 

reliability or precision 

Figure suppressed to comply with 

confidentiality requirements 

Copyright information 

This report may be reprinted without further 

permission. 

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c