The Cost Burden of Disease: U.S. and Michigan

Most Common Reasons for Hospitalization, U.S. and Michigan, 20071

Diagnosis at Discharge

In 2007, there were almost 40 million discharges from the hospital in the U.S. and 1.3 million in Michigan. The ten most common inpatient diagnoses in the U.S. and in Michigan accounted for nearly one-third of all inpatient discharges (31.6 percent U.S., 31.4 percent in Michigan). Of these, the most common reason for hospitalization was infant birth (newborns), which accounted for 11.5 percent of all hospital discharges.

Aside from childbirth-related diagnoses, these data show that cardiovascular disease was the most common reason for hospitalization in 2007. Nationally, four of the top ten diagnoses related to cardiovascular disease (coronary atherosclerosis, congestive heart failure, chest pain, and cardiac dysrhythmias); in Michigan, three of the top ten (coronary atherosclerosis, congestive heart failure, and cardiac dysrhythmias).

Mental health disorders were also in the top ten diagnoses in both Michigan and nationally, accounting for approximately two percent of all discharges from the hospital in the U.S. and Michigan.

Gender Differences

Excluding childbirth-related diagnoses, most diagnoses were common to both males and females.

Overall, while heart-related diagnoses were common among both men and women, they were more frequent for men. Four heart-related diagnoses (coronary atherosclerosis, congestive heart failure, non-specific chest pain, and cardiac dysrhythmias) were among the ten most common principal diagnoses for male hospitalizations. Congestive heart failure and coronary atherosclerosis were among the ten most common among females.

Heart attacks (acute myocardial infarctions) ranked as the fifth most common discharge diagnosis among males, but were not among the top ten discharge diagnoses for females (rank for women was 25th).

Osteoarthritis (degenerative joint disease) was responsible for many more hospitalizations for females (498,199 discharges in the U.S.; 20,528 in Michigan) than for males (314,000 discharges in the U.S.; 13,002 in Michigan).

In the U.S. and in Michigan, women accounted for 57 percent of discharges for mood disorders, and men accounted for 43 percent.

In Michigan, mood disorders ranked seventh for females but was not among the top ten discharge diagnoses for males2.

1 Facts and Figures 2007 Healthcare Cost and Utilization Project (HCUP). September 2009. Agency for Healthcare Research and Quality, Rockville, MD.

2 The rank for men was 11th.

Spending for Hospitalizations, U.S. and Michigan, 2007

Per Discharge Spending—Highest Charges per Discharge by Diagnosis3

One important determinant of health care spending is the intensity of services provided during a hospital stay, often reflected in the charges per hospital discharge.

Conditions treated with more expensive technology or requiring intensive care—such as spinal cord injuries, heart valve disorders, cardiac and circulatory disorders, and leukemia—were among the top ten most costly diagnoses per stay in the U.S. and Michigan.

Nine of the top ten most costly diagnoses per hospital stay were the same for the U.S. and Michigan. However, in Michigan charges were consistently lower per hospitalization for all top diagnoses.

Among the most costly diagnoses per hospital stay in 2007 were those related to newborns. The average charge per discharge for premature birth and low birth weight was $119,389 in the U.S. and $102,103 in Michigan. This is approximately 14 times higher than the average charge of $7,182 per discharge for a healthy infant birth in Michigan.

Total Spending—Highest Total Costs by Diagnosis

Heart disease accounted for the highest total spending of any condition—over $143 billion nationally and $4.2 billion in Michigan.

Among the most common reasons for hospitalization are conditions that are defined as “potentially preventable”—that is, those that may be preventable with high quality primary and preventive care. Thus, higher rates of “potentially preventable hospitalizations”—including hospitalizations for heart failure and pneumonia—highlight specific areas where targeted improvements can be made.

Additionally, conditions such as septicemia and back disorders are viewed as at least partially preventable, and are also among the top ten in spending in the U.S. and Michigan. Total hospital spending on back disorders alone was almost $26 billion in the U.S. and $819 million in Michigan.

Many who have coronary artery disease also have diabetes. Recent research estimates that medical expenditures for people with diabetes are more than twice as high as those without diabetes. In fact, spending on diabetes and associated complications accounted for approximately one in ten health care dollars spent in the U.S. in 2007.5

Total Spending—Highest Total Costs by Procedure

The four highest-cost inpatient procedures were the same for the U.S. and Michigan:

1. respiratory intubation and mechanical ventilation
2. percutaneous coronary angioplasty
3. spinal fusion
4. arthroplasty of the knee (knee replacement)

Nine of the top ten highest total cost inpatient procedures were the same for the U.S. and for Michigan.

3 Because of available data, information included in this report related to hospital spending is based on charges rather than actual payments by payers and consumers. Charges can be significantly higher than payments but the relative rankings should not be significantly affected.

4 Hospital charges are the amounts usually seen by a patient when they receive their hospital bill. Charges seldom represent what is actually paid for hospital stays because of negotiated discounts, but they do offer a useful benchmark for comparing the relative costliness of conditions.

5 Economic Costs of Diabetes in the U.S. in 2007, American Diabetes Association, 2008.

Prescription drugs, U.S. and Michigan, 2008

Top Drugs by Number of Dispensed Prescriptions

Drug spending represented approximately 20 percent of total spending for health care in the U.S and in Michigan ($291 billion and $11 billion respectively).

The most commonly prescribed drug in the U.S. and Michigan was the generic equivalent for Vicodin, a prescription narcotic pain medication. Generic Vicodin accounted for more than 124

million prescriptions in the U.S. and 5.1 million prescriptions in Michigan. While it is difficult to separate out the costs of pain management from other treatment costs, we know that drugs like Vicodin are associated with some of the high cost procedures listed in Figure IB2.8.

The second- and third-most prescribed medications in the U.S. and Michigan were ACE inhibitor Lisinopril and cholesterol-lowering Simvastatin (brand name Zocor).