AHRQ: End-of-life hospitalization costs total nearly $20 billion for 2007

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An Agency for Healthcare Research and Quality (AHRQ) report, examining the cost of end-of-life care and hospitalization for individuals and payors within and outside of the Medicare system in 2007, found that the average cost of 765,651 hospital patient stays ending in death totaled $26,035 per patient.

While Medicare patients accounted for $12 billion in hospital costs and 67 percent of in-hospital deaths (512,391), Medicaid patients accounted for 2 percent of deaths and $2.4 billion in hospital costs. However, Medicaid patients cost hospitals approximately $15,000 more (with an average per patient cost of $38,939) than a Medicare or uninsured patient, and $10,000 more than the privately insured.

Privately insured patients accounted for 20 percent of deaths and $4 billion in hospital costs. Uninsured patients reached $630 million at 3 percent.

For 2007, it is estimated that the total cost for end-of-life care totaled approximately $20 billion and the average cost of a hospital stay ending in death was found to be 2.8 times higher than for a patient discharged alive, due to the longer period of time in which the patient is typically admitted.

The report broke down U.S. inpatient death rates by payor, sex, age, admission type, household income and hospital region. The Centers for Disease Control and Prevention (CDC) has estimated that about 2.42 million people died in the U.S. in 2007.  Of this number, the AHRQ estimated 32 percent (one out of every three) of these deaths took place in the hospital.

In terms of hospital region, the Northeast ranked the highest in inpatient death rates in 2007, at 2.13 percent.  The Midwest ranked lowest with 1.77 percent and the south and west had 1.96 percent and 1.89 percent, respectively.

The leading cause of inpatient death was septicemia with a death rate of 17 percent and main diagnosis of 15 percent of deaths, followed by respiratory failure at a 17 percent death rate. Other conditions leading to inpatient death were aspiration pneumonitis (13 percent), cancer of the bronchus (11 percent) and acute cerebrovascular disease (9 percent).

Moreover, 72 percent of these patients were admitted for emergencies and 12 percent were elective or non-urgent admissions. Accidents or intentional injury admissions reached approximately 7 percent and newborn infants accounted for 2 percent of inpatient deaths. Of the inpatient deaths, 73 percent of the individuals had one or more procedures during the hospital stay and 27 percent of inpatient deaths had no procedure.

The report also found that inpatient death rates declined as household income increased.

The AHRQ based its estimations on data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for 2007.