The number of uninsured hospital stays grew by 21 percent between 2003 and 2008, according to an April report from the Agency for Healthcare Research and Quality (AHRQ) under the Healthcare Cost and Utilization Project (HCUP).

“In 2008, the uninsured accounted for 2.1 million inpatient hospitalizations, or 5.3 percent of all U.S. community hospital stays,” stated authors Elizabeth Stranges, MS, Niranjana Kowlessar, PhD, and P. Hannah Davis, MS in a statistical brief. Their report was based on data from HCUP Nationwide Inpatient Sample (NIS) on uninsured hospital stays in 2008 and compared with data from the 2003 NIS. 

"Compared to insured stays, uninsured hospitalizations were typically shorter (3.8 days versus 4.7 days) and cost less (average cost per stay of $7,300 versus $9,200),” AHRQ stated. Even when the elderly were excluded, uninsured stays remained shorter and less expensive than insured stays (3.7 versus 4.1 days; $7,100 versus $8,100).

“Uninsured hospitalizations more frequently resulted in discharge against medical advice than did insured stays (3.4 percent versus 0.8 percent), and less frequently resulted in release to another institution or short-term hospital (5.3 percent versus 15.3 percent) or a discharge to home healthcare (2.7 percent versus 10.3 percent),” the authors noted.

Overall, hospitalized uninsured patients had fewer chronic conditions than insured hospital patients (2.5 versus 3.5 chronic conditions per patient).

Geographically, a larger share of hospital stays in the South were uninsured (7.6 percent) compared to 4.9 percent in the Midwest, 3.6 percent in the West and 3.2 percent in the Northeast, the data showed.

The majority of those sampled with uninsured hospital stays came from the poorest communities (36.2 percent), compared with the wealthiest communities (13.9 percent).

According to the report, uninsured hospitalizations accounted for 8.3 percent of stays in public hospitals. In private, for-profit hospitals, 5.5 percent of all stays were uninsured, and in private, nonprofit hospitals, 4.7 percent of all stays were uninsured.

Childbirth was the most common reason for an uninsured stay. Skin infections, gallbladder disease and diabetes complications accounted for the largest growth in uninsured stays, the authors stated. 

HCUP is a group of healthcare databases and related software tools developed through a federal-state-industry partnership and sponsored by the AHRQ. HCUP provides a comprehensive all-payer encounter-level collection of longitudinal inpatient, ambulatory surgery and emergency department healthcare data.