Trends in Uninsured Hospital Stays, 1998-2007

The number of uninsured individuals in the United States has increased drastically over the last decade. When there is no insurance coverage, hospitals bill patients directly. The burden of payment for uninsured individuals and their families can be substantial, particularly during an economic downturn. Likewise, when these bills remain unpaid, the costs of uncompensated care represent a financial burden to hospitals and, ultimately, contribute to increases in health care costs to society overall. Data for this study were obtained from the 1998 through 2007 Healthcare Cost and Utilization (HCUP) Nationwide Inpatient Sample (NIS). The NIS is the largest, multi-year, all-payer, publicly available inpatient care database in the US and includes weights for calculation of reliable, representative national estimates of care in US hospitals. Characteristics of uninsured hospitalizations, such as changes in utilization, cost, patient populations, geographic locations, and diagnoses, were compared to the overall picture of hospital care. From 1998 to 2007 the number of uninsured hospitalizations increased by 31 percent, to 2.3 million uninsured stats in 2007. Inflation-adjusted hospital charges for uninsured stays grew by 88 percent during this time period, from an average for $11,400 to $21,400 per stay. Compared to all patients, uninsured patients were nearly 4 times more likely to leave the hospital against medical advice. Alcohol and substance-related disorders were also about 4 times more common in uninsured stays. Examination of characteristics and trends of uninsured hospital stays can offer valuable insight into the overall picture of US hospital care.