Assessing charges associated with stroke hospitalizations in Florida, 2008-2012

Background: Stroke is the fourth leading cause of death and the leading cause of disability in Florida.  Charges associated with stroke hospitalizations in Florida have increased by 35% during the past five years, while the number of stroke hospitalizations has remained relatively level.  The objective of this study was to investigate how charges associated with stroke hospitalizations vary by age, gender, socio-economic status, race, payer, and geographic location and how they have changed over time.

Methods: Stroke hospitalization charges for the period of 2008-2012 were obtained from the Agency for Health Care Administration. Hospitalization charges were computed using SAS 9.3 for cases with stroke as the primary discharge diagnosis as well as hospitalizations with stroke included as a diagnosis. Stroke hospitalization charges were computed using SAS 9.3 and mapped using ArcGIS 10 technology.

Results: The combined annual charges associated with stroke hospitalizations exceeded $16.8 billion during this time period.  The number of stroke hospitalizations increased for all payers, with the exception of commercial insurance (22% decrease).  The total charges for stroke hospitalizations increased among all payers, with the largest increase seen among hospitalizations covered by Medicaid (83%).  Patients living outside of a 30 minute drive time to a stroke center tended to have higher hospitalization charges and worse outcomes for stroke as compared to patients living within this range.

Conclusion: Historically, stroke hospitalization charges have not been mapped in Florida. Examining and mapping charge data by geographic region can assist policy makers, state agencies, and community health partners quantify the public health and financial impact of stroke. Focusing on how charges vary by payer type and geographic location can lead to improved prevention efforts and ultimately decreased healthcare costs. This broad examination of charges is a first step in helping public health partners and health care systems understand the imbalances of the financial impacts of stroke.  Future analysis should focus on direct and indirect costs of stroke, such as ambulatory care, medication, work absenteeism, and years of productive life lost.