The following information is from data obtained from the American Hospital Association (AHA), the Centers for Medicare and Medicaid Services (CMS) the Kaiser Family Foundation (KFF) and this study done by Health Affairs.
Hospital Inpatient Care
Overall, the number of admissions to U.S. hospitals and hospital inpatient censuses (hospital admissions times average length of stay) have been declining for decades. This is in spite of the fact that the U.S. population has both aged and increased substantially over the same period of time. In 1981 the U.S. population was just under 230 million and the median age for all U.S. citizens was about 30 years old. By 2014 the U.S. population had increased to over 318 million with a median age that’s over 37 years old. The following three graphs from AHA data show this declining hospital inpatient utilization:
Figure 1: Hospital censuses for all U.S. hospitals have been declining since 1981.
Figure 2: The total number of admissions to U.S. hospitals dropped significantly after the implementation of Diagnostic Related Groups (DRGs) as criteria for Medicare admissions in 1984. After rebounding slightly in the late nineties, they began to drop again in 2008.
Figure 3: Even during the years that hospital admissions were increasing (1995-2008) hospital censuses only increased slightly, if at all, because hospital stays have continued to decline. The average length of a hospitalization in the U.S. has dropped from 7.6 days in 1981 to 5.6 days in 2014.
Medicare and Medicaid Hospital Admissions
It should come as no surprise to anyone that the total number of Medicare and Medicaid recipients in the U.S. continues to rise. In 1970 there were only about 20 million Medicare recipients in the U.S. but by 2015 that had grown to over 55 million recipients. The number of people who qualify for Medicaid has also grown substantially due both to our increasing population and our increasing rate of poverty. What is somewhat surprising is that about the same number Medicare and Medicaid recipients were hospitalized in 2015 as were in 1980. What’s more, hospital censuses for Medicare patients were lower in 2015 than they were in 1972! Medicaid recipients are also hospitalized less frequently now.
The following five graphs compare the number of Medicare recipients to Medicare hospitalizations and censuses since 1972:
Figure 4: Between 1972 and 1990 the number of Medicare recipients (yellow line) rose from about 21 million to over 34 million. Hospital admissions of Medicare patients leveled off after 1980, though, largely due to the implementation of DRGs in 1984.
Figure 5: Between 1972 and 1980, the percentage of Medicare recipients who were hospitalized each year rose from 30% to over 36%. That percentage fell back to around 30% of Medicare recipients hospitalized each year by 1990.
Figure 6: Hospital censuses for Medicare patients dropped significantly after the implementation of DRGs because hospital stays were also shortened by that policy. In 1980, a Medicare recipient who was hospitalized would remain in the hospital an average of 10.6 days. By 1985 that average had decreased to 8.6 days.
Figure 7: Since 1996, the number of Medicare recipients (yellow line) has continued to rise. Even so, hospital Medicare censuses (blue line) and admissions (red line) in the U.S. have been falling steadily since 2004.
Figure 8: A similar trend is seen with Medicaid patients as with Medicare patients. Though the number of Medicaid recipients has about doubled since 1996, Medicaid admissions to U.S. hospitals have been declining in recent years.
Figure 9: The percentage of both Medicare and Medicaid recipients hospitalized in the U.S each year have fallen dramatically in recent years. In 2015 fewer than 20% of Medicare recipients and only about 7% of Medicaid recipients in the U.S. were hospitalized which is down since just 2001. Hospitalizations for those who don’t have either Medicare or Medicaid (which includes the uninsured) have risen somewhat during the same period of time, though.
Fewer people are being admitted to hospitals in the U.S. each year and hospital stays are also decreasing, but that doesn’t mean people aren’t still using hospitals. The following four graph show how hospital outpatient utilization has increased in the U.S over the last few decades. An outpatient visit includes any visit to a hospital for an x-ray, MRI, blood test, emergency room visit, outpatient surgical procedure, etc…
Figure 10: The total number of outpatient visits to U.S. hospitals have more than tripled since 1983.
Figure 11: Even if you adjust for the population increase in the U.S. hospital outpatient visits/person have more than doubled since 1983.
Figure 12: Emergency rooms visit in the U.S. have increased only modestly. According to the AHA, the were just over 136 million visits to U.S. hospital ERs in 2014 which was about one and a half times the number of ER visits in 1991.
Figure 13: When adjusted for population growth, ER visits in the U.S. were rather flat throughout the 90’s but have grown by about 20% since 1999.
Figure 14: In 1981 only 13% of U.S. hospital revenues came from outpatient visits whereas 87% came from inpatient care. By 2014 nearly half of all U.S. hospital revenues (46%) came from outpatient visits.
Figure 15: The number of surgeries performed in U.S. hospitals (both inpatient and outpatient) has been surprisingly stable since 2000. The total number of inpatient and outpatient surgeries performed in hospitals in the U.S. has remained between 26 and 27.5 million with fewer surgeries performed in 2014 than in 2001. This figure also shows that inpatient surgeries have declined dramatically since the 1980’s.