TABLE 3.1 Inpatient Activity in Community Hospitals, Total Patients and Patients 65 Years of Age or Older, United States, Selected Years, 1983–1993

 

Year

Inpatient Activity

1983

1987

1990

1993

Percent Change 1983–1993

All patients

 

Number (in millions)

Admissions

36.152

36.601

31.181

30.748

-14.9

Beds

1.020

0.955

0.928

0.916

-10.2

Inpatient Days

273.200

227.000

226.000

215.900

-21.0

Length of Stay

7.550

7.180

7.240

7.030

-6.9

Persons 65 years or older

Discharges

11.562

10.295

10.693

11.354

-1.8

Inpatient Days

115.100

92.100

97.200

95.700

-16.9

Length of Stay

9.960

8.950

9.090

8.430

-15.4

 

SOURCE: American Hospital Association, Annual Surveys, 1983–1993, special tabulations.

For persons 65 years of age and older, however, after a decline of 5.4 percent in admissions and 18 percent in inpatient days between 1983 and 1986, inpatient hospital use has been increasing. The annual number of admissions for this age group grew by 7 percent between 1990 and 1993, whereas admissions for persons under 65 years of age declined by 5.5 percent (HRSA, 1993).

More recent data from the AHA indicate that inpatient admissions are increasing. A comparison of hospital data for the first quarter of 1995 and the first quarter of 1994 shows a 3.2 percent increase in total admissions. This rate of increase in admissions is the highest since 1976. The growth in admissions of persons 65 years and older accounts for a large part of this increase. While admissions show an increase, length of stay continues to decline, marked by a sharp decline of 7.8 percent among patients 65 years of age and older (AHA, 1995a). The drop in length of stay resulted in a decrease in inpatient days (see Table 3.2). Several factors in addition to cost containment influence inpatient length of stay, including reimbursement incentives, technological advances, and increased availability of home health care. The number of staffed beds in U.S. community hospitals has continued to decline since 1983. Between 1983 and 1993, the total number of staffed beds had dropped by more than 104,000 beds (AHA, 1995b (see Table 2.3 in Part II of this report). As seen in Table 3.2, this trend has continued in 1994 and 1995 (AHA, 1994c, 1995a).

Inpatient case mix also has changed in recent years, along with a strong trend toward higher levels of acuity (ProPAC, 1995). This increase in acuity can be attributed to several factors, including movement of less complex services out of



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