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HEALTH RESOURCE UTILIZATION -
Charges & Payers
Hospital charges are defined as the amount the hospital bills for the entire stay (excluding most physician fees). Charges may not reflect the actual cost of hospital care or how much is reimbursed. Examining charges over time can provide insight into the relative growth in various areas.

Total Charges and Average Charge per Day: Statewide, total charges for hospitalization in 2008 were approximately $2.9 billion. The average charge of $23,832 per discharge was lower compared to the U.S. average charge (U.S.: $26,120).1 Between 1995 and 2008, total hospital charges increased from $1.4 billion to $2.9 billion, an annual growth rate of 7.5 percent. The average charge per day of $4,550 (2008) represents a 36 percent increase (adjusted for inflation) from 1995. The increase in the average charge per day reflects Hawai'i's increasing total charges and decreasing average length of stay (see "Hospital Length of Stay and Occupancy"). However, Hawai'i's average charge per day remains below the U.S. average charge per day (Hawai'i: $4,550; U.S.: $5,681). Five of the top ten conditions with the highest average charge per hospitalization were related to infants.2

County Average Charge: In 2008, patients hospitalized on O'ahu had the highest average charge per discharge at $26,700. The higher average charge on O'ahu is attributed to the concentration of tertiary care services in Honolulu. These services are necessary for treating sicker and often high-risk patients.

Payers: Private insurance is billed for 31 percent of all hospital stays, Medicare for 46 percent, and Medicaid/QUEST for 17 percent; 2 percent of stays are uninsured.2 Between 1995 and 2008, the largest increase in charges was experienced within the Medicaid/QUEST program. Hospital charges billed to private insurance and the uninsured decreased.3
  • Medicare: Medicare, the federally sponsored health care program for the elderly and disabled, serves an estimated 190,515 individuals in Hawai'i, most of whom are 65 years of age and older.4 In 1995 Medicare was billed for 42 percent of hospital charges in Hawaii.  In 2008, Medicare was billed for 46 percent of Hawai'i's hospital charges, while only 33 percent of hospital stays are for Medicare patients and only 14 percent of the Hawai'i population is 65 or older. The most common reason for hospitalization among stays billed to Medicare is congestive heart failure, followed by pneumonia, septicemia, stroke, and respiratory infections.5 In 2008, Medicare hospital charges totaled $1.3 billion.
  • Medicaid/QUEST: Medicaid/QUEST, the federal- and state-government-sponsored health care program for low-income people, serves about 200,000 individuals in Hawai'i. Approximately 16 percent of the Hawai'i population is covered by Medicaid/QUEST. This program is billed for 22 percent of all stays; 17 percent of hospital charges. Women and children continue to comprise a large portion of Medicaid enrollment, which results in Medicaid/QUEST being billed for a larger share of certain conditions. One in three newborn stays and stays for obstetrics/delivery are billed to Medicaid/QUEST. This program is also billed for a large portion of mental health condition, including 34 percent of all stays for depression. In 2008, Medicaid/QUEST hospital charges totaled $491 million.
  • Private: About 850,000 individuals have private health insurance through private insurance plans in Hawai'i.6 These plans include employer-sponsored health plans and self-purchased plans. In 2008, private plans were billed for 31 percent of hospital charges in Hawai'i, down from 38 percent in 1995; 40 percent of hospital stays are for private patients(2008). The most common conditions for hospitalizations under commercial plans are pregnancy and childbirth. In 2008, hospital charges to private insurers totaled $881 million.
  • Uninsured: About 113,000 individuals, or approximately 9 percent of Hawai'i's population, have no health insurance.7 Top reasons for hospitalization of the uninsured include pregnancy and childbirth, cellulitis, and depression. In 2008, hospital charges for the uninsured totaled $65 million.

Related Topics
Summary
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> Charges, by County - Charge per Day
> Charges, by County - Charge per Discharge
> Primary Payers, Hawai`i
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Source: Hawaii Health Information Corporation, Inpatient Database.; Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample.
Note: Based on county of discharging facility. Non-federal hospitals only. Includes newborns.
Source: Hawaii Health Information Corporation, Inpatient Database.; Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample.
Note: Based on county of discharging facility. Non-federal hospitals only. Includes newborns.
Source: Hawaii Health Information Corporation, Inpatient Database.
Note: Non-federal hospitals only.