Report Shows Baby Boomers - the “Near Elderly” - are Costly to Care for in U.S. Hospitals

Sept. 9, 2009 - Hospitals in the U.S. spent almost as much to treat baby boomers – those ages 55 to 64 – in 2007 as they did to treat senior citizens – people ages 65 to 74. A new report, which refers to these boomers as the “near-elderly,” says hospitals spent $56 billion treating them in 2007, which was 16 percent of total patient care costs.

The spending to care for senior citizens was $59 billion - $3 billion higher. But, spending to care for the near-elderly boomers was $10 billion more than was spent on the generation below them – those ages 45 to 54.

The latest News and Numbers from the Agency for Health Care Research says, “With an expected increase of 18 percent by 2020, the baby boom population is expected to increase at a faster rate than any other group under age 65.”

Highlights include -

● In 2007, there were more than 4.7 million hospital stays among near-elderly adults (55 to 64 years old) totaling $55.9 billion—16 percent of total hospital costs in the U.S.

● The average hospital cost for a baby boomer patient $11,900, was about the same as for seniors but was only $10,400 for 45-54 year-olds.

● The rate of hospitalization among elderly (65 to 74 years old) and near-elderly adults fell slightly between 1997 and 2007, while rising among middle-aged adults (45 to 54 years old).

● Baby boomers were 2-3 times more likely than 45-54 year olds to be hospitalized for osteoarthritis, stroke, respiratory failure, irregular heart beat, chronic obstructive pulmonary disorder, blood infections, and congestive heart failure as well as undergo knee and hip replacements and have heart bypass surgery.

● Hospitalizations for near-elderly adults were more similar to those for the elderly in terms of lengths of stay, costs, and percentage of elective stays.

● The hospital stays among the near-elderly were were less likely than hospital stays among middle-aged adults to be uninsured.

● About 37 percent of baby boomer patients were covered by public insurance, mainly Medicaid, 52 percent had private insurance, and 6 percent were uninsured.

● The highest percentages of uninsured and publicly insured stays among the near-elderly occurred in the poorest communities; in contrast, privately insured stays were more common in wealthiest communities.

● The percentage of stays for chest pain, heart attack and stroke was highest among uninsured near-elderly adults, while the percentage of stays for pneumonia, CHF, COPD, diabetes with complications, and dehydration—diseases that might have been avoided with timely and effective ambulatory care—was highest among publicly insured near-elderly adults.

● Procedures that were more likely to be elective, such as knee replacement, back surgery, spinal fusion, and hip replacement, had the highest rates among privately insured near-elderly patients and were lowest among the uninsured.

Lawmakers face balancing act - limit insurers to a small difference in premiums between older and younger people and younger ones likely to pay far more than now; allow larger spread, and boomers may be priced out of coverage. Seniors on Medicare not affected.

By Julie Appleby

Aug. 31, 2009

Read more Baby Boomer News

Characteristics of hospital stays among the near-elderly

In 2007, near-elderly hospital stays were longer (5.2 versus 4.8 days) and more costly ($11,900 versus $10,400) than stays among adults 45 to 54 years old, but were no different from stays among 65 to 74 year olds.

On average, nearly one-third (29.0 percent) of near-elderly adult hospital stays were elective - higher than 45 to 54 year olds, but the same as older patients. The percentage of stays ending in a discharge to home health or long-term care was 12.1 percent and 10.8 percent, respectively, and in-hospital mortality for near-elderly stays was 2.1 percent.

These percentages were higher than those for 45 to 64 year olds but lower than those for 65 to 74 year olds.

Like elderly hospital stays, the rate of hospitalization among the near-elderly was slightly higher in males (151.7 stays per 1,000 near-elderly males versus 140.4 stays per 1,000 near-elderly females). In contrast, the rate of hospitalization among males and females ages 45 to 54 years old was nearly equal.

The hospitalization rate among all three age groups was highest in the poorest communities. Hospitalization rates were highest in non-urban areas for 55 to 64 year olds—similar to older patients—but for 45 to 54 year olds, the rate was highest in large urban core centers. The highest hospitalization rate for 55 to 64 year olds was in the South—similar to the younger age group—but for the elderly, the rate was highest in the Midwest.

Characteristics of hospital stays among the near-elderly, by payer

Figure 1 shows that 51.7 percent of near-elderly hospitalizations were covered by private insurance and 36.9 percent were covered by public insurance (Medicaid and Medicare).5 There were fewer uninsured hospital stays among the near-elderly, as compared to younger patients 45 to 54 years (6.0 versus 10.5 percent).

On average, uninsured near-elderly stays were longer than stays covered by private insurance (5.1 versus 4.5 days), but the near-elderly with public insurance had the longest hospitalizations (6.2 days). Insured stays among the near-elderly, private or public, were also more expensive ($12,000 and $11,900, respectively) than uninsured stays ($10,500).

Privately insured near-elderly patients were more than twice as likely to be admitted to the hospital electively than were uninsured patients (37.0 versus 14.3 percent), while about 20 percent of publicly insured near-elderly patients were admitted electively.

Uninsured near-elderly patients were less likely to be discharged to home health care (5.1 percent), compared with privately and publicly insured patients (12.3 and 13.3 percent, respectively). On the other hand, discharge to long-term care was most likely for near-elderly patients with public insurance (17.5 percent)—about three times greater than uninsured (5.4 percent) and privately insured patients (6.9 percent).

In-hospital death was also more common among uninsured and publicly insured near-elderly patients and those with public insurance (2.5 and 2.6 percent, respectively, versus 1.7 percent among privately insured patients).

Not surprisingly, the highest percentages of uninsured and publicly insured stays among the near-elderly occurred in the poorest communities, and privately insured stays were more common in the wealthiest communities.

Over half of uninsured near-elderly stays were for males (53.1 percent), but more publicly insured near-elderly stays were for females (52.3 percent). The gender distribution for privately insured stays was nearly equal.

Most frequent procedures performed during hospital stays among the near-elderly.

Procedure rates for the near-elderly were significantly higher than for patients 45 to 54 years old. Rates of knee replacement surgery, coronary artery bypass graft (CABG), and the use of a heart-lung machine during surgery were three times higher among the near-elderly, as compared with patients 45 to 54 years old, while the rates for most of the other common procedures were twice as high among the near-elderly.

Among the near-elderly, blood transfusion was the most frequently performed procedure, occurring at a rate of 12.9 procedures per 1,000 patients 55 to 64 years old. In fact, blood transfusion was the most common procedure performed on any patient 45 to 74 years old.

Diagnostic cardiac catheterization was the second most frequent procedure performed, occurring at a rate of 11.6 procedures per 1,000 patients 55 to 64 years old.

Other common cardiovascular procedures performed on this age group included: percutaneous transluminal coronary angioplasty (PTCA), hemodialysis (for renal failure), echocardiogram, extracorporeal circulation (heart-lung machine) auxiliary to open heart procedures, and CABG.

Procedures related to degenerative bone and joint disorders accounted for four of the most common procedures performed on the near-elderly: knee replacement, back surgery, spinal fusion, and hip replacement. Procedures used to diagnose and/or treat gastrointestinal disorders comprised four of the most common procedures: upper gastrointestinal (GI) endoscopy, colonoscopy and biopsy, gall bladder removal, and colorectal resection.

Most frequent reasons for hospital stays among the near-elderly

Table 3 (below) highlights the 20 most frequent health conditions causing hospitalization among near-elderly patients compared with middle-aged and elderly adults. With the exception of mood disorders, the top 20 inpatient conditions among the near-elderly resulted in significantly higher hospitalization rates than among 45 to 54 year olds.

For many conditions, hospitalization rates were at least two times higher among near-elderly patients than among middle-aged patients. Similarly, hospitalization rates were higher by a factor of two or more for 65 to 74 year olds compared to the near-elderly. Specifically, as patients aged, there were dramatic increases in hospitalization rates for coronary atherosclerosis (hardening of the arteries), osteoarthritis, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), cardiac dysrhythmias, septicemia, stroke, and respiratory failure.

Coronary atherosclerosis was the most common reason for hospitalization among the near-elderly, occurring at a rate of 7.8 stays per 1,000 patients 55 to 64 years old.

Osteoarthritis, a degenerative joint disease that progresses with age, was the second most common condition causing hospitalization among the near-elderly and accounted for 6.9 stays per 1,000 population.

Cardiovascular conditions accounted for six of the 20 most common reasons for near-elderly hospital stays: coronary atherosclerosis, nonspecific chest pain, CHF, heart attack, cardiac dysrhythmias, and stroke.

Six of the top 20 reasons for admission to the hospital were for potentially preventable conditions (conditions for which a hospital stay may be avoided with effective and timely ambulatory care): pneumonia, CHF, COPD, diabetes with complications, skin infections, and dehydration.

Hospital stays for back problems were also very common among the near-elderly (3.9 stays per 1,000 population), as were stays for mood disorders (2.3 stays per 1,000 population). Complications of device, implant or graft and complications of surgery or medical care were also top-ranked conditions in this age group. Septicemia, respiratory failure, biliary tract disease, and metastasis were also in the top 20 most common conditions.

Table 3. Most common principal diagnoses among hospitalized near-elderly adults 55 to 64 years old compared to other age groups, 2007
Rank (55–64 years)	Top 20 principal diagnoses, CCS category	45–54 years	55–64 years		65–74 years
Rank (55–64 years)	Top 20 principal diagnoses, CCS category	Rate per 1,000 population*	Rate per 1,000 population*	Relative rate**	Rate per 1,000 population*	Relative rate**
1	Coronary atherosclerosis (hardening of the arteries)	3.5	7.8	2.2	13.6	1.7
2	Osteoarthritis	2.3	6.9	3.0	13.3	1.9
3	Nonspecific chest pain	4.7	5.4	1.1	6.3	1.2
4	Pneumonia	2.6	4.6	1.8	10.1	2.2
5	Congestive heart failure (CHF)	2.0	4.5	2.2	10.7	2.4
6	Acute myocardial infarction (heart attack)	2.2	4.1	1.9	6.7	1.6
7	Complication of medical device, implant or graft	2.3	4.0	1.8	6.7	1.7
8	Back problems	3.3	3.9	1.2	5.5	1.4
9	Chronic obstructive pulmonary disease (COPD)	1.5	3.8	2.5	8.6	2.3
10	Cardiac dysrhythmias (irregular heart beat)	1.6	3.7	2.3	8.6	2.3
11	Septicemia (blood infection)	1.6	3.1	2.0	6.7	2.1
12	Complications of surgical procedures or medical care	1.9	2.8	1.5	4.6	1.6
13	Diabetes mellitus with complications	2.2	2.8	1.2	3.8	1.4
14	Acute cerebrovascular disease (stroke)	1.3	2.7	2.0	5.4	2.0
15	Skin infections	2.5	2.7	1.1	3.3	1.2
16	Mood disorders	3.7	2.3	0.6	1.9	0.8
17	Adult respiratory failure or arrest	1.0	2.2	2.2	4.8	2.2
18	Biliary tract disease	1.7	2.1	1.3	3.4	1.6
19	Dehydration	1.1	2.0	1.8	4.0	2.0
20	Metastasis (spread of cancer or secondary cancer)	1.0	2.0	2.0	3.3	1.7
* Denominator data for rates were based on Claritas Population Estimates, 2007. **Relative to previous age group. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (NIS), 2007

Table 6 shows considerable variation by payer in the utilization of these procedures among the near-elderly. For example, rates of cardiac catheterization, PTCA, the use of extracorporeal circulation (heart-lung machine), gall bladder removal, and CABG were lower among near-elderly patients with public insurance, as compared with uninsured and privately insured near-elderly patients.

Conversely, rates of respiratory intubation, hemodialysis, and the use of a feeding tube were significantly higher among those near-elderly with public insurance. Procedures that were more likely to be elective—such as knee replacement, back surgery, spinal fusion, and hip replacement—had the highest rates among privately insured near-elderly patients, and were lowest among the uninsured.

Table 6. Most common procedures among hospitalized near-elderly adults 55 to 64 years old, by payer, 2007
Rank all (55–64 years)	Top 20 all-listed procedures, CCS category	55–64 years									65–74 years
		Uninsured			Private insurance			Public insurance			Medicare
		N	%	Rank	N	%	Rank	N	%	Rank	N	%	Rank
1	Blood transfusion	20,600	7.2	2	213,000	8.7	2	160,700	9.3	1	450,900	10.8	1
2	Diagnostic cardiac catheterization	27,000	9.5	1	223,600	9.2	1	103,400	6.0	4	308,400	7.4	2
3	Respiratory intubation and mechanical ventilation	12,900	4.5	4	83,400	3.4	6	104,000	6.0	3	199,800	4.8	3
4	Upper GI endoscopy	13,600	4.8	3	90,900	3.7	5	82,800	4.8	5	191,700	4.6	4
5	Percutaneous transluminal coronary angioplasty (PTCA)	12,400	4.3	5	126,800	5.2	4	44,800	2.6	7	158,900	3.8	6
6	Knee replacement	1,300	0.5	54	129,000	5.3	3	30,100	1.7	9	168,600	4.30	5
7	Hemodialysis	3,900	1.4	16	35,000	1.4	23	128,500	7.4	2	156,100	3.7	7
8	Echocardiogram	10,300	3.6	6	74,200	3.0	7	49,500	2.9	6	126,300	3.0	8
9	Back surgery	1,200	0.4	56	69,400	2.9	8	18,100	1.0	21	67,000	1.6	15
10	Colonoscopy and biopsy	6,100	2.1	8	46,400	1.9	14	36,100	2.1	8	97,400	2.3	9
11	Spinal fusion	1,000	0.4	60	55,300	2.3	10	15,800	0.9	27	48,000	1.1	23
12	Hip replacement	1,400	0.5	52	58,300	2.4	9	14,500	0.8	31	79,800	1.9	10
13	Bronchoscopy	4,200	1.5	13	38,500	1.6	19	29,000	1.7	11	74,000	1.8	12
14	Chest drainage	4,600	1.6	11	38,000	1.6	20	24,600	1.4	13	70,100	1.7	14
15	Tube feeding (intravenous or intestinal)	3,100	1.1	24	35,700	1.5	22	29,000	1.7	10	71,200	1.7	13
16	Extracorporeal circulation (heart-lung machine) auxiliary to open heart procedures	4,200	1.5	14	47,100	1.9	13	13,800	0.8	34	66,500	1.6	16
17	Gall bladder removal	5,000	1.7	9	43,500	1.8	17	16,400	0.9	25	54,200	1.3	21
18	Colorectal resection	3,100	1.1	22	49,100	2.0	11	13,300	0.8	37	62,600	1.5	18
19	Coronary artery bypass graft (CABG)	4,600	1.6	10	45,000	1.8	16	14,200	0.8	32	65,400	1.6	17
20	Cancer chemotherapy	3,500	1.2	18	40,800	1.7	18	16,900	1.0	23	40,500	1.0	28
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (NIS), 2007

This information is provided by the Agency for Healthcare Research and Quality (AHRQ). And is based on data in Hospital Utilization among Near-Elderly Adults, Ages 55 to 64 Years, 2007.

The report uses statistics from the 2007 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-Federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.

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