Table 4.
Comparison of Prices for Hospital Stays by Payer among Various Datasets, 2006
| Data Source | All Payers | Medicare | Medicaid | Private and Other Insurance | Self-Pay* |
|---|---|---|---|---|---|
| HCUP–10 states† | $8,827 | $8,418 | $7,128 | $10,290 | $7,813 |
| MEPS–all states‡ | $8,888 | $9,584 | $6,751 | $9,493 | $5,374 |
| MarketScan–all states§ | $10,101 | ||||
| Medicare–10 states*,¶ | $9,850 | ||||
| Medicare–all states¶ | $8,691 |
Note.
Self-pay is a relatively small payer category, accounting for only 4% of all hospital revenue.
Ten states refer to California, Florida, Massachusetts, New Jersey, Nevada, Virginia, West Virginia, Wisconsin, and two states where permission to identify them was not obtained. HCUP estimated prices for self-pay are less reliable than estimates for other payers because of its small size and the amount of estimation that is required in many states.
MEPS is a household survey that collects health care event information from a sample of 12,811 households that included 32,577 individuals in 2006. There were 3,202 inpatient hospitalizations in 2006 included in the survey. High cost and Medicaid stays tend to be undercounted and subsidies for uninsured care, including Medicaid Disproportionate Share payments, are not included.
The Truven Health Analytics MarketScan commercial claims database is comprised of claims from a convenience sample of self-insured employer plans with generous benefit coverage as well as some health insurance plans. Stays were counted only if the insurance payment was greater than or equal to 50% of revenue the hospital was expected to receive for the stay, indicating that private insurance was the primary payer. Other payers are not included in the MarketScan data.
Derived from a sample of Medicare fee-for-service claims. Available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareMedicaidStatSupp/2007.html, Table †. *. Excludes managed care payments and final payment settlements that take place after initial reimbursement is made to the hospital.
Sources: Hospital financial data from 10 states; Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Survey, State Inpatient Databases for 10 states; Medical Expenditure Panel Survey; Truven Health Analytics MarketScan database; and Centers for Medicare and Medicaid Services Medicare payment tables.