Drug-Related Inpatient Hospitalizations: A Five-Year Perspective (1991-1995) - Introduction

Based upon a special request from Pennsylvania Attorney General Mike Fisher's Office of Investigations, the Pennsylvania Health Care Cost Containment Council has produced this report entitled: Drug-Related Inpatient Hospitalizations: A Five Year Perspective (1991-1995).

This report includes drug-related inpatient hospitalizations to acute care and specialty hospitals in Pennsylvania for the calendar years 1991-1995. The cases included in this analysis were identified using ICD.9.CM codes (the International Classification of Diseases, Ninth Revision, Clinical Modification). The cases selected are those having either drug psychosis, dependence, abuse, detoxification (detox) or rehabilitation (rehab) as their principal reason for admission to the hospital or individuals who were admitted through the emergency department with a drug-related diagnosis regardless of principal reason for admission. The goal of the methodology was to eliminate those patients where the drug diagnosis appeared to be unrelated to the principal reason for hospitalization.

For the purposes of isolating a count of hospitalizations, cases were assigned to mutually exclusive categories; i.e., cases were assigned to either psychosis or dependence or abuse, or rehab/detox. In actuality, many of these cases have multiple codes present within the same admission record. Therefore, one cannot use the isolated counts of rehab/detox as a reflection of rehab efforts. Approximately 40% of the admissions undergo some combination of detox and/or rehab. Also, the analysis represents hospital admissions not persons so the same individual may have been hospitalized for drug-related admissions multiple times within a given year. If we were to look at the number of persons represented in this report we are likely to have a lesser number.

It is important to remember that for the total charge figures, all the individual hospitalization charges for a given category were summed to come up with a total charge. These charges are associated with the entire hospitalization not just the treatment of the drug-related illness, and they are hospital charges only (they do not include physician fees). Further, while charges are a standard way of reporting data, they do not reflect the actual cost of the treatment nor do they reflect the payment that the hospital may have actually received. Total charges statewide as listed on page 1 include all hospitalizations for the cases included in this report. However, the charges by county and the statewide total listed in the table on pages eight through ten include only state residents.

It is also important to be aware that the population rates reported by county of residence are not adjusted for age and sex differences. The practical implication of this approach is that some portion of the differences in rates are likely to be explained simply by differences in the age and sex composition of the counties since we know that the rate of hospitalization for drug use is not equal across all age groups.

Finally, the hospital charge figures include treatment for the entire admission, not just for drug treatment. If other types of treatment were provided, those charges are included. In addition, it is important to note that the total hospital charge figures include some aberrant cases with extremely high charges. This is reflected in several dramatic increases and decreases from year to year in certain counties.

The Pennsylvania Health Care Cost Containment Council is an independent state agency responsible for addressing the cost and quality of health care in Pennsylvania. The Council promotes health care competition through the collection, analysis, and public distribution of uniform cost and quality health care information.