The Social Security system: benefit differences among racial/ethnic groups.

Based on published and unpublished data from the Bureau of the Census and the Social Security Administration, an assessment is presented of how major racial/ethnic groups in the United States fare under Social Security. The Social Security Act was signed into law in 1935 to provide economic security to U.S. workers. Today, there are some 44.5 million Social Security beneficiaries in this country. The majority of these beneficiaries are retired workers (62.3 percent) with survivors of deceased workers comprising another 11.6 percent. Several aspects of the Social Security system are particularly important to minority groups. The data indicate that minorities rely more on Social Security benefits in retirement than do whites. In comparison with only 16 percent of white elderly beneficiaries, one-third of elderly blacks and one-third of elderly Hispanics depend on Social Security payments for 100 percent of their retirement income. Minorities also have less retirement income from other sources, such as pensions and assets, than do whites. Both blacks and Hispanics tend to have lower earnings than whites and, thus, benefit from the progressive benefit formula of the Social Security system. Further, blacks, with shorter life expectancies, benefit more from the disability and survivors benefits than do whites. Social Security has a major impact on poverty rates, particularly for minorities. Without Social Security benefits and no other changes in savings or pensions, poverty rates would be around 60 percent for blacks, Native Americans and Hispanics versus 24, 12 and 20 percent, respectively, with Social Security benefits. The U.S. minority population will continue to grow in both numbers and proportions. By 2050, almost half (47 percent) of the total U.S. population will be minorities due principally to growth in Hispanic, black and Asian populations. The increasingly diverse population will change the composition of the nation's workforce as well as the size and makeup of its elderly population. These demographic changes will be important to consider when evaluating the future role that Social Security will play in the lives of these changing populations.

Average charges for three types of hysterectomy procedures: United States, 1998.

The average charges associated with three forms of hysterectomies (abdominal-laparotomy) vaginal and laparoscopically-assisted vaginal hysterectomy (LAVH) in 1998 were investigated by geographic area and individual states. Considerable variation in the rates of and charges for these three procedures was reported. Based on data from more than 400,000 women insured under group health contracts, the average charges for these three gynecological surgeries were calculated for the study group of 14,184. The majority of the surgeries were laparotomies (64 percent) with LAVH accounting for only 10 percent; the largest proportion of the procedures were performed in the West South Central and South Atlantic regions of the country and the highest average charge was associated with the LAVH procedures. In 1998, the average charge for an abdominal hysterectomy in the United States was $12,500: that for a vaginal hysterectomy was $10,380; and that for a laparoscopically-assisted vaginal hysterectomy was $14,500. The Pacific area registered the highest average charges for all three (between 19 and 21 percent higher than the U.S. norm) while the lowest geographic area charges were reported in West North Central states (between 18 and 21 percent lower than the U.S. average). The charges in California were the highest of all study states for each of the surgeries, ranging from 38 to 43 percent higher than the average, whereas the charges in Iowa were the lowest for the laparotomies and vaginal hysterectomies (42 and 36 percent, respectively below the norm) and in Kansas for the LAVHs (34 percent lower than the U.S. average). Physicians fees were the highest in New York for each procedure ranging from 33 percent higher than the norm for a vaginal hysterectomy, 50 percent higher for an LAVH and 72 percent higher for a laparotomy. The lowest physician charges were reported in Iowa for the vaginal and abdominal surgeries and in Minnesota for the LAVHs. The average length of stay was 3.10 days for the laparotomy procedures, 2.20 days for the vaginal hysterectomies and 1.99 days for the LAVH patients, with substantial variation between states for each procedure.

Cardiac catheterizations: average inpatient charges, 1998.

In 1998 the average change for an impatient cardiac catheterization (CC)was $12,450 among 13,922 group health insured over age 30. Among the 29 states in which at least 150,CCs were performed, the average total charge ranged from $24,000 in California, which was 93 percent above the U.S. norm, to just over one-third of this total in Iowa ($8,810). The second highest average charge was reported in Texas ($20,140, 62 percent above the norm) and the second lowest was in Maryland ($11,420, 8 percent below). On average, the hospital proportion of the total CC charges accounted for 80 percent but ranged from 86 percent in California to 71 percent in Maryland. Physician fees averaged $2,450 across the country and ranged from $3,830 in Texas (56 percent above in average) to $2,140 in Iowa (13 percent below the norm). Length to stay averaged 3.2 days, with patients in Iowa remaining in the hospital for 5.6 days and those in Washington 2.9 days. Per diem costs averaged $3,850 and were the highest in California, $6,470 (68 percent above the average) and $1,570 in Iowa (59 percent below).

Costs of alcohol and drug abuse in the United States, 1992. Alcohol/Drugs COI Study Team.

In a study of the economic costs to society of alcohol and drug abuse, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health estimate the cost to be $246 billion in 1992, the most recent year for which sufficient data were available. This estimate represents $965 for every man, woman and child living in the United States in 1992. Alcohol abuse and alcoholism generated about 60 percent of the estimated costs ($148 billion), while drug abuse and dependence accounted for the remaining 40 percent ($98 billion). Prior to this study, the most recent comprehensive estimates of these costs were based on data for 1985. The need to update earlier estimates was driven primarily by the changing culture of substance abuse and the changing nature, extent and treatment of the problem. Over 80 percent of the increase in estimated costs of alcohol abuse can be attributed to changes in data and methodology employed in the new study, suggesting that the previous study significantly underestimated the costs of alcohol abuse. In contrast, over 80 percent of the increase in estimated costs of drug abuse is due to real changes in drug-related emergency room episodes, criminal justice expenditures and service delivery patterns. Estimated costs for alcohol and drug abuse in 1995 were also calculated and were projected to be $276 billion. After adjusting for population growth and inflation, this estimate represents a 12.5 percent increase over the 1992 estimates.

Prostate surgeries: average charges throughout the United States, 1997.

During 1997 hospital claims for 2,149 radical (open) prostatectomies among selected group policy insureds averaged $16,990 and for 2,192 transurethral resections of the prostate (TURPs), $6,620. There was marked geographic variation in both the distribution and charges for these two procedures. The Pacific region reported the highest average total charges for both procedures, driven by the high charges in California. The California average total charges were 39 percent above the norm for an open procedure and 54 percent above for a TURP. Illinois and Florida each reported open prostatectomy charges over $20,000, 20 and 18 percent, respectively, above the norm. For a TURP, however, Minnesota and Arizona reported the second and third highest charges, each over $8,000, and around 30 percent above the average. Washington state reported the lowest average charge for an open procedure ($12,020, 29 percent below the norm and about half that in California); Pennsylvania had the lowest TURP total charge ($3,860, 42 percent below the norm and 62 percent lower than the California charge). Among study states, charges 15 percent or more below average for an open procedure were also recorded in Pennsylvania, Indiana, Maryland and North Carolina. Similarly low charges for a TURP were recorded in Ohio. Michigan and North Carolina (each more than 15 percent below the norm). The hospital charges comprised 63 percent of the total for an open procedure and 68 percent for a TURP. The California average was the highest for both surgeries. 58 and 69 percent, respectively, above the norm and 129 percent above the low charge in Maryland for an open procedure and 193 percent above the low charge in Pennsylvania for a TURP. Physicians' charges averaged $6,370 for an open prostatectomy and $2,130 for a TURP. For both surgeries, these charges were the highest in New Jersey and New York (between 20 and 30 percent above the norm) and the lowest in Pennsylvania where they averaged 28 percent lower than the norm for an open procedure and 40 percent lower for a TURP. The length of stay averaged 3.75 days for a radical prostatectomy and 2.80 days for a TURP. These days ranged from 4.20 days in New Jersey to 3.11 days in Minnesota for an open procedure and 3.51 days in New Jersey to 2.14 days in Minnesota for a TURP.

U.S. cancer incidence, mortality and survival: 1973-1996.

Earlier predictions of morbidity and mortality improvements for the four leading sites of cancer are beginning to occur. After decades of increases, incidence and mortality rates for all cancers combined have declined since 1992. Between 1990 and 1996 the age-adjusted death rates for all cancers had dropped 3.7 percent to 166.9 per 100,000 and incidence rates had decreased 2.8 percent to 388.6. The overall decreases were greater among men than women; male mortality rates dropped 6.2 percent and incidence dropped 5.2 percent for men versus 1.8 and 1.9 percent, respectively, for women. Lung cancer incidence among men continued its more than 10-year decline in age-adjusted rates and mortality rates dropped for a fifth consecutive year to 68.2 per 100,000 population. Among women, lung cancer incidence rates began to plateau in the mid-1990s similar to the pattern experienced by men a decade earlier. The rates of prostate cancer have begun to decrease but remain 65 to 75 percent higher among black men than white. Mortality rates dropped 9.5 percent among white men but only 2.0 percent among blacks since 1990. By 1996 even breast cancer death rates were declining ahead of the predicted decrease by the end of the century. Mortality rates for all women combined was 24.3 per 100,000 population, 24.0 for white women and 30.8 for blacks, 11.3, 12.1 and 2.5 percent, respectively lower than in 1990. The previously noted decreases in colorectal cancer mortality and incidence continue with age-adjusted rates dropping to 16.8 and 42.7 per 100,000 population, respectively, in 1996.

Average charges for hip replacement surgeries: United States, 1997.

Hip replacement surgeries continue to increase in both number and rates in the United States. In 1996 around 140,000 total hip arthroplasties (THAs) were performed across the country. In addition, 103,000 revision surgeries and 30,000 partial hip replacements were performed. More women than men have these procedures and almost seven out of ten are performed on patients over age 64. The 1997 charges for these surgeries varied extensively between geographic areas and states. The THA total charge averaged $20,290 across the United States, with California reporting an average 56 percent above this and Pennsylvania with a charge 29 percent below. Per diem charges totaled $4,110 and the length of stay was 4.94 days. THA revision surgeries cost $24,530 on average with the charge in California the highest of the study states, 42 percent above the U.S. norm and more than twice that in Indiana. Per diem charges were $4,370 and average hospitalization lasted 5.61 days. Partial hip replacement charges averaged $15,890 across the United States, with an average length of stay of 7.07 days.

International mortality rates and life expectancy: selected countries.

The total U.S. mortality rate for men and women, all causes combined, continues to decrease, but remains less favorable than that in many other developed countries. The 1995 age-adjusted rate for men was ranked 9th among 15 selected industrialized countries and that for women 11th. In 1996 the U.S. age-adjusted rate dropped to a record low of 491.6 per 100,000 population. Since 1990 this rate decreased substantially more among U.S. nonwhites than whites. The rates dropped 11 and 6 percent for nonwhite men and women, respectively, and 8 and 2 percent for their white counterparts. Thus, the gender gap continues to narrow as do the racial differentials in U.S. life expectancy and mortality. International mortality data for 1995 indicate that Iceland had the best recorded age-adjusted rate for men (487.4 per 100,000 population)--just ahead of Japan which has had the lowest mortality rate for more than 20 years. Age-adjusted death rates among U.S. nonwhite men and for men in Scotland were ranked the lowest, while among women, the worst mortality rates were evident among the Danish and Scottish women. Although life expectancy values are improving in all 15 countries, U.S. longevity continues to fare poorly in comparison to other developed countries. The U.S. life expectancy for men was ranked 13th for the 1990-1995 period and 11th for women. Longevity was the highest for men in Japan and Iceland, 76.4 and 76.3 years, respectively, and the lowest for men in Finland (72.0 years). For women, longevity was the best in Japan at 82.4 years, and the worst in Denmark (77.8 years). Life expectancies for men during 1995-2000 are projected to improve from 1.6 years in New Zealand to 0.4 years in Japan. For women, life expectancy will remain at 80.8 years in Sweden while increasing 0.8 years in the United States, Germany, the United Kingdom and New Zealand.

Laparoscopic and open appendectomies--average charges, 1997.

During 1997 the average total charge for an open appendectomy (OA) was $9,670 while that for a laparoscopic appendectomy (LA) was $11,290. The 20 study states (those with 50 or more OAs) accounted for 77 percent of the 2,979 OA procedures investigated. The total charges ranged from $12,800 in California to $6,540 in Oklahoma. The hospital charges were more than 30 percent higher than the U.S. norm in California and Florida and more than 30 percent below it in Oklahoma and Washington. New York and New Jersey reported the highest physicians' fees while the Michigan doctors' charges were 35 percent below the average. Length of stay for an open appendectomy averaged 2.92 days across the country and ranged from 3.33 days in New York to 2.33 days in Colorado. The hospital plus physicians' charges for LAs ranged from $14,350 in California (27 percent above the norm) to $9,210 in Colorado (18 percent below). California and Florida reported the highest hospital charges whereas those in New York were the lowest. The physicians' fees ranged from $4,280 in New York to $1,830 in Colorado. The patients with LAs remained in the hospital, on average, 2.22 days. The length of stay ranged from almost three days in Ohio to 1.62 days in Colorado.

Average charges for cholecystectomies in the United States, 1996.

During 1996 average total charge for an in-hospital laparoscopic cholecystectomy (LC) was $13,940 and $15,380 for an open cholecystectomy (OC). Per diem charges averaged $4,130 for the LCs and $2,510 for the OCs. Among the 18 study states, Florida, Illinois and California each had total in-hospital LC charges more than 20 percent above the average, whereas North Carolina and Ohio reported charges 26 and 20 percent lower. Average length of stay for an LC was 3.37 days and ranged from 4.14 days in Tennessee to 2.51 days in Connecticut. The hospital portion of the total charge averaged 70 percent but ranged from 52 percent in New York to 78 percent in Arizona. The doctors' charges in New York and New Jersey were 39 and 26 percent, respectively, higher than the U.S. average of $4,120. Those in Michigan and Arizona were 29 and 20 percent, respectively, below the norm. The hospital and physician total charge for an OC was the highest in Florida and California, 40 percent above the U.S. average, and lowest in Tennessee, Missouri and Virginia, 32 to 24 percent below. The hospital stay for an open cholecystectomy averaged 6.12 days but varied from 8.71 days in New York to 4.84 days in Arizona. Per diem charge was $2,510 and ranged from $3,890 in California (55 percent above the average) to $1,620 in Tennessee (35 percent below). The hospital charges accounted for 76 percent of the total and ranged from 80 percent in Pennsylvania, Florida and Arizona to 66 percent in New Jersey. The physicians' charges averaged $3,750 but were $5,410 in New Jersey, $5,370 in New York vs. $2,720 in Missouri. In contrast, the average professional charge for an LC performed in an outpatient setting was $1,480. This total varied by 31 percent and was the highest in the Middle Atlantic area. The Pacific area reported the lowest regional charge ($1,250), 16 percent below the norm. Among the 16 states with 20 or more outpatient LCs, the average ambulatory LC charge was the highest in New York and Ohio and lowest in Kentucky and Kansas.

Average charges for uncomplicated vaginal, cesarean and VBAC deliveries: regional variations, United States, 1996.

Average charges during 1996 among women insured under MetraHealth group health contracts were analyzed for three methods of childbirth. Among the 40,697 study women who had an uncomplicated vaginal birth with no prior cesarean the total charge to insurance was $7,090. For the 10,305 study women who had a cesarean delivery, the average charge totaled $11,450, in comparison with the 887 women who had a vaginal birth after a previous cesarean (VBAC), whose average charge was $7,730. The Pacific and Middle Atlantic regions reported higher-than-average charges for each of the three delivery methods, whereas the New England area had higher-than-average charges for both vaginal methods of delivery but charges just below the norm for cesarean births. New York and New Jersey had the two highest total charges as well as the two highest average charges by physicians for each method of delivery. North Carolina and Indiana had the lowest charges for vaginal births, Tennessee and Ohio had the lowest cesarean charges and Ohio and Washington reported the lowest total VBAC charges. Ancillary fees accounted for just under two-thirds of the total hospital charges for all three birthing methods. Women with an umcomplicated vaginal delivery. remained in the hospital, on average, for 1.71 days, those with a cesarean birth for 3.01 days and those undergoing a VBAC for 1.76 days. By insurance coverage, the women with an indemnity plan had the longest hospital stays across each method of delivery. Women in HMOs had the shortest average length of stay (ALOS) for routine vaginal as well as cesarean deliveries, while the VBAC women with point-of-service coverage had the shortest ALOS.

Variations in charges for two major breast cancer surgeries, United States, 1996.

In 1996 the total in-hospital charges for the primary treatment of breast cancer with a modified radical mastectomy averaged $10,000 throughout the United States. The total charge (hospital plus physician's fees) varied by 95 percent between the high charge reported in New York ($12,690) and the low charge in Michigan ($6,510). The hospital portion of the bill averaged 65 percent of the total and ranged from 51 percent in New York to 74 percent in Virginia. The average length of stay for these women was 2.39 days and ranged from 3.18 days in New York to 1.69 and 1.66 days in Washington and Arizona, respectively. The average charge for a partial mastectomy was $8,760 with notable variations between states. The Texas total charge was the highest ($12,890, some 47 percent above the U.S. norm) and more than twice the low charge in Ohio ($6,080, 31 percent below the U.S. average). The physicians' charges averaged $3,330 for the country as a whole and accounted for 38 percent of the bill. This proportion ranged from 46 percent of the total in New York to 70 percent in Indiana and Colorado. The average length of hospitalization for a partial mastectomy was 1.84 days. On average, women remained in the hospital for the longest time in New Jersey (2.78 days) and for the shortest time in Oregon and Massachusetts (1.40 days and 1.45 days, respectively).

Variation in in-hospital charges for colorectal cancer treatment.

The total in-hospital charges for the treatment of 1,768 colorectal cancer patients averaged $17,800 across the United States in 1995. The Pacific area charge (driven by that in California) led all nine regions with an average 17 percent above the national norm and 37 percent higher than the lowest average charge in the East South Central area. Among states, the average totals varied by as much as 94 percent, however--Illinois and California had the highest charges (33 and 29 percent, respectively, above the U.S. average) and Ohio, Kentucky and Wisconsin the lowest (each more than 20 percent below the norm). Over three-fourths of the total charge was attributed to the hospital portion of the bill and this proportion varied from 69 percent in Ohio to over 86 percent in Minnesota. Physician charges averaged just under $4,000 across the country and ranged from $5,120 in New York to less than half this amount in Iowa ($2,410). The length of hospital stay averaged 8.8 days with fairly wide variation evident among study states. Patients were hospitalized for almost 11 days in Indiana, Tennessee and New York while for only 6.7 days in Colorado. The per diem charge was the highest in California ($2,875, 42 percent higher than the average) and lowest in Ohio ($1,386, 31 percent below the norm).

Variations in average charges for strokes and TIAs: United States, 1995.

The 1995 in-hospital charges for 6,628 group health insured stroke victims averaged $11,010 across the country. This total was over twice the average charge for the 1,584 patients hospitalized with a transient ischemic attack (TIA), $4,940. The Mountain and the neighboring Pacific areas of the country reported the highest charges for a stroke, 24 and 16 percent, respectively, higher than the U.S. average. The charges in the East North Central and East South Central areas were the lowest, each under $9,000 and 20 and 25 percent below the norm, respectively. Between study states, the highest stroke charge was reported in Arizona ($17,590) and the lowest in Ohio ($6,670). Hospital charges comprised 81 percent of the total bill to insurance, averaging $8,940. Physicians' charges averaged $2,070, with those in New York 34 percent above the norm and those in Alabama 30 percent below ($1,450). The New Jersey hospital stays averaged 8.1 days, whereas the stay in Oregon was 5.2 days. The total TIA charge was just under $5,000 across the country. Illinois reported the highest TIA in-hospital charge, $6,160, 25 percent above the U.S. average and almost twice the total in Alabama ($3,170). The hospital charges comprised 87 percent of the total, averaging $4,290. Physicians' charges in Pennsylvania were the highest ($890, 37 percent above the U.S. norm of $650) and those in Alabama the lowest ($450, 31 percent below). The average length of stay was 3.7 days for a TIA, ranging from 5.4 days in New York to 2.3 days in Arizona.

Highway fatalities: leading cause of work-related deaths.

Unintentional-injury deaths predominate among the younger ages and consequently rank number one in terms of years of potential life lost before age 65. Motor vehicles are the major way in which unintentional-injury deaths occur each year, and these deaths have been increasing since 1992. Rates rose 4 percent to 16.7 per 100,000 population in 1995 with the deaths totaling 43,900. Of these, 3 percent were classified as work-related and accounted for 1,329 highway deaths in 1995. According to the Bureau of Labor Statistics, there were 6,210 workplace fatalities in 1995 and 41 percent were related to various means of transportation. Highway travel claims more lives than any other transportation work-related injury (52 percent and its rate and proportion of total workplace fatalities have been trending upward. For the country as a whole, highway injury deaths in 1995 represented 21 percent of the occupational injury mortality. Such deaths accounted for 44 and 37 percent, respectively, of the totals in Maine and Arkansas, but 10 percent or less in Alaska, Oklahoma, and New York City. Home health care workers had a higher rate of disabling highway accidents than the trucking/carrier industry, 76 and 48 per 10,000 workers, respectively. A median of 10 days of missed work was associated with highway injuries in 1995-twice the national figure for workdays lost due to all injuries on the job.

Average hospital charges for asthma treatment: United States, 1995.

Asthma is a chronic condition that affects some 14 to 15 million persons in the United States and is one of the most frequent causes for hospitalizations among children as well as adults. Asthma-related morbidity and mortality rates have been increasing for more than a decade in this country as have hospital admissions and visits to doctors' offices for acute episodes of this condition. In 1995, the average total hospital plus physicians' charges for treating 3,559 group health insured hospitalized asthma patients was $5,710. The highest regional charge was reported for the Pacific area states (28 percent above the U.S. average) and the lowest in the East South Central states, where the total was 20 percent below the average and 38 percent below that in the Pacific area. Variation in charges was even more pronounced between study states. Arizona, Colorado and California had average charges from 30 to 47 percent above the U.S. average, whereas Washington, Tennessee and Ohio had averages 32 to 35 percent below. Hospital charges (room and board plus ancillary fees) accounted for 92 percent of the total charge to insurance with the per diem charge averaging $1,640. Physicians' charges were less the $500 for the country as a whole but ranged from $710 in Florida (54 percent above the average) to $260 in Michigan (43 percent below the norm). The average length of stay was 3.48 days, with patients in Washington averaging 2.92 days and those in Pennsylvania and New York 4.10.

Sexually transmitted diseases: United States, 1995.

Over the past two decades, the United States has experienced some dramatic changes in the rates of three "classic" sexually transmitted diseases (STDs) as well as the introduction of a variety of newer and more complex STD organisms. Rates of primary and secondary syphilis increased through the mid-1980s to a record high of 20.3 cases per 100,000 population in 1990. Since then, rates have dropped 69 percent to 6.3, the lowest rate in 35 years. Gonorrhea rates increased steadily between 1950 and 1975, plateaued between 1975 and 1978, before beginning a gradual but quite steady decline. In 1995 the rate of gonorrhea reached a 30-year low of 149.5 per 100,000. Rates of chlamydial infections, however, have increased more than 55 since 1984 as screening programs proliferated and reporting improved. These infections are commonly found in sexually active adolescents and young adults, and for every case detected in men, there are approximately six detected in women. Rates of syphilis (primary and secondary) and gonorrhea are concentrated primarily in southern states, while chlamydial infections appear to be more widespread geographically. Despite the availability of diagnostic tests and effective treatment regimens for many infectious diseases, STDs continue to target certain populations. They disproportionately affect the poor, inner-city residents and minority groups. The consequences of the diseases are many and varied, and risk of sterility, ectopic pregnancy, fetal death and/or blindness are markedly increased among women with STDs. In addition, risk of HIV infection appears to be increased among persons with a history of having an STD.

Average charges for coronary artery bypass grafts and percutaneous transluminal coronary angioplasties, 1995.

In 1995 the average charge for a coronary artery bypass graft (CABG) among 1,643 patients age 30 and over was $44,820. This charge was more than twice that for 3,569 patients undergoing a percutaneous transluminal coronary angioplasty (PTCA)-$20,370. The Middle Atlantic area reported the highest average charge for a CABG (18 percent above the norm) due mainly to the high charge in Pennsylvania, which was 37 percent higher than the national average. Each of the four regions west of the Mississippi River had higher than average charges for both revascularization procedures. The lowest charge for a CABG was reported in West Virginia-36 percent below the average and less than half the Pennsylvania charge Arizona, California and Illinois had the highest average PTCA charges, each 20 percent or more above that for the U.S. The lowest PTCA charge was reported in Ohio ($14,680), 28 percent lower than the U.S. average and 42 percent lower than in Arizona Hospital charges accounted for 73 percent of the total CABG charge and 77 percent of the PTCA total. Physician charges were the highest in New York and New Jersey for CABGs (each 31 percent above the average) and the lowest in Colorado (37 percent below). For PTCAs, the physicians' fees were the highest in Indiana, Connecticut and New York (between 18 and 21 percent above the norm) and lowest in Washington (25 percent below). CABG patients remained hospitalized for 8.32 days, more than twice the number of days for the PTCA (3.86 days).

Average charges for a total hip arthroplasty: geographic variations, 1995.

The total replacement of the hip is the most successful operation for patients with debilitating osteoarthritis of the hip. An estimated 124,000 total hip arthroplasties (THAs) were performed in U.S. nonfederal short-stay hospitals in 1994 and approximately 28,000 THA revisions were also reported for that year. In 1995 the average hospital and physician charges to insurance for a THA totaled $23,260 and $27,760 for a revision of the primary THA. The average THA charges ranged from a high of $25,500 in the New England region (10 percent above the U.S. average) to $19,930 in the East South Central region (14 percent below the U.S. average). Illinois reported the highest average total charge and Michigan the lowest. The hospital THA charges averaged $16,810 and accounted for 72 percent of the total charges. Physician fees differed by 101 percent between the high reported in New York and the low in Michigan. THA patients remained hospitalized for an average of 5.9 days, ranging from 8 days in Virginia to 4.6 in Utah. Average total charges for the revision surgeries were the highest in the Middle Atlantic region ($35,660, 28.5 percent above the U.S. average) and the lowest in the East South Central region, where they were less than half, $14,930 and 46 percent lower than that for the United States as a whole. Physician fees accounted for a little more than one-fourth of the total charge and averaged $7,410. THA revision patients remained in the hospital for an average of 6.6 days.