INCREASED USE OF AN EXPENSIVE, ELECTIVE PROCEDURE - TOTAL HIP REPLACEMENTS IN THE 1980S

Between 1980 and 1987, the number of hospital discharges with total hi p replacement (THR) increased by more than 90%, while total hospital d ischarges fell by more than 10%. Total hip replacement is one of the m ost costly hospital inpatient procedures, both per case and in total M edicare expenses. Explanations for the growth in use of THR may clarif y some of the major forces driving national health care costs. This st udy assumes that treatment choices are made by (or for) each patient t o maximize expected net benefits. Within this framework, the use of TH R might have increased because of improved safety for the procedure, l onger life expectancy and better control of many serious illnesses tha t led to increased demand for quality-enhancing procedures, and increa sed out-of-pocket cost for alternative treatments that are not covered well by insurance. These possible explanations imply changes in the c haracteristics of THR recipients over time. An upward shift was found in the age distribution of patients, more than simply because of an ag ing of the population. Sharply increased proportions of patients were also found with serious comorbidities such as cancer and dementia. The safety of the procedure seems to have improved, in terms of the death rate in the hospital. The results suggest that demands for expensive, elective procedures have been increasing for patients previously rega rded as too old or impaired to benefit sufficiently. This process lead s to continuing increases in real health care expenses even without th e invention of new technologies.