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difference between the two groups would have been greater. Nevertheless, despite this 

 problem, complications resulting from a secondary diagnosis of substance abuse accounted for 

 SI 08 million in added cost to Medicare. 



These figures represent average lengths of stay in Medicare but, for some diseases, 

 the difference in length of stay was much higher. For example, for patients with pancreatitis, 

 those requiring major joint and limb reattachments, and those with pathological fractures with 

 a secondary diagnosis of substance abuse, patients stayed approximately twice as long as their 

 non-substance abusing counterparts (pancreatitis 17 days vs. 8 days; major joint 24 vs. 10; 

 pathological fractures 17 vs. 10) (Graph 4). 



However,' for other diseases, the ALOS was, in fact, shorter for some Medicare 

 patients with a secondary diagnosis of substance abuse. For example, patients with respiratory 

 infections and inflammations, cellulitis, and GI obstruction, who also had a secondary 

 diagnosis of substance abuse, stayed less time in the hospital than non-substance abusers (e.g., 

 respiratory infections 8.4 days vs. 11.7 days, cellulitis 7.4 vs. 8.6, and GI obstruction 3.7 vs. 

 7.4) This does not mean that patients with substance abuse needed less care. There are several 

 possible explanations for why these substance abusers had shorter lengths of stay. It may 

 result from an aberration in the data due to the small sample size of patients within these 

 diagnoses, or because of the premature departure caused by some patients signing out against 

 medical advice. However, it may also reflect the financial or social undesirability to hospitals 

 of many of these patients which, in turn, may lead to their early discharge or transfer to 

 another facility. In this context, it is worth noting that, if this hypothesis is true, as the forces 

 of competition in health care intensify, these results suggest that such "undesirable" patients 

 may be increasingly pushed out prematurely from some institutions. Further, the nature of the 



