Avoidable-Hospitalization Rates Climb

Healthcare Financial Management, May, 2001

Hospitalizations due to medical conditions that could have been avoided by earlier interventions and effective ambulatory care increased from 2.2 million in 1980 to 3.7 million in 1998, an increase of 5.6 percent, the Centers for Disease Control and Prevention (CDC) reported in the March/April 2001 issue of Health Affairs. Avoidable-hospitalization rates increased for pneumonia, congestive heart failure, cellulitis, ruptured appendix, and potassium deficiency. In particular, rates skyrocketed among senior citizens.

The CDC report cited several variables that are worth investigating as causes of the increased rates, including lack of prescription drug insurance among the elderly, levels of illness in the overall population, physicians' treatment patterns, and HMO policies. For example, an elderly patient whose insurance does not cover some vital medications may not be able to afford to purchase these drugs; the increase in the number of elderly as a percentage of the overall population may boost levels of chronic illness; and fear of medical malpractice lawsuits may affect physicians' treatment patterns.

A particularly intriguing explanation may be that the rate of avoidable hospital admissions may have risen because HMOs are being less restrictive in allowing hospital visits. HMOs' emphasis on prevention and ambulatory care resulted in fewer hospitalizations in the mid-1990s, the report noted. In recent years, however, HMOs, under pressure from providers, politicians, and consumers, have relaxed their efforts to control certain healthcare management techniques, which may have resulted in a surge of emergency department visits for avoidable conditions, leading to hospitalizations.

The CDC report, "Trends in Avoidable Hospitalizations, 1980-1998," can be purchased for $12 at the Health Affairs Web site (http//:www.healthaffairs.org; go to "archives," click on "library," click on "number 2" under volume 20, and scroll down to the report).

The issue of avoidable hospitalizations has generated interest on the state level as well. The Health Research and Educational Trust of New Jersey, a not-for-profit affiliate of the New Jersey Hospital Association, released a report on March 28, 2001, that noted that the number of patients in the state's Medicaid program could be a factor in that state's avoidable-hospitalization rates. The report noted that individuals in such programs often have less access to preventive care; some New Jersey Medicaid patients may wait months for a physician's appointment, while others cannot afford to fill prescriptions. The first line of care might not occur until an emergency department visit, which often leads to hospitalization. To read the report, Access to Primary Care in New Jersey: Geographic Variation of Hospitalizations for Ambulatory Care Sensitive Conditions in 1995 and 1997, go to http://www.njha.com/html/pdf/032701/HCNJv10No3.pdf.>

COPYRIGHT 2001 Healthcare Financial Management Association

COPYRIGHT 2001 Gale Group