We examined geographic variation in the rate of inappropriate hospitalization and the effect of cost sharing on that rate. The medical records of 1132 adults hospitalized in a randomized trial of health insurance plans were reviewed by two physicians who were blinded to the patients' insurance plan. They judged 23 percent of the admissions to be inappropriate and an additional 17 percent to have been avoidable by the use of ambulatory surgery. The percentage of inappropriate admissions varied among six sites (from 10 to 35 percent), but areas with low total admission rates did not necessarily have low proportions of inappropriate admissions. In plans with cost sharing for all services, 22 percent of admissions and 34 percent of hospital days were classified as inappropriate, as compared with 24 percent of admissions and 35 percent of hospital days in the plan under which care was free to the patient (these differences were not statistically significant). Our data show that a substantial fraction of hospitalization is potentially avoidable. Because cost sharing did not selectively reduce inappropriate hospitalization, it is important to develop other mechanisms to do so.
This article has been cited by other articles:
Newhouse, J. P., Brook, R. H., Duan, N., Keeler, E. B., Leibowitz, A., Manning, W. G., Marquis, M. S., Morris, C. N., Phelps, C. E., Rolph, J. E.
(2008). Attrition in the RAND Health Insurance Experiment: A Response to Nyman. Journal of Health Politics, Policy and Law
33: 295-308
[Abstract]
Wells, D. A., Ross, J. S., Detsky, A. S.
(2007). What Is Different About the Market for Health Care?. JAMA
298: 2785-2787
[Full Text]
Nyman, J. A.
(2007). American Health Policy: Cracks in the Foundation. Journal of Health Politics, Policy and Law
32: 759-783
[Abstract]
Chernew, M. E., Rosen, A. B., Fendrick, A. M.
(2007). Value-Based Insurance Design. Health Aff (Millwood)
26: w195-w203
[Abstract][Full Text]
Anton, P., Peiro, S., Aranaz, J. M, Calpena, R., Compan, A., Leutscher, E., Ruiz, V.
(2007). Effectiveness of a physician-oriented feedback intervention on inappropriate hospital stays. J. Epidemiol. Community Health
61: 128-134
[Abstract][Full Text]
Meropol, N. J., Schulman, K. A.
(2007). Cost of Cancer Care: Issues and Implications. JCO
25: 180-186
[Abstract][Full Text]
Bauer, M. S., McBride, L., Williford, W. O., Glick, H., Kinosian, B., Altshuler, L., Beresford, T., Kilbourne, A. M., Sajatovic, M., and Coauthors for the Cooperative Studies Program,
(2006). Collaborative Care for Bipolar Disorder: Part I. Intervention and Implementation in a Randomized Effectiveness Trial. Psychiatr. Serv.
57: 927-936
[Abstract][Full Text]
Lesser, C. S., Ginsburg, P. B.
(2006). Strategies to Enhance Price and Quality Competition in Health Care: Lessons Learned from Tracking Local Markets. Journal of Health Politics, Policy and Law
31: 557-567
[Abstract]
Fuchs, V. R., Emanuel, E. J.
(2005). Health Care Reform: Why? What? When?. Health Aff (Millwood)
24: 1399-1414
[Abstract][Full Text]
Milstein, A.
(2004). Hot Potato Endgame. Health Aff (Millwood)
23: 32-34
[Abstract][Full Text]
Wynia, M. K., Gostin, L. O.
(2004). Ethical Challenges in Preparing for Bioterrorism: Barriers Within the Health Care System. Am. J. Public Health
94: 1096-1102
[Abstract][Full Text]
Birch, S.
(2004). Charging the patient to save the system? Like bailing water with a sieve. CMAJ
170: 1812-1813
[Full Text]
Kerr, E. A., McGlynn, E. A., Adams, J., Keesey, J., Asch, S. M.
(2004). Profiling The Quality Of Care In Twelve Communities: Results From The CQI Study. Health Aff (Millwood)
23: 247-256
[Abstract][Full Text]
Bindman, A. B., Haggstrom, D. A.
(2003). Small Steps or a Giant Leap for the Uninsured?. JAMA
290: 816-818
[Full Text]
Barnato, A. E., Garber, A. M.
(2003). Performance of the RAND Appropriateness Criteria. Med Decis Making
23: 177-179
SANGHA, O., SCHNEEWEISS, S., WILDNER, M., COOK, E. F., BRENNAN, T. A., WITTE, J., LIANG, M. H.
(2002). Metric properties of the appropriateness evaluation protocol and predictors of inappropriate hospital use in Germany: an approach using longitudinal patient data. Int J Qual Health Care
14: 483-492
[Abstract][Full Text]
Fuchs, V. R.
(2002). What's Ahead for Health Insurance in the United States?. NEJM
346: 1822-1824
[Full Text]
Eisenberg, J. M., Power, E. J.
(2000). Transforming Insurance Coverage Into Quality Health Care: Voltage Drops From Potential to Delivered Quality. JAMA
284: 2100-2107
[Abstract][Full Text]
Benbassat, J., Taragin, M.
(2000). Hospital Readmissions as a Measure of Quality of Health Care: Advantages and Limitations. Arch Intern Med
160: 1074-1081
[Abstract][Full Text]
Sirio, C. A., Shepardson, L. B., Rotondi, A. J., Cooper, G. S., Angus, D. C., Harper, D. L., Rosenthal, G. E.
(1999). Community-Wide Assessment of Intensive Care Outcomes Using a Physiologically Based Prognostic Measure: Implications for Critical Care Delivery From Cleveland Health Quality Choice. Chest
115: 793-801
[Abstract][Full Text]
Ashton, C. M., Petersen, N. J., Souchek, J., Menke, T. J., Yu, H.-J., Pietz, K., Eigenbrodt, M. L., Barbour, G., Kizer, K. W., Wray, N. P.
(1999). Geographic Variations in Utilization Rates in Veterans Affairs Hospitals and Clinics. NEJM
340: 32-39
[Abstract][Full Text]
Enthoven, A. C., Singer, S. J.
(1999). Unrealistic Expectations Born of Defective Institutions. Journal of Health Politics, Policy and Law
24: 931-939
Edwards, N., Hensher, M.
(1998). Managing demand: Managing demand for secondary care services: the changing context. BMJ
317: 135-138
[Full Text]
Rosenthal, G. E., Sirio, C. A., Shepardson, L. B., Harper, D. L., Rotondi, A. J., Cooper, G. S.
(1998). Use of Intensive Care Units for Patients With Low Severity of Illness. Arch Intern Med
158: 1144-1151
[Abstract][Full Text]
Steen, P. M.
(1998). Utilization Management Criteria for Psychiatry. Am. J. Psychiatry
155: 577-577
[Full Text]
Booth, B. M., Ludke, R. L., Fisher, E. M.
(1998). Inappropriate Hospital Care and of Illness: Results from a Nationwide Study. American Journal of Medical Quality
13: 36-43
[Abstract]
Rice, T.
(1997). Can Markets Give Us the Health System We Want?. Journal of Health Politics, Policy and Law
22: 383-426
[Abstract]
Bakheit, A., Ward, C., Morris, S., Walker, P.
(1996). The use of a multidisciplinary rehabilitation assessment clinic as an alternative to hospital admission. Clin Rehabil
10: 243-246
[Abstract]
Rasell, M. E.
(1995). Cost Sharing in Health Insurance -- A Reexamination. NEJM
332: 1164-1168
[Full Text]
Pauly, M. V.
(1995). Practice Guidelines: Can They Save Money? Should They?. J Law Med Ethics
23: 65-74
Fleming, S. T.
(1995). Primary Care, Avoidable Hospitalization, and Outcomes of Care: A Literature Review and Methodological Approach. Med Care Res Rev
52: 88-108
[Abstract]
Rice, T., Morrison, K. R.
(1994). Patient Cost Sharing for Medical Services: A Review of the Literature and Implications for Health Care Reform. Med Care Res Rev
51: 235-287
Booth, B. M., Ludke, R. L., Fisher, E. M.
(1994). Reliability of a Utilization Review Instrument in a Large Field Study. American Journal of Medical Quality
9: 68-73
[Abstract]
Emanuel, E. J., Emanuel, L. L.
(1994). The Economics of Dying -- The Illusion of Cost Savings at the End of Life. NEJM
330: 540-544
[Full Text]
Phelps, C. E.
(1993). The Methodologic Foundations of Studies of the Appropriateness of Medical Care. NEJM
329: 1241-1245
[Full Text]
Halpin Schauffler, H., Rodriguez, T.
(1993). Managed Care for Preventive Services: A Review of Policy Options. Med Care Res Rev
50: 153-198
Bashshur, R., Smith, D. G., Stiles, R. A.
(1993). Defining Underinsurance: A Conceptual Framework for Policy and Empirical Analysis. Med Care Res Rev
50: 199-218
Schlackman, N.
(1993). Evolution of a Quality-based Compensation Model: The Third Generation. American Journal of Medical Quality
8: 103-110
[Abstract]
Mechanic, D.
(1993). America's Health Care System and its Future: The View of a Despairing Optimist. Med Care Res Rev
50: 7-48
Baigelman, W.
(1991). Identifying Physicians and Patterns Generating Unnecessary In-Hospital Days: An Exploratory Stage of Developing an Institution-Specific Physician-Focused Utilization Effort. American Journal of Medical Quality
6: 95-98
[Abstract]
Tape, T. G., Heckerling, P. S., Ornato, J. P., Wigton, R. S.
(1991). Use of Clinical Judgment Analysis to Explain Regional Variations in Physicians' Accuracies in Diagnosing Pneumonia. Med Decis Making
11: 189-197
[Abstract]
Wickizer, T. M.
(1990). The Effect of Utilization Review on Hospital Use and Expenditures: A Review of the Literature and an Update on Recent Findings. Med Care Res Rev
47: 327-363
Wickizer, T. M., Feldstein, P. J., Wheeler, J. R. C., McDonald, M. C.
(1990). Reducing Hospital Use and Expenditures through Utilization Review: Findings from an Outcome Evaluation. American Journal of Medical Quality
5: 80-85
[Abstract]
Lee, P. R., LeRoy, L. B., Ginsberg, P. B., Hammons, G. T.
(1990). Physician Payment Reform: An Idea Whose Time Has Come. Med Care Res Rev
47: 137-163
Russell, L.
(1989). Some of the tough decisions required by a national health plan. Science
246: 892-896
[Abstract]
Paranjpe, N., Strumwasser, I., Ronis, D. L., Bartzack, C., Zech, C.
(1989). Efficiency Gains in Utilization Review. American Journal of Medical Quality
4: 108-114
[Abstract]
Spiro, A.
(1989). Utilization Management in the Small Group Insurance Market. American Journal of Medical Quality
4: 43-46
[Abstract]
Restuccia, J. D., Payne, S. M. C., Tracey, L. V.
(1989). A Framework for the Definition and Measurement of Underutilization. Med Care Res Rev
46: 255-270
Berwick, D. M.
(1988). Toward an Applied Technology for Quality Measurement in Health Care. Med Decis Making
8: 253-258
[Abstract]
Previous
