California Health Care Coalition
Hospital admissions are arguably the earliest, best and fairest indicator of a local health system’s performance and the effectiveness of health plans in managing care. Here’s why:
· Research shows that hospital admission rates for medical and surgical admissions vary enormously within and across cities, states and regions. For example, women in Shasta County have had hysterectomies at a rate five times that of their peers in Marin County.
· In the case of health care services, supply determines demand. The variation in hospital admission rates reflects differences in the capacity and quality of local health care delivery systems. We experience more elective surgeries where there is a higher per capita concentration of surgeons, higher hospital admission rates where effective primary care is lacking, and greater use of tests where heavy investments have been made in diagnostic technologies.
The problem of hospital admissions variation is widespread in California. Recently, the Public Health Institute used public data to calculate admission rates by county. It found striking variation in both surgical and medical admissions by county and a four-to-six fold variation in hospital costs. In Stanislaus County:
· Questionable hospital admissions totaled 6412 in 2002
· The estimated cost of these questionable admissions totaled $494 million
· The most striking variation occurred in the following diagnostic categories: heart disease; hysterectomies; surgical procedures for obesity; post-operative and post-traumatic infections; and ambulatory care sensitive conditions.
These findings raise serious questions about the appropriateness of hospital admissions for some surgical procedures and the effectiveness of patient care in ambulatory care settings. Why are hospital admissions for some conditions so much higher in Stanislaus County? Do these admissions reflect the legitimate health needs of residents or some other factor, like provider strategies to increase income? In which hospitals do questionable or preventable admissions most occur? Purchasers must ask health plans and hospitals how they calculate, monitor and/or address questionable hospital admissions in our community. One thing is clear. We pay health plans to assure appropriate and high quality care. If they cannot or will not ask and answer questions related to the appropriateness of hospital admissions, how can they claim to be assuring high standards of care by providers in their networks?