Inappropriate Use of Hospitals in a Randomized Trial of Health Insurance Plans

Siu, Albert L.; Sonnenberg, Frank A.; Manning, Willard G.; Goldberg, George A.; Bloomfield, Ellyn S.; Newhouse, Joseph P.; Brook, Robert H.

doi:10.1056/nejm198611133152005

Cited by 247 publications

(90 citation statements)

References 17 publications

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“…[1][2][3][4][5] In the RAND Health Insurance Experiment, we reported previously that 23 percent of the admissions made inappropriate use of the acute hospital setting or level of care, while an additional 17 percent of admissions were avoidable by use of ambulatory surgery. 2 In this report, we examined the effect of patient, physician, and hospital variables on inappropriate hospitalizations and days. Our data provide some of the most detailed and comprehensive information available on the health status of patients.…”

Section: Introductionmentioning

confidence: 99%

Patient, provider and hospital characteristics associated with inappropriate hospitalization.

Siu¹,

Manning²,

Benjamin³

1990

Am J Public Health

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To determine the relation between patient and provider characteristics and inappropriate hospital use, we examined adult nonpregnancy hospitalizations from a randomized trial of health insurance conducted in six sites in the United States. Appropriateness of inpatient treatment was based on medical record review; patient characteristics on sociodemographic, economic, and health status; and provider characteristics on descriptors of physician practice and hospital facilities.Twenty

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Section: Introductionmentioning

confidence: 99%

Patient, provider and hospital characteristics associated with inappropriate hospitalization.

Siu¹,

Manning²,

Benjamin³

1990

Am J Public Health

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“…Patients with HDHPs have fewer checkup, primary care, emergency department (ED), and physician visits compared with those with no deductibles (2,7). The effect is greatest for low-income patients (8)(9)(10). Chronically ill patients with an HDHP also both have fewer physician visits and use fewer medications (11,12).…”

mentioning

confidence: 99%

Among Low-Income Respondents With Diabetes, High-Deductible Versus No-Deductible Insurance Sharply Reduces Medical Service Use

et al. 2016

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OBJECTIVE To contrast the effect of private insurance and deductibles (by size) on medical service use, health status, and medical debt for adult respondents with diabetes with low and high incomes. RESEARCH DESIGN AND METHODS Using the 2011–2013 Medical Expenditure Panel Survey, bivariate and regression analyses were conducted to compare demographic characteristics, medical service use, diabetes care, and health status among privately insured adult respondents with diabetes, aged 18–64 years (N = 1,461) by lower (<200% of the federal poverty level) and higher (≥200% of the federal poverty level) income and deductible vs. no deductible (ND), low deductible ($1,000/$2,400) (LD), and high deductible (>$1,000/$2,400) (HD). The National Health Interview Survey 2012–2014 was used to analyze differences in medical debt and delayed/avoided needed care among adult respondents with diabetes (n = 4,058) by income. RESULTS Compared with privately insured respondents with diabetes with ND, privately insured lower-income respondents with diabetes with an LD report significant decreases in service use for primary care, checkups, and specialty visits (27%, 39%, and 77% lower, respectively), and respondents with an HD decrease use by 42%, 65%, and 86%, respectively. Higher-income respondents with an LD report significant decreases in specialty (28%) and emergency department (37%) visits. Diabetes care measures are similar by income and insurance; there were no changes in physical health status. Medical debt is similar by income, but deferred service use is two times greater for those indebted and with lower income. CONCLUSIONS Private insurance with a deductible substantially and problematically reduces medical service use for lower-income insured respondents with diabetes who have an HD; these patients are more likely to report forgoing needed medical services.

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“…The AEP, firstly developed in the United States [10], has been used in a number of studies [11][12][13][14][15][16]. It includes objective criteria related to both the level of care and monitoring and the clinical condition.…”

Section: Introductionmentioning

confidence: 99%

A survey on hospitalised communityacquired pneumonia in Italy

Migliorati¹,

Boccoli

Bracci

et al. 2016

Monaldi Arch Chest Dis

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Background and aim. Community Acquired Pneumonia (CAP) remains a major cause of disease and death. We evaluated the levels of care, the outcome and the characteristics of hospitalised patients with CAP in a primary hospital in Italy. We also investigated the value of both the Pneumonia Severity Index (PSI) and the modified Appropriateness Evaluation Protocol (AEP) for recognising both the outcome and the unnecessary admissions and stay of hospitalised patients with CAP. Methods. A retrospective review of all the charts of adult patients with CAP at Manerbio, Brescia, Italy between January 2001 and December 2002 was performed. Results. We evaluated 148 patients; their mean age (±SD) was 70 (±17) years; 34% were female. Most patients (87%) had at least a concomitant co-morbid disease. The overall survival rate at 30 days was 88%. All but one death occurred in the high-risk group of patients according to the PSI. On the contrary, the death rate of patients with inappropriate hospital admission according to the AEP was high. Patients with high PSI score had a significantly longer hospital length of stay than the low-risk group. However, a substantial part of the hospital stay did not show any justification into the charts. Conclusions. The PSI, but not the AEP, upon hospital admission, was useful for evaluating the outcome of patients with CAP. The PSI score and the modified AEP can be useful for assessing the appropriateness of hospitalisation for patients with CAP. There is the need for a practical and validated tool to support physicians in their decision making regarding the early and safe discharge of hospitalised patients with CAP.

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Inappropriate Use of Hospitals in a Randomized Trial of Health Insurance Plans

Cited by 247 publications

References 17 publications

Patient, provider and hospital characteristics associated with inappropriate hospitalization.

Patient, provider and hospital characteristics associated with inappropriate hospitalization.

Among Low-Income Respondents With Diabetes, High-Deductible Versus No-Deductible Insurance Sharply Reduces Medical Service Use

A survey on hospitalised communityacquired pneumonia in Italy

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