Characterizing Potentially Preventable Hospitalizations of High-Cost Patients in Rural China

Abstract

IntroductionHigh-cost patients are characterized by repeated hospitalizations, and inpatient cost accounts for a large proportion of their total health care spending. This study aimed to assess the occurrence and costs of potentially preventable hospitalizations and explore contributing factors among high-cost patients in rural China.MethodsWe examined a population-based sample of patients using the 2016 New Rural Cooperative Medical Scheme in Dangyang city, China. Eighteen thousand forty-three high-cost patients were identified. A validated tool and logistic regression analysis were used to determine preventable hospitalizations and their patient-level and supply-side factors.ResultsHigh-cost patients were older (average age of 54 years) than non-high-cost patients (50 years) and more likely to come from poverty-stricken families. The occurrence of preventable hospitalization was 21.65% among high-cost patients. The proportion of preventable inpatient cost in total inpatient and outpatient expenditure among high-cost patients (5.81%) was lower than that of non-high-cost patients (7.88%) but accounted for 75.87% of the overall preventable inpatient cost. High-cost patients with more hospitalizations were more likely to experience preventable hospitalization, and those with heart failure, COPD, diabetes and mixed conditions were at a higher risk of preventable hospitalization, while those with more outpatient visits were less likely to show preventable hospitalization.ConclusionsThe occurrence of preventable hospitalization among high-cost patients in rural China was sizeable. The preventable inpatient cost of the overall population was concentrated among high-cost patients. Interventions such as improving preventive care and disease management targeting high-cost patients within counties may improve patients' health outcomes and quality of life and reduce overall preventable inpatient cost.

Subgroups of High-cost Patients and Their Preventable Inpatient Cost in Rural China

“…[7][8][9] According to our previous study on the rural population, the occurrence of potentially preventable hospitalization (PPH) among highcost patients was sizable (22%), indicating that 22 preventable hospitalizations occurred per 100 high-cost persons. 10 Moreover, the preventable inpatient cost (PIC) of high-cost patients amounted to the majority (around 70%) of total preventable spending of overall patients as previous studies reported. 6,[10][11][12] Although high-cost patients only occupy a small proportion of the population, they are highly heterogeneous, which has substantial variations in demographics, functional status and disease burden.…”

“…10 Moreover, the preventable inpatient cost (PIC) of high-cost patients amounted to the majority (around 70%) of total preventable spending of overall patients as previous studies reported. 6,[10][11][12] Although high-cost patients only occupy a small proportion of the population, they are highly heterogeneous, which has substantial variations in demographics, functional status and disease burden. 7,13,14 Not all hospitalizations are potentially preventable among high-cost patients.…”

Drivers of high-cost persistence in rural China: A population-based retrospective study

“…On this basis, we established hypothesis 1: sociodemographic, socio-environmental, and disease factors would affect healthcare utilization. Previous studies have confirmed that inpatient service utilization is highly correlated with high-cost status (15). Hence, we established hypothesis 2: hospitalizations in the initial year would affect the HCP.…”

Older high-cost patients in Norwegian somatic hospitals: a register-based study of patient characteristics

“…Studies on high-cost patients have argued that cost is a reasonable measurement of healthcare utilisation,16 17 because cost has far-reaching impacts on the adequacy and performance of patient services 18. In this study, DRG weights were selected as a measurement for overall resource use, reflecting total healthcare costs for each patient admitted to hospital wards.…”