Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups.

OBJECTIVES The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. METHODS With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. RESULTS An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. CONCLUSIONS Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care.

[1]  N. Krieger.  Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. , 1992, American journal of public health.

[2]  J. Iglehart.  Managed care and mental health. , 1996, The New England journal of medicine.

[3]  W. Watson,et al.  SOCIOLOGY IN MEDICINE , 1963, The Ulster Medical Journal.

[4]  B. Starfield,et al.  Hospitalizations of Children and Access to Primary Care: A Cross-National Comparison , 1995, International journal of health services : planning, administration, evaluation.

[5]  K. Rask.  Hospital Discharge Data and the Uninsured , 1994, Journal of health care for the poor and underserved.

[6]  T S Carey,et al.  Impact of socioeconomic status on hospital use in New York City. , 1993, Health affairs.

[7]  T. Bodenheimer.  Underinsurance in America. , 1992, The New England journal of medicine.

[8]  S. Schroeder.  The Medically Uninsured — Will They Always Be with Us? , 1996 .

[9]  David R. Williams,et al.  Us socioeconomic and racial differences in health: patterns and explanations , 1995 .

[10]  D. Rowland,et al.  A profile of the uninsured in America. , 1994, Health affairs.

[11]  Graves Ej.  Expected principal source of payment for hospital discharges: United States, 1990. , 1992, Advance data.

[12]  Massey Jt,et al.  Design and estimation for the National Health Interview Survey 1985-94. , 1989 .

[13]  L. Kozak,et al.  Trends in hospital utilization, 1965-86. , 1990, American journal of public health.

[14]  Kozak Lj.  Underreporting of race in the National Hospital Discharge Survey. , 1995, Advance data.

[15]  B Starfield,et al.  Primary care and health. A cross-national comparison. , 1991, JAMA.

[16]  J. Billings,et al.  Uninsured patients in District of Columbia hospitals. , 1990, Health affairs.

[17]  Michael Millman,et al.  Access to Health Care in America , 1993 .

[18]  D. Commerce.  Statistical abstract of the United States , 1978 .