+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Inappropriate use of hospitals in a randomized trial of health insurance plans



Inappropriate use of hospitals in a randomized trial of health insurance plans



New England Journal of Medicine 315(20): 1259-1266



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.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 005657584

Download citation: RISBibTeXText

PMID: 3773939

DOI: 10.1056/NEJM198611133152005


Related references

Show Me My Health Plans: a study protocol of a randomized trial testing a decision support tool for the federal health insurance marketplace in Missouri. Bmc Health Services Research 16(): 55-55, 2016

The relationship between hospitals and health plans organizations in the scope of ANS Health Insurance Qualification Program. Ciencia & Saude Coletiva 12(4): 903-914, 2007

Children's insurance attractive market for health plans, hospitals. Executive Solutions for Healthcare Management 1(10): 7-10, 1999

Shifting burdens. Hospitals increasingly concerned over effects of cost-sharing provisions in health plans to be offered through insurance exchanges. Modern Healthcare 43(24): 30-31, 2013

Explanatory introduction to the policy of th Commission of Physicians and Health Insurance Plans on the performance of psychotherapy under health insurance care. Zeitschrift für Psychosomatische Medizin und Psychoanalyse 33(4): 301-303, 1987

Health insurance reform and the development of health insurance plans: the case of the Emirate of Abu Dhabi, UAE. Journal of Health Care Finance 40(3): 47-66, 2014

Testing health information technology tools to facilitate health insurance support: a protocol for an effectiveness-implementation hybrid randomized trial. Implementation Science 10(): 123-123, 2016

The demand for dental care: evidence from a randomized trial in health insurance. Journal of the American Dental Association 110(6): 895-902, 1985

The Health Insurance Field. How The Health Insurance Council Is Working In Cooperation With Hospitals And Physicians. Ohio State Medical Journal 59: 1064-1066, 1963

The effects of health care benefits on health care use and health: a randomized trial for disability insurance beneficiaries. Medical Care 50(9): 764-771, 2012

Use of outpatient mental health services in HMO and fee-for-service plans: results from a randomized controlled trial. Health Services Research 21(3): 453-474, 1986

The elderly and healthcare plans in Brazil: analysis of the complaints received by the National Regulatory Agency for Private Health Insurance and Plans. Ciencia & Saude Coletiva 20(12): 3817-3826, 2015

A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured. Medical Decision Making 36(7): 911-922, 2015

AHA survey shows: most hospitals depend on own insurance plans. Business Insurance 12(26): 6-6, 1978

Self-insurance plans for hospitals: a way to cope with the malpractice problem. Bulletin - American Protestant Hospital Association 41(1): 16-7, 30-1, 1978