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Keeping Americans Out of the Hospital and Money in Your Pocket

By Dr. Evan Saulino

Ever since I met him 5 years ago on a blustery, cold winter afternoon a lot like today, I’ve been telling John’s story.  He exemplified the core problems in our health care system - one I used to think was the best in the world.

John taught me many things about how the system works, but ultimately his problem was that he lacked access to basic primary care and medications to prevent and control his illnesses. Because of this fundamental issue, he rode a 2-year rollercoaster of hospitalization after hospitalization after hospitalization.  Each time around the circle, he was discharged from the hospital with no doctor he could afford to see, and medications he could scarcely pay for. In the end, he died with $200,000 of debt that was "cost-shifted" to other purchasers of health insurance via higher premiums, co-pays, and deductibles.  Like his premature death, most, if not all of John’s hospitalizations were preventable.

John could have been a case-study for the section of the recently released CDC Report on Health Disparities that discusses preventable hospitalizations (Section starts on page 82). 

Investigators looked at rates of preventable hospitalization in communities across the United States between 2004 and 2007.  Their report outlines the effects of financial status and race on Americans’ rate of preventable hospitalizations.

Although overall, preventable hospitalizations declined slightly during this time-period, a wide gap in risk persisted, demonstrating that lower income Americans suffer preventable hospitalizations at rates nearly twice those of Americans at the high end of the income spectrum.  The authors estimate that if we figured out a way for Americans in the lower income brackets to experience the same rates as those Americans with incomes in the top 25%, we could prevent 910,000 unnecessary hospitalizations. This would save an estimated $6,700,000,000

Preventable hospitalization rates were also found to be higher among Black and Hispanic Americans. The authors estimate if Black and Hispanic Americans had rates equivalent to those of White and Asian Americans, we could prevent 540, 000 unnecessary hospitalizations and would save an estimated $4,300,000,000

Of course then there are the sickness, pain, family/job disruption, and loss of life that come along with those hospitalizations we could prevent as well, but the investigators did not attempt estimate those potential costs or savings.

But before you get stuck feeling overwhelmed thinking there’s not much we can do about the disparities in preventable hospitalizations that end up ballooning all of our health care costs, you should know there are solutions. 

Among the potential strategies the authors recognized to combat the problem, one shown to be particularly effective is the implementation and support of Patient-Centered Primary Care (PC2) Homes – or “Medical Homes”. This model improves access to care and prevents unnecessary hospitalizations/ER visits by providing multidisciplinary, coordinated, comprehensive care in a patient-centered manner. 

But like many potential solutions, these take up-front money to implement. So, even though there’s money and lives that could be saved, the perennial chicken-or-the-egg question is: who should help pay to successfully implement innovations we know will work? Figure that out, and we can really start to treat this symptom of our nation’s health disparities.

I have my own ideas on this that I’ll share on a future post…but right now I’m more interesting in hearing your ideas. 

Leave me a comment below and tell me how you think preventable hospitalizations can best be avoided in high-risk communities, and how these efforts should be funded sustainably. 

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