Avoidable hospital admissions and resource use in China: an exploratory analysis of 2·57 million hospital admissions

Abstract

BackgroundAppropriate treatment of ambulatory-care sensitive disorders and reductions of avoidable admissions can play an important part in enabling health systems to respond to growing chronic disease burdens and population ageing. But little evidence is available from middle-income countries with respect to the extent of avoidable admissions and their resource use, and no study has addressed these questions in China. MethodsIn this exploratory analysis, we analysed hospital admissions at the province, city, and county level in 2012 and 2013, applying the OECD definition of avoidable admissions and using ICD10 codes for asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes, and hypertension. Data limitations—including the absence of population denominators and incomplete coding on inpatient summary sheets—prompted a second definition of potentially avoidable admissions in consultation with Chinese clinicians. Shorter length of stay and lower expenditure were used as proxies for cases amenable to management within primary care. χ2 test was used for variable screening, and logistic regression analysis was used to test the influence of factors such as hospital level, sex, region, and age on avoidable admissions. FindingsWe analysed 2·57 million admissions to 822 hospitals in all 31 mainland Chinese provinces. For patients aged between 15 years and 74 years, avoidable admissions constituted 7·67–11·83% of the admissions sample, accounting for 2·04–4·1% of total inpatient days and 2·68–4·42% of total renminbi expenditures. Our alternative definition based on length of stay and spending suggests broadly consistent results, with avoidable admissions constituting 9·12% of the inpatient sample, 2·92% of total inpatient days, and 3·72% of total renminbi expenditures. Analyses of patient case–mix (age, sex, comorbidities) and hospital characteristics suggest that avoidable admissions are more prevalent at lower-level hospitals, but potentially avoidable spending was high at tertiary hospitals as well. InterpretationOur results suggest the importance of enhancing capacity at grassroots facilities in China and the potential for resource savings from quality primary care. Health insurance policies and payment reforms should be developed to reduce avoidable admissions, and (with improved data quality) this metric should be considered when monitoring progress towards sustainable universal health coverage in China and elsewhere. FundingWorld Bank as part of the World Bank, WHO, and Government of China study on improving health-service delivery in China.