Hospitalizations reduce health care utilization of household members.

Abstract

To examine whether the financial burden of hospitalizations affects the health care utilization of household members of the admitted patient. We utilized health care claims data from the Massachusetts All-Payer Claims Database, 2010-2015, to identify emergency hospitalizations of patients on family insurance plans and the health care utilization of the family members on those plans. We used an event-study analysis to compare health care spending and utilization of family members of a hospitalized individual and family members of an individual who was hospitalized 1 year later. We examine whether such hospitalizations were associated with changes in medical spending, the frequency of ambulatory office visits, other ambulatory care, and preventive care. The analyses include household members of patients with an emergency admission and a length of stay between 5 and 90 days. Unexpected hospital admissions reduced household members' health care spending and utilization by more than 6.4% (95% confidence interval [CI]: -8.2%, -4.5%) on average in the year following the hospitalization. Household members had fewer ambulatory visits with primary care physicians (PCPs), fewer referrals to specialists, and reduced utilization of other ambulatory care, including high-value preventive services. These changes were observed for both children and adults and were exacerbated if members of the household had previously been on Medicaid. The reduction in utilization was less pronounced when the admitted patient and household member shared the same PCP and when their health insurance plan had a family deductible. Compared with families without a hospitalized family member, family members of hospitalized individuals reduced their medical spending and utilization, including a substantial reduction in the use of preventive care. This study highlights the challenges of providing continuity in care when families face financial hardship.