The Persistent Challenge of Avoidable Hospitalizations

Abstract

In the late 1980s John Billings developed the concept of counting potentially avoidable—or ambulatory care sensitive—hospitalizations as an indirect reflection of problems with access to care and effective primary care. (Billings and Teicholz 1990) The appeal of this approach is self-evident: the majority of states have good data on hospital discharges and limited data about ambulatory care. Avoiding a hospital admission represents a substantial “win” in restraining costs as well as enhancing patients' quality of life. Since that initial study, a body of literature examining avoidable hospitalizations has emerged, demonstrating a higher rate of such admissions among the poor and less well educated in many urban areas. As the U.S. struggles to increase the return on investment in public programs, particularly the Medicaid program, identifying mutable factors associated with avoidable hospitalizations is an issue of considerable urgency to policy makers and the public.