US Healthcare Analysis

US Healthcare Analysis



US Healthcare Analysis

Background

Hospitalizations are the most expensive type of care within the healthcare system. Yet many patients find themselves frequently returning to the hospital, particularly those in Medicare. Hospital readmission rates for Medicare patient's range between 18 to 20 percent, higher than other private insured patients. In an effort to reduce spending within Medicare, federal reimbursements will decrease to penalize hospitals performing below national benchmarks. As an indicator of quality of care, readmission rates may identify areas of weakness within the healthcare continuum, and may occur as a result of a combination of different factors. Some of these factors include but are not limited to, incomplete treatment, poor care of the underlying problem, poor coordination of services, medication compliance and follow up care.

The United States spends approximately 16% of its gross domestic product (GDP) on healthcare, an expenditure expected to increase within the next couple of years (WHO, 2009). With an increase in cost and a weak economy, the healthcare industry has been seeking methods to control and reduce its expenditures, while continuing to provide quality patient care. As a result, performance measurements have become key instruments for improvement. Performance measures can also be seen as an agent for change and are commonly used to improve areas within healthcare such as, patient safety, quality improvement, outcome measures, efficiency, and effectiveness.

Ensuring the delivery of high quality cost effective patient care is essential for healthcare facilities, particularly hospitals. Hospitalizations are one of the most expensive types of care within the healthcare continuum and account for 31% of total health care expenditures in the United States (Minott, 2008). However, the high cost of care does not necessarily indicate that the patient is receiving quality care. As a measure of performance in care delivery hospital readmission rates have been identified as an indicator for quality of care. Readmission rates may identify areas of weakness within the healthcare continuum and occur as a result of a combination of different factors. These include but are not limited to, incomplete treatment, poor care of the underlying problem, poor coordination of services before and after discharge, or non adherence to the discharge plan, medication compliance and follow up care. Other factors include the patient's socioeconomic status and whether they are insured, underinsured or uninsured. Readmission rates also differ by hospitals, states and geographic areas. As a result, predicting patients who are at high risk for re-hospitalization is often difficult and inaccurate to determine. While some readmissions are desirable and part of the planned care, others may be indications of a quality issue related to shortened length of stay and premature discharge.

Readmissions rates may indicate a combination of quality related weaknesses within the hospital. It may also serve to gauge the patient's involvement in the recovery process, resulting in several possible reasons for readmissions. As each hospital meets the needs of their specific patient population, readmission rates may occur and indicate unique challenges facing that particular hospital. Performance measures are tools used in the health ...