Characteristics and Costs of Potentially Preventable Inpatient Stays
Hospital care represents the largest component of U.S. healthcare expenditures. As a result, reducing potentially preventable hospitalizations has become a priority among policymakers and public and private payers. Potentially preventable hospitalizations are inpatient stays for treating ambulatory care-sensitive conditions that evidence suggests may be avoidable, in part, through timely and quality primary and preventive care.
Characteristics and Costs of Potentially Preventable Inpatient Stays, a statistical brief from the Healthcare Cost and Utilization Project, presents weighted national estimates of potentially preventable inpatient stays separately for adults and children. Obstetric stays and neonatal stays are excluded.
- In 2017, 3.5 million potentially preventable adult inpatient stays accounted for $33.7 billion in aggregate hospital costs. These stays represented 12.9 percent of all nonobstetric stays and 8.9 percent of costs for all nonobstetric stays.
- Of the 1,358,900 nonobstetric pediatric stays in 2017, 108,300 (8.0 percent) were potentially preventable. These preventable stays cost $561.6 million, or 2.8 percent of the $20.0 billion in aggregate hospital costs for all pediatric stays.
- The most common and most expensive reason for potentially preventable stays was heart failure for adults (1,112,600 stays and $11.2 billion in aggregate hospital costs) and asthma for children (53,900 stays and $278.1 million in aggregate costs).
- In 2017, the rate of potentially preventable adult stays increased with age and decreased with community-level income.
- Potentially preventable stays with a primary expected payer of Medicare accounted for 65.4 percent of potentially preventable adult stays and 65.9 percent of hospital costs associated with these stays.
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