I wrote a little while ago about the high rates of chronic disease in indigenous Australians compared to the rest of the population. Near the end of the post I quoted from the Expenditures on health for Aboriginal and Torres Strait Islander peoples 2004-05 which stated that hospital separations for Indigenous Australians living in remote and very remote areas are 820 and 606 per 1000 people respectively.
I don’t for a minute believe that 820 out of every 1000 Indigenous people in remote Australia have gone to hospital. Some are bound to be frequent visitors. But how many re-present at a hospital due to being booted out too soon.
I haven’t found any data for Australia but the blog Notes from Dr. RW looks at an interesting study from the NEJM on Medicare Readmission Rates in America.
Let me steal some of the quotes from the blog.
Almost one fifth (19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days, and 34.0% were rehospitalized within 90 days; 67.1% of patients who had been discharged with medical conditions and 51.5% of those who had been discharged after surgical procedures were rehospitalized or died within the first year after discharge. In the case of 50.2% of the patients who were rehospitalized within 30 days after a medical discharge to the community, there was no bill for a visit to a physician’s office between the time of discharge and rehospitalization.
Twenty per cent re-hospitalised within thirty days. Half of those had not been seen by a doctor before being readmitted. Put this into the remote Australia context where doctors are very thin on the ground. Discharges are often difficult to obtain from a hospital in a timely manner. We usually know when the patient is coming back home due to bookings via the patient Assisted Transport Service and our own Patient Liasion staff, but they are not always seen at the clinic on return. As well as perhaps being discharged too soon the continuity of care lapses due to many other reasons, lack of communication in particular. I am not surprised that some re-present.
Being discharged early may save the hospital money on weekends and public holidays as they cut back on staffing but costs are borne by other parts of the health service. From overworked Remote Area Nurses trying to see these patients and chase up discharge notes and obtain prescriptions to the Royal Flying Doctor Service flying the patient back to hospital and the costs borne by the Patient Assisted Travel Scheme (PATS)
The article goes on to state:
Even a small decrease in the readmission rate could result in substantial savings for the Medicare program. The recently enacted prospective-payment legislation, however, creates economic incentives that could increase readmission rates
I am sure a study done in Australia would show early discharges leading to representations costs the hospital system heaps rather than saving money.
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