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There is limited evidence on the determinants of hospitalisation and its causes in India. This study aims to examine the differential in the hospitalisation rates and its socioeconomic determinants. This study also examines the causes of diseases in hospitalisation among the elderly (≥60 years) in India.

This study used data from the 75th round of the National Sample Survey Organizations, collected from July 2017 to June 2018. The elderly samples in this survey are 42,759, where 11,070 were hospitalised, and 31,689 were not hospitalised in the past year or 365 days. This study estimated hospitalisation rates and carried out binary logistic regression analysis to examine the associations of hospitalisation with the background variables. The cause of diseases in hospitalisations was also calculated.

The hospitalisation rate was lower among elderly female compared to elderly male. Elderly who belongs to middle-old aged groups, non-married, North-Eastern region, Southern region, general caste, health insurance, partially and fully economically dependent have a higher chance of being hospitalised. About 38% elderly were hospitalised due to communicable diseases (CDs), 52% due to non-communicable diseases (NCDs) and 10% due to injuries and others (IO). Nearly 40% elderly were hospitalised in public hospitals due to CDs, whereas 52% were hospitalised in private hospitals due to NCDs and 11% due to IO.

Firstly, this study is based on cross-sectional survey due to which temporal ambiguity averted to draw causal inferences. Secondly, other significant factors can also predict hospitalisations and provide insightful results, such as lifestyle factors, behavioral factors, obesity, mental state and several personal habits such as smoking cigarettes, drinking alcohol, consuming tobacco or other harmful substances. But this information was not available in this study. Even with these limitations, the hospitalisation issues among the elderly are beneficial to understand the current circumstances of CDs, NCDs and injury and other diseases for India and its states to formulate health policy.

Early screening and early treatment for NCDs are needed, which are non-existent in almost all parts of India. It is essential to necessitate and identify the important factors that best predict hospitalisation or re-visit of hospital admission. Although, the medical advances in India have made rapid strides in the past few decades, it is burdened none the less, as the doctor–patient ratio is very low. It is important to develop preventive measures to minimize the accidents and causalities to avoid substantial cost associated with elderly health care.

Raising awareness, promotion of healthy life style and improving the quality of good health-care provisions at primary level is a necessity.

The findings, practical and social implications provide a way forward for the health policymakers to potentially alter the future research to reduce associated comorbidities, unnecessary hospitalisations and other medical complications.

The purpose of this paper is twofold: first, to present patient-level utilisation patterns of hospital-based mental health services funded by private health insurers; and second, to examine the implications of the findings for planning and delivering private mental health services in Australia.

Analysing private health insurance claims data, this study compares differences in demographic and hospital utilisation characteristics of 3,209 patients from 13 private health insurance funds with claims for mental health-related hospitalisations and 233,701 patients with claims for other types of hospitalisations for the period May 2014 to April 2016. Average number of overnight admissions, length of stay and per patient insurer costs are presented for each group, along with overnight admissions vs same-day visits and repeat services within a 28-day period following hospitalisation. Challenges in analysing and interpreting insurance claims data to better understand private mental health service utilisation are discussed.

Patients with claims for mental health-related hospitalisations are more likely to be female (62.0 per cent compared to 55.8 per cent), and are significantly younger than patients with claims for other types of hospitalisations (32.6 per cent of patients aged 55 years and over compared to 57.1 per cent). Patients with claims for mental health-related hospitalisations have significantly higher levels of service utilisation than the group with claims for other types of hospitalisations with a mean length of stay per overnight admission of 15.0 days (SD=14.1), a mean of 1.3 overnight admissions annually (SD=1.2) and mean hospital costs paid by the insurer of $13,192 per patient (SD=13,457) compared to 4.6 days (SD=7.3), 0.8 admissions (SD=0.6) and $2,065 per patient (SD=4,346), respectively, for patients with claims for other types of hospitalisations. More than half of patients with claims for mental health-related hospitalisations only claim for overnight admissions. However, the findings are difficult to interpret due to the limited information collected in insurance claims data.

This study shows the challenges of understanding utilisation patterns with one data source. Analysing insurance claims reveals information on mental health-related hospitalisations but information on community-based care is lacking due to the regulated role of the private health insurance sector in Australia. For mental health conditions, and other chronic health conditions, multiple data sources need to be integrated to build a comprehensive picture of health service use as care tends to be provided in multiple settings by different medical and allied health professionals.

This study contributes in two areas: patient-level trends in hospital-based mental health service utilisation claimed on private health insurance in Australia have not been previously reported. Additionally, as the amount of data routinely collected in health care settings increases, the study findings demonstrate that it is important to assess the quality of these data sources for understanding service utilisation.

This study is to examine factors contributing to the variability in chronic obstructive pulmonary disorder (COPD) and asthma hospitalization rates when the influence of patient characteristics is being simultaneously considered by applying a risk adjustment method.

A longitudinal analysis of COPD and asthma hospitalization of rural Medicare beneficiaries in 427 rural health clinics (RHCs) was conducted utilizing administrative data and inpatient and outpatient claims from Region 4. The repeated measures of risk-adjusted COPD and asthma admission rate were analyzed by growth curve modeling. A generalized estimating equation (GEE) method was used to identify the relevance of selected predictors in accounting for the variability in risk-adjusted admission rates for COPD and asthma.

Both adjusted and unadjusted rates of COPD admission showed a slight decline from 2010 to 2013. The growth curve modeling showed the annual rates of change were gradually accentuated through time. GEE revealed that a moderate amount of variance (marginal R ² = 0.66) in the risk-adjusted hospital admission rates for COPD and asthma was accounted for by contextual, ecological, and organizational variables.

The contextual, ecological, and organizational factors are those associated with RHCs, not hospitals. We cannot infer how the variability in hospital practices in RHC service areas may have contributed to the disparities in admissions. Identification of RHCs with substantially higher rates than an average rate can portray the need for further enhancement of needed ambulatory or primary care services for the specific groups of RHCs. Because the risk-adjusted rates of hospitalization do not vary by classification of rural area, future research should address the variation in a specific COPD and asthma condition of RHC patients.

Risk-adjusted admission rates for COPD and asthma are influenced by the synergism of multiple contextual, ecological, and organizational factors instead of a single factor.

Purpose: We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts.

Methodology/Approach: A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008–2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period.

Findings: Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of “ACO RHCs,” there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel.

Research Limitations/Implications: There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs.

Originality/Value of Paper: This chapter presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The US Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the US healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.

The purpose of this study is to capture the variety of issues that concern patients and to examine the extent to which personal characteristics of patients, such as education, ethnicity, age, gender and conditions of hospitalisation, influence the tendency to “express (negative) voice” and raise “critical views”.

Using data obtained from the 2014 Survey of Health Satisfaction in Israel, the study focuses on patients' responses to an open-ended question regarding the medical care experience in hospitals.

The analysis reveals that “the voice of patients” spreads across a wide variety of issues, including the physical condition of the hospital and caregiver behaviour. Multivariate regression models show that subgroups with greater access to social and economic resources (i.e. in Israel, individuals who are Jewish), academics, women and younger patients are more likely to express critical voice regarding the hospitalisation experience. Likewise, inferior hospitalisation conditions are likely to increase expression of negative “voice” and criticism.

The findings underscore the importance and value of open-ended questions in evaluating healthcare satisfaction, suggesting that the likelihood of expressing critical voice is higher among patients of high socio-economic status – perhaps because they are more likely to expect, demand and feel entitled to high-quality care. Likewise, inferior hospitalisation conditions increase the critical voice.

Chronic kidney disease (CKD) is a worldwide public health problem which imposes a significant financial burden not only on patients but also on the healthcare systems, especially under the pressure of the rapid growth of the elderly population in China. The purpose of this paper is to examine the hospitalization costs of patients with CKD between two urban health insurance schemes and investigate the factors that were associated with their inpatient costs in Guangzhou, China.

This was a prevalence-based, observational study using data derived from two insurance claims databases during the period from January 2010 to December 2012 in the largest city, Guangzhou in Southern China. The authors identified 5,803 hospitalizations under two urban health insurance schemes. An extension of generalized linear model – the extended estimating equations approach – was performed to identify the main drivers of total inpatient costs.

Among 5,803 inpatients with CKD, the mean age was 60.6. The average length of stay (LOS) was 14.4 days. The average hospitalization costs per inpatient were CNY15,517.7. The mean inpatient costs for patients with Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY15,582.0) were higher than those under Urban Resident-based Basic Medical Insurance (URBMI) scheme (CNY14,917.0). However, the percentage of out-of-pocket expenses for the UEBMI patients (19.8 percent) was only half of that for the URBMI patients (44.5 percent). Insurance type, age, comorbidities, dialysis therapies, severity of disease, LOS and hospital levels were significantly associated with hospitalization costs.

The costs of hospitalization for CKD were high and differed by types of insurance schemes. This was the first study to compare the differences in hospitalization costs of patients with CKD under two different urban insurance schemes in China. The findings of this study could provide economic evidence for understanding the burden of CKD and evaluating different treatment of CKD (dialysis therapy) in China. Such useful information could also be used by policy makers in health insurance program evaluation and health resources allocation.

This work seeks to assess the possible contribution of hospitalization to hip fractures sustained in an acute care hospital and to determine the need for hospital care for these patients at the time of the fracture. Between 1988 and 1997 there was an average of 399 falls and four in‐hospital hip fractures per year. For 14 percent, no predisposing factors for falling were noted, 38 percent of the fractures occurred within the first three days and 47 percent during the first week of hospitalization. Original admission did not seem warranted for 10 percent and 48 percent no longer required inpatient care at the time of the fracture. Most fractures occur early during hospitalization; some patients seem to have no predisposing factors for falling and about one‐half may not require hospitalization at the time, all implicating hospitalization as a causative factor.

The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).

The methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.

The authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.

The methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.

The aim of this paper is to support public decision‐makers in a local healthcare agency (LHA) in evaluating the effects of different de‐hospitalization strategies and the potential for outsourcing clinical services.

The approach adopted is based on the “patient pathway” perspective. Starting from the identification of specific care pathways, all the feasible care paths in a given LHA in Italy are investigated in order to evaluate the practicability of the de‐hospitalization of some phases with a particular focus on co‐ordination of hospitals and territorial services. A heuristic approach based on discrete‐event simulation modelling is proposed. The methodology and the simulation model have been validated with reference to field data derived from a full‐scale case study carried out within a LHA in southern Italy.

The results show where, in terms of care pathways, de‐hospitalization is practicable, valuable in terms of better resource utilization, and eligible for outsourcing. The outsourcing option appears to be more sustainable from a social point of view. It specifies that there would be no dismissal of employees, and that there would be recruitment of specialized workers such as nurses and doctors, employed under more flexible conditions. Savings in overheads would be achieved by means of patient de‐hospitalization.

The existing scientific literature, to the best of the authors' knowledge, deals with patient flow management at the hospital level. However, in the European countries, the public healthcare system is generally organized in terms of the territorially based allocation of service centres. Given the scarcity of public resources, the main difficulty seems to be a mismatch among actions needed to improve territorial and residential care for outsourcing, and the interventions needed to contain hospital costs.

Heart Failure (HF) is one of the leading mortality causes in elderly people. The purpose of this study is to assess readmission rates and reasons in elderly patients with HF.

The authors explored medical records of elderly patients with HF (75 years and more) at Chapidze Emergency Cardiology Center (Georgia) from 2015 to 2019. The authors analyzed the structure of the cardiovascular diseases and readmission rates of hospitalized patients with HF (I50, I50.0 I50.1). A multivariate logistic regression model was used to identify factors, associated with readmission for any reason during 6–9 months after the initial hospitalization for HF.

The major complication of cardiovascular diseases in elderly patients is HF (68.6%). Hospitalization rates due to HF in elderly patients have increased in recent years, which is associated with the population aging process. This trend will be most likely continue. Despite significant improvements in HF treatment, readmission rates are still high. HF is the most commonly revealed cause of readmission (48% of all readmissions). About 6–9 months after the primary hospitalization due to HF, readmission for any reason was 60%. Patients had concomitant diseases, including hypertension (43%), myocardial infarction (14%), diabetes (36%) and stroke (8%), affecting the readmission rate.

HF remains an important problem in public health. During HF-associated hospitalizations, both cardiac and non-cardiac conditions should be addressed, which has the potential for health problems and disease progression. Some readmissions may be prevented by the proper selection of medicines and monitoring.