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Closure of a home hospital program: impact on hospitalization rates
Jeremy M Jacobs1, Aaron Cohen, Ora Rozengarten
1Institute of Geriatric Medicine, Jerusalem Home Hospitalization Program, Clalit Health Services, Rehov Paran 12, Jerusalem, Israel. jacobs4@bezeqint.net
Insights
Closing the Jerusalem home hospitalization program led to significantly increased hospital use among elderly patients. This shift resulted in higher healthcare costs, with a 5:1 ratio of increased expenses to savings, impacting geriatric and general medical admissions.
Area of Science:
- Health economics
- Geriatric care
- Healthcare policy
Background:
- Home hospitalization (HH) offers an alternative to inpatient care, especially for the elderly.
- The economic viability of HH programs remains a subject of debate.
- Spending cuts led to the closure of a large HH program in Jerusalem.
Purpose of the Study:
- To examine the impact of closing a home hospitalization program on hospital utilization among elderly individuals.
- To assess the economic consequences of this HH program closure.
Main Methods:
- A natural experiment design was used, studying the Jerusalem HH program closure.
- Hospitalization rates for geriatric and general medicine were compared before and after HH closure.
- Analysis of variance and linear regression were employed to analyze hospitalization trends and costs.
Main Results:
- Geriatric hospitalization rates increased significantly (p<0.0001) post-closure.
- General medical hospitalization rates also showed a significant increase (p=0.02).
- Excess hospital utilization costs amounted to $6.2 million, while savings from HH closure were $1.3 million.
Conclusions:
- The closure of the home hospitalization program resulted in increased hospital utilization among the elderly population.
- The economic impact demonstrated a cost ratio of 5:1 for increased hospital costs versus savings from HH closure.
- This study confirms the hypothesis that HH program discontinuation can lead to greater inpatient demand.
Abstract:
Home hospitalization (HH), as a substitute to in-patient care, is an area of growing interest, particularly amongst the elderly. Debate nonetheless exists concerning its economic justification. This study describes a natural experiment that arose following spending cuts and closure of the 400 patient Jerusalem HH program. It examines the hypothesis that HH closure would cause increasing geriatric and general medical hospital utilization amongst the 45,000 beneficiaries of the Jerusalem Clalit Health Fund (HMO) aged 65 years and over. Hospitalization rates were measured prior to and following HH closure, and analysis of variance confirmed the significance of the differences in both geriatric (p<0.0001) and general medical hospitalization rates (p=0.02) over the study period. Linear regression analyses of the hospitalization rates prior to HH closure were performed to determine the expected trajectory of hospitalization rates following HH closure. The observed hospital utilization in the year following HH closure cost 6.2 million US dollars in excess of predicted expenditure; closure of the HH resulted in the saving of 1.3 million USdollars. The ratio of direct increased costs to savings was 5:1 thus confirming the hypothesis that HH closure would result in increased hospital utilization rates among the local elderly population.
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