Objectives: Inappropriate hospital admissions are commonly believed to
represent a potential for significant cost reductions. However, this
presumes that these patients can be identified before the hospital
stay. The present study aimed to investigate to what extent this is
Methods: Consecutive admissions to a department of internal
medicine were assessed by two expert panels. One panel predicted the
appropriateness of the stays from the information available at
admission, while final judgments of appropriateness were made after
discharge by the other.
Results: The panels correctly classified 88% of the appropriate and
27% of the inappropriate admissions. If the elective admissions
predicted to be inappropriate had been excluded, 9% of the costs
would have been saved, and 5% of the gain in quality-adjusted life-years
lost. The corresponding results for emergency admissions were
14% and 18%.
Conclusions: The savings obtained by excluding admissions predicted to
be inappropriate were small relative to the health losses. Programs
for reducing inappropriate health care should not be implemented
without investigating their effects on both health outcomes and costs.