Oral Plenary Abstracts

Avoidable hospital admissions and resource use in China:

an exploratory analysis of 2·57 million hospital admissions
Qin Jiang, Jingjing Lang, Jie Cai, Caiyuan Wu, Karen Eggleston

Abstract
Background Appropriate treatment of ambulatory-care sensitive disorders and reductions of avoidable admissions can Published Online
play an important part in enabling health systems to respond to growing chronic disease burdens and population October 30, 2015

ageing. But little evidence is available from middle-income countries with respect to the extent of avoidable admissions China National Health
Development Research Center,
and their resource use, and no study has addressed these questions in China. National Health and Family
Planning Commission, Beijing,
Methods In this exploratory analysis, we analysed hospital admissions at the province, city, and county level in 2012 China (Q Jiang PhD, J Lang MS,
and 2013, applying the OECD definition of avoidable admissions and using ICD10 codes for asthma, chronic J Cai MS, C Wu MS); Shorenstein
Asia-Pacific Research Center,
obstructive pulmonary disease, congestive heart failure, diabetes, and hypertension. Data limitations—including the FSI, Stanford University,
absence of population denominators and incomplete coding on inpatient summary sheets—prompted a second Stanford, CA, USA
definition of potentially avoidable admissions in consultation with Chinese clinicians. Shorter length of stay and (K Eggleston PhD); and National
lower expenditure were used as proxies for cases amenable to management within primary care. χ² test was used for Bureau of Economic Research,
Cambridge, MA, USA
variable screening, and logistic regression analysis was used to test the influence of factors such as hospital level, sex, (K Eggleston)
region, and age on avoidable admissions. Correspondence to:
Qin Jiang, China National Health
Findings We analysed 2∙57 million admissions to 822 hospitals in all 31 mainland Chinese provinces. For patients Development Research Center,
aged between 15 years and 74 years, avoidable admissions constituted 7∙67–11∙83% of the admissions sample, National Health and Family
Planning Commission, Beijing,
accounting for 2∙04–4∙1% of total inpatient days and 2∙68–4∙42% of total renminbi expenditures. Our alternative China
definition based on length of stay and spending suggests broadly consistent results, with avoidable admissions jiangqin2007@gmail.com
constituting 9∙12% of the inpatient sample, 2∙92% of total inpatient days, and 3∙72% of total renminbi expenditures.
Analyses of patient case–mix (age, sex, comorbidities) and hospital characteristics suggest that avoidable admissions
are more prevalent at lower-level hospitals, but potentially avoidable spending was high at tertiary hospitals as well.

Interpretation Our results suggest the importance of enhancing capacity at grassroots facilities in China and the
potential for resource savings from quality primary care. Health insurance policies and payment reforms should be
developed to reduce avoidable admissions, and (with improved data quality) this metric should be considered when
monitoring progress towards sustainable universal health coverage in China and elsewhere.

Funding World Bank as part of the World Bank, WHO, and Government of China study on improving health-service
delivery in China.
Contributors
Q J oversaw the entire study, directed the analyses and interpretation, and edited the abstract. JL consulted with clinicians and did the literature
search. JC and CW did data cleaning, diagnosis code screening, and data analysis. KE provided technical advice on the analyses and drafted the
abstract.
Declaration of interests
Q J reports personal fees from the World Bank, during the conduct of the study. KE was a consultant for the World Bank project on health service
delivery reform in China. JL, JC, and CW declare no competing interests.

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