• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1997 May; 87(5): 811–816.
PMCID: PMC1381055

Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups.


OBJECTIVES: The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. METHODS: With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. RESULTS: An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. CONCLUSIONS: Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Rutstein DD, Berenberg W, Chalmers TC, Child CG, 3rd, Fishman AP, Perrin EB. Measuring the quality of medical care. A clinical method. N Engl J Med. 1976 Mar 11;294(11):582–588. [PubMed]
  • Solberg LI, Peterson KE, Ellis RW, Romness K, Rohrenbach E, Thell T, Smith A, Routier A, Stillmank MW, Zak S. The Minnesota project: a focused approach to ambulatory quality assessment. Inquiry. 1990 Winter;27(4):359–367. [PubMed]
  • Billings J, Teicholz N. Uninsured patients in District of Columbia hospitals. Health Aff (Millwood) 1990 Winter;9(4):158–165. [PubMed]
  • Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, Billings J, Stewart A. Preventable hospitalizations and access to health care. JAMA. 1995 Jul 26;274(4):305–311. [PubMed]
  • Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992 Nov 4;268(17):2388–2394. [PubMed]
  • Billings J, Zeitel L, Lukomnik J, Carey TS, Blank AE, Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood) 1993 Spring;12(1):162–173. [PubMed]
  • Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991 Feb 15;114(4):325–331. [PubMed]
  • Starfield B. Primary care and health. A cross-national comparison. JAMA. 1991 Oct 23;266(16):2268–2271. [PubMed]
  • Levit KR, Olin GL, Letsch SW. Americans' health insurance coverage, 1980-91. Health Care Financ Rev. 1992 Fall;14(1):31–57. [PubMed]
  • Rowland D, Lyons B, Salganicoff A, Long P. A profile of the uninsured in America. Health Aff (Millwood) 1994 Spring;13(2):283–287. [PubMed]
  • Iglehart JK. Managed care and mental health. N Engl J Med. 1996 Jan 11;334(2):131–135. [PubMed]
  • Casanova C, Starfield B. Hospitalizations of children and access to primary care: a cross-national comparison. Int J Health Serv. 1995;25(2):283–294. [PubMed]
  • Schroeder SA. The medically uninsured--will they always be with us? N Engl J Med. 1996 Apr 25;334(17):1130–1133. [PubMed]
  • Bodenheimer T. Underinsurance in America. N Engl J Med. 1992 Jul 23;327(4):274–278. [PubMed]
  • Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992 May;82(5):703–710. [PMC free article] [PubMed]
  • Rask KJ. Hospital discharge data and the uninsured. J Health Care Poor Underserved. 1994;5(4):275–279. [PubMed]
  • Pokras R, Kozak LJ, McCarthy E, Graves EJ. Trends in hospital utilization, 1965-86. Am J Public Health. 1990 Apr;80(4):488–490. [PMC free article] [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...