Health resource utilization
refers to consumer use of health care resources and
services and reflects the way patients interact with
health care providers. Patterns of utilization tell
a story about the health status of the population and
availability of resources. The most available and reliable
utilization data are available from acute care hospitals
and long-term care facilities.
Acute Care Utilization
For the most part, the characteristics of hospitalizations
remained consistent between 1995 and 2007. However,
notable exceptions include significant increases in
total charges, the increase in the percent of admissions
that begin in the emergency department (ED), and the
increase in the number of cardiology-related hospitalizations.
These differences are elaborated upon in this chapter.
Hospitalizations: The number of hospitalizations
per 1,000 population has remained stable since 1995,
with Hawai'i's acute care hospitalization rates consistently
below U.S. averages. Overall, the elderly population
was hospitalized more than the rest of the population
and females were hospitalized less than men in their
age group (with the exception of childbearing age women).
Oahu's hospitalizations per 1,000 population (87,
2007) is much lower than the neighbor island hospitalization
Length of Stay: Average length of stay
in Hawai'i, a major indicator used in the analysis of
health care costs, has been reduced from a high of 6.1
days in 1997 to 5.3 days in 2007, but remains above
the U.S. average of 4.6 days.
Occupancy Rates: Occupancy rates (percent
of beds utilized) are higher in Hawai'i compared to
the nation, due in large part to Hawai'i's lower capacity.
Statewide, approximately 72 percent of acute beds are
utilized. In comparison, the occupancy rate at the national
level is 65 percent. Occupancy rates vary among the
counties: Honolulu (71%), Hawai'i (76%), Kaua'i (78%), and Maui (77%). Between 1995
and 2006, all counties experienced
an increase in occupancy.
Top Reasons for Hospitalization: The
top five service lines for hospitalization between 1995
and 2007 were maternity, newborn services, general surgery,
cardiology, and pulmonary. Collectively, these areas
accounted for 52 percent of all inpatient cases and
43 percent of all charges. The top two reasons for hospitalization,
newborn and maternity services, experienced 4.0 and 5.6 percent, respectively, more discharges in 2007
compared to 1995. In contrast, cardiology and pulmonary-related
discharges, most commonly including elderly patients,
increased by 12.6 and 6.6 percent, respectively, during the same time period.
Preventable Hospitalizations In 2005,
potentially preventable hospitalizations represented
over 13,000 discharges, or 12 percent of all hospitalizations
statewide. Many of these hospitalizations can be avoided
through educating the high-risk populations, increasing
access and availability of influenza and pneumonia vaccines,
developing early interventions, and greater availability
of appropriate outpatient care.
Admission via Emergency Department: In 2006, almost half of all hospital admissions in Hawai'i
were through the emergency department (ED), an increase
from 42 percent in 1996 (the first year "admission type"
Financing: Over fifty percent of all
Hawai'i hospitalizations in 2006 were financed by tax
dollars (e.g., Medicare, Medicaid, QUEST). Private insurance
was billed for 40 percent of all hospital stays, Medicare
for 33 percent, and Medicaid/QUEST for 21 percent; 3.0
percent of stays were uninsured.2 Between
1995 and 2007, total hospital charges increased by 36
percent (adjusted for inflation).3 In 2007,
total charges for hospitalization in Hawai'i were approximately
$2.7 billion, with an average charge of $22,596 per
discharge or $4,244 per day. Honolulu experienced the
highest charge at $25,348 per discharge. Hawai'i had
the lowest at $13,662 per discharge. Hawai'i's
average charge per discharge is less than the U.S. comparison.
Hawai'i's long-term care admission rate increased from
25.1 per 1,000 population aged 65 and older in 1990
to 44.1 per 1,000 population for the same group in 2003.
Significant differences existed between counties, with
Kaua'i's admission rate much higher than the other counties
(64.4 compared to 40.1 to 53.9 admissions per 1,000
population). Statewide, average length of stay figures
for long-term care show a steady decline from 1994,
when both average length of stay (368.6 days) and occupancy
rates (97.8 percent) were at their highest. In 2002,
occupancy rates averaged around 93 percent statewide
remaining higher than the state's target occupancy of
Emergency Room and Primary Care Clinic Utilization
Over the past decade, Hawai'i has had fewer emergency
room visits per capita compared to the U.S. as a whole.
The Hawai'i Primary Care Association (HPCA) clinics,
which are community health clinics offering health services
to underinsured and uninsured individuals, logged over
377,000 visits by over 80,000 people in 2004. Of these,
32 percent of the individuals were uninsured.