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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 rate

(98-109, 2007). 

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" was collected).1

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.

Long-Term Care

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 90 percent.

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.

> Aging Population
> Opportunities for Improvement
> High Occupancy for Long-Term Care
> Improved Medical Technologies
> Lack of Appropriate Resources
> Use of Hospital Emergency Depts
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