> The financial burden is not imposed on the patient only; the healthcare system is also affected by the consequence of leaving against medical advice. Reports have shown that the cost of an average stay was USD 3716.00 for those patients who left as planned. However, patients who left against medical advice and were readmitted had an average bill of USD 10,761.56 for staying 4.7 days in the hospital upon readmission.
This makes me laugh. As if medical care in the USA isn't already ridiculously inflated.
> Perhaps the most effective way to decrease discharge AMA is through changing existing policies and/or implementing new policies. Historically, governmental policies, incentivizing or penalizing, have dramatically driven substantial changes in the medical system. For example, different healthcare policies/programs have led to improved healthcare access in non-urban areas. Another example is the change of practitioner compensation from traditional fee-for-service models to bundled-payment models that resulted in a better quality of patient experience [51]. Therefore, implementing a lower rate of discharge AMA in hospital metrics, for example, will incentivize hospitals to further invest in mitigating discharge AMA.
We absolutely shouldn't penalize people who leave a for-profit business for not getting the service they desire. Also changing to fee-for-service would help people do a cost-benefit on their medical issues. If we are going to live in a capitalism world, then let hospitals compete for your money.
Part of my job I build predictive models to identify individuals at high risk of 'readmission' (it impacts billing, hence why healthcare systems are interested).
Conditional on an individual's history (e.g. do you have diabetes, other comorbidities, etc.), I haven't found much evidence that leaving against Dr advisement matters all that much for predicting readmission.
The number in the GP is conditional on the patient being readmitted, so it's inflated by adverse selection: it doesn't include all the zeros where the patient recovered, but it does include all of the cases where something went wrong and they needed more/different treatment.
So although tongue-in-cheek, it is an interesting question when dealing with medical records data (in particular I deal with insurance claims data in the US).
So to be clear, I know the person is alive when discharged (there is a code for death, as well as to hospice for example, in which you don't want to look at readmission either).
So a scenario in which someone is discharged, has a follow up heart attack, goes to ER and dies I would observe. The case the person dies and does not go to the hospital though I would not observe (no follow up insurance claim).
The latter scenario certainly happens -- how often it happens and how much it would bias my estimate in this case I am not sure.
> This makes me laugh. As if medical care in the USA isn't already ridiculously inflated.
Honestly this is an area where I'd invite Elon Musk to come in and disrupt. In the same way that he disrupted space travel and electric vehicles in part by asking, "do we need to do everything in the expected high cost manner"? Question if you need certain things to be at certain medical grade for everything. I get that staff is expensive, but everything else seems WAY overpriced.
Oh, no. Musk can do nothing good for social systems. His models of social systems are oversimplified, and his methods are not for social systems. You can fail an orbital launch just to see how it will go wrong, to learn things. But such experiments on human subjects and societies are frown upon at very least. And with medical care there are people lives at stake. Thousands or maybe hundreds of thousands annually. You don't want to disrupt this system, to reform gently maybe, but without any disruptions.
> The financial burden is not imposed on the patient only; the healthcare system is also affected by the consequence of leaving against medical advice. Reports have shown that the cost of an average stay was USD 3716.00 for those patients who left as planned. However, patients who left against medical advice and were readmitted had an average bill of USD 10,761.56 for staying 4.7 days in the hospital upon readmission.
This makes me laugh. As if medical care in the USA isn't already ridiculously inflated.
> Perhaps the most effective way to decrease discharge AMA is through changing existing policies and/or implementing new policies. Historically, governmental policies, incentivizing or penalizing, have dramatically driven substantial changes in the medical system. For example, different healthcare policies/programs have led to improved healthcare access in non-urban areas. Another example is the change of practitioner compensation from traditional fee-for-service models to bundled-payment models that resulted in a better quality of patient experience [51]. Therefore, implementing a lower rate of discharge AMA in hospital metrics, for example, will incentivize hospitals to further invest in mitigating discharge AMA.
We absolutely shouldn't penalize people who leave a for-profit business for not getting the service they desire. Also changing to fee-for-service would help people do a cost-benefit on their medical issues. If we are going to live in a capitalism world, then let hospitals compete for your money.