Early hospital discharge (EHD) of term newborns (TNB) is a significant change in clinical practice that has been driven primarily by economic interests and based on assumptions of significant cost-savings. However, the real decrease in overall health care costs has not been well defined. In an era where the emphasis is on shorter length of stay and fewer hospital admissions, it would seem that rehospitalizations and their associated economic costs would decrease for newborns. In order to examine the costs associated with rehospitalizations due to dehydration in TNB and their association with EHD, we analyzed data from all births in California from computerized HD records provided by the Office of Statewide Health Planning and Development (OSHPD) for 1983 and 1991 (most recent year with complete data). Computerized financial data (OSHPD & HCFA) was used to compute an expense/revenue ratio for each hospital. Charges for each hospitalization were adjusted by the corresponding hospital ratio value. Findings are shown in thetable: Many more infants were readmitted for dehydration in 1991 than in 1983 in association with the increase in EHD. This is accompanied by a threefold increase in overall hospital costs. We conclude that careful evaluation of costs incurred in treating illness associated with decreased care of healthy individuals (i.e., EHD) is necessary in order to determine accurately the real cost savings for society.
