Comparison of rehospitalization rates in France and the United States

Abstract

Objective: To compare rates of 30-day all-cause rehospitalization in France and the US among patients aged 65 years and older and explain any difference between the countries.

Methods: To calculate rehospitalization rates in France, we use an individual identifying variable in the national hospital administrative dataset to track unique individuals aged 65 years or more hospitalized in France in 2010. To calculate the proportion of rehospitalized patients (65+) who received outpatient visits between the time of initial discharge and rehospitalization, we linked the hospital database with a database that includes all medical and surgical admissions. We used step by step regression models to predict rehospitalization.

Results: Rates of rehospitalization in France (14.7%) are lower than among Medicare beneficiaries in the US (20%). We find that age, sex, patient morbidity and the ownership status of the hospital are all correlated with rehospitalization in France.

Conclusions: Lower rates of rehospitalization in France appear to be due to a combination of better access to primary care, better health among the older French population, longer lengths of stay in French hospitals and the fact that French nursing homes do not face the same financial incentive to rehospitalize residents.

Keywords: France; health policy; rehospitalization.