Health Economics, Policy and Law


Can all cause readmission policy improve quality or lower expenditures? A historical perspective on current initiatives

James F. Burgess Jr.a1 and Jason M. Hockenberrya2 c1

a1 Senior Investigator, Center for Organization, Leadership and Management Research, VA Boston Healthcare System Professor, Department of Health Policy and Management, Boston University

a2 Assistant Professor, Department of Health Policy and Management, Emory University Investigator at Center for Comprehensive Access Delivery Research and Evaluation (CADRE) Faculty Research Fellow, National Bureau of Economic Research (NBER)


All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a ‘full’ conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions.

(Received June 26 2013)

(Revised June 26 2013)

(Accepted July 23 2013)

(Online publication August 30 2013)


c1 Correspondence to: Jason M. Hockenberry, 1518 Clifton Road, Atlanta, GA 30322, USA. Email: