The most incisive guide to issues facing the American family today . . . An invaluable resource for anyone wishing to stay on the cutting edge of research on family trends.

-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia 

From Divorce Court to Hospital Ward

Bryce J. Christensen and Robert W. Patterson

At a time when runaway medical costs hold the national economy hostage, perhaps Americans need to turn off the Age of Aquarius soundtrack and soberly discuss the terrible costs of the nation’s Sexual Revolution and the consequent meltdown of marriage and family life. As material that might help facilitate such discussion, a study by health scholars at Boston University establishes that hospitalization rates climb when men do not marry—or do not stay married.

Acknowledging that “in the 30 days after hospital discharge, hospital utilisation is [both] common and costly,” the Boston researchers set out to determine the social predictors of such utilization by parsing data collected through Project Re-Engineered from 737 English-speaking hospitalized adults from general medical service in an urban, academic safety-net medical center. Gender defined the researchers’ primary focal point for inquiry, and gender does significantly affect post-discharge hospital use: the data indicate that “men have a higher rate of hospital utilisation within 30 days of hospital discharge than women.”

But the data indicate that rates for readmission to the hospitalization reflect more than gender. Marital status emerges as an important predictor of such re-admission. The researchers report that risk factors for a man’s readmission to the hospital included being unmarried, whose Incidence Rate Ratio relative to married peers was striking. In part because of this particular finding, the researchers identify “social isolation” as a likely reason that men are significantly more likely than women to be readmitted to the hospital within thirty days of discharge. After all, they note, previous studies have established that “in general, men are more socially isolated than women and that this contributes to worse health outcomes among men.”

When patients discharged from the hospital are re-admitted within a month, the consequent medical costs run high—as high as $17.4 billion just among Medicare patients in 2004, according to a study the researchers cite. The researchers consequently have reason to scrutinize the provisions of the Affordable Care Act that are intended to reduce the incidence of such re-admission, provisions that include “multiple provisions designed to improve care transitions. The act includes both funding to stimulate hospitals and community-based providers to coordinate post-discharge services and a programme to withhold payments, of progressively increasing amounts, to hospitals that demonstrate higher rates of readmission within 30 days after discharge.” Still, the researchers admit that “the extent to which readmissions are preventable is debated.

“However, given the magnitude of the problem,” the researchers reason, “even a moderate reduction in unnecessary readmissions could have a large economic impact.” To that end, the researchers call for “interventions targeting factors at the root of this phenomenon,” highlighting particularly the need to address the social isolation that leaves men more likely to be re-admitted to the hospital after a discharge.

In their attempts to get “at the root” of the problem of hospital readmissions, the researchers have not one word to say about the national retreat from wedlock, a retreat that their own data implicate as a cause of the medical problem they are probing. If Americans are serious about dealing with medical costs, it is time to stop hacking at leaves while pretending to get at roots. It is time to talk frankly about our national retreat from marriage and family life as a prime reason that the United States is fast moving toward medical bankruptcy.

(Shaula Woz et al., “Gender as Risk Factor for 30 Days Post-Discharge Hospital Utilisation: A Secondary Data Analysis,”BMJ Open 2.2 [April 18, 2012]: e000428.)