Health care is a regional enterprise, and the region that figures out how to reduce health-care spending and make health insurance more affordable will be a magnet for both business and population growth.

The best opportunity to reduce the growth in health care costs, at least in the short run, is by reducing unnecessary hospitalizations. Hospital care represents more than one-third of total health-care spending, both in Pennsylvania and nationally. Since hospital care is very expensive, even small reductions in hospitalizations could reduce health-care costs significantly.

Reducing hospitalizations doesn't mean restricting people who need hospital care from getting it. Many people have what are called "ambulatory care sensitive conditions" -- chronic diseases and other conditions in which many hospitalizations can be prevented with the right kind of health care in the community.

National data indicate that more than one out of every 100 adults ages 40 to 64 is hospitalized, possibly unnecessarily, for an ambulatory care sensitive (ACS) condition, and nearly one of every 20 adults ages 65 to 74 is hospitalized for one of these conditions. The biggest ACS categories by far among adults are congestive heart failure, pneumonia and COPD (chronic obstructive pulmonary disease, which includes emphysema and chronic bronchitis).

Pittsburgh does particularly poorly in preventing preventable hospitalizations. In 2005, among Medicare enrollees (the only population for which national data are available), Pittsburgh had the third highest rate of hospitalizations for ACS conditions among the top 40 regions.

Pittsburghers with congestive heart failure and COPD were hospitalized more than twice as often as in such places as Denver, Minneapolis, San Diego, Seattle and Portland, Ore. So there is clearly plenty of room for improvement in our region.

One of the best places to start is reducing hospital readmissions. Data from the Pennsylvania Health Care Cost Containment Council show that one of every five people who go to the hospital for such conditions as congestive heart failure, COPD or pneumonia go back to the hospital within 30 days after discharge, often for the same condition, costing health insurers in our region tens of millions of dollars every year.

Demonstration projects in other parts of the country have shown that hospital admission and readmission rates can be reduced dramatically -- by 20 percent to 50 percent or more -- through fairly simple improvements in primary care. These include better education for patients about how to manage their diseases, better training in how to use their medications and more frequent contacts to identify problems before they require hospitalization. Improvements such as these don't cost much, and they more than pay for themselves almost immediately in reduced hospitalization costs.

So why aren't all patients with ACS conditions getting this kind of quality care? The biggest barrier is the current health care payment system. Most health insurance plans won't reimburse primary care physicians for providing this kind of care, and they often charge high co-pays for the medications that can keep patients out of the hospital. Fundamental changes in the way we pay for health care are needed in order to make fundamental improvements in the way health care is delivered.

The Pittsburgh Regional Health Initiative (www.prhi.org) is leading several initiatives to improve care for people with chronic diseases and to reduce hospital readmissions, and the Pittsburgh Business Group on Health (www.pbghpa.com) is pioneering new payment models. If employers, health insurance plans, hospitals and physicians will support the payment changes and care changes needed to implement these kinds of initiatives, the Pittsburgh region can be a leader in reducing health-care costs.