Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply

Abstract

Background: Ambulatory care sensitive conditions (ACSC) hospitalization is a widely accepted measure of the access to primary care. However, given its discretionary characteristics, the ACSC hospitalization can be a measure reflecting the influence of hospital bed supply. In Korea, where the quality of primary care and oversupply of hospital beds are coexistent concerns, ACSC hospitalization can be used to examine the impact of both factors. This study was performed to investigate the ACSC hospitalization rate as a measure of the hospital bed supply as well as access to primary care. Methods: Data were obtained from the National Health Insurance Database for 2015. We calculated the age-sex standardized hospitalization rates for ACSC in the total population and crude rates of ACSC hospitalization for three different age groups in 252 districts in Korea. We calculated the variation statistics of ACSC hospitalization rates, and we estimated a linear regression model to investigate the factors for ACSC hospitalization. Results: There was a very high geographic variation in ACSC hospitalization rates. Higher density of primary care physicians was associated with a decreased ACSC hospitalization rate while a higher density of hospital beds in small to medium sized hospitals was associated with an increased rate. The deprivation index score had a strongly positive association with the ACSC hospitalization rates. Conclusion: ACSC hospitalization, while being a negative index of primary care access, can also be a measure indicating the impact of the hospital bed supply, and it is still a valid measure of the disparity of health care, the original motivation for this topic.

Regional Variation of Hospitalization Rates for Asthma in Korea: Association with Ambient Carbon Monoxide and Health Care Supply

“…The negative association between the hospitalization rates for asthma and the number of primary care physicians suggests the likelihood that the hospitalization for asthma declines if it is properly cared for at the primary care level. This relationship has been documented in studies about the hospitalizations for ambulatory care sensitive conditions which included asthma [31,48,49]. However, since those studies were not performed separately for asthma, our results can be considered to show more clearly the negative association between the PCP supply and the hospitalization rate for asthma.…”

“…The positive association between the hospital bed supply and the hospitalization rates for asthma can be understood likewise. As in the prior studies about the ambulatory care sensitive conditions in Korea [30,31], the positive association was observed only with the hospital beds in the small to medium sized hospitals. This result, while reflecting the overcrowding and competitive nature of the current supply of beds in those hospitals, shows the existence of supply induced demand.…”

“…The hospitalization rates for asthma among age groups show a similar trend with the prevalence of asthma: highest among children, which is followed by the elderly. However, the regional difference in the hospitalization rates is far above the difference in the prevalence of asthma in Korea [25], and the variation in the hospitalization rates for asthma is unusually large compared with hospitalization rates of other common causes, which are also considered large compared to other countries [31,41]. This suggests that the decision for hospitalization for asthma in Korea is highly discretionary.…”

“…This study first described the regional variation of the hospitalization rates for asthma in 251 districts divided into three age groups. Second, with the hospitalization rate for asthma in each district as a dependent variable, this study examined how the ambient CO was related to asthma when health-care supply factors, which were known to be highly related to hospitalization rates due to other common conditions [30,31], were adjusted. Meanwhile, this study investigated what might have resulted in the large difference in hospitalization rates for asthma in Korea.…”

Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study

“…This is highly probable in view of the health care system in Korea. Korea provides universal health care through the National Health Insurance System, and the payment system is largely based on the fee-for-service structure [16]. These characteristics can lead to overuse of health care services both on the patients’ and providers’ side in that they lessen the financial burden on the patients and can motivate the providers to provide more service.…”