Abstract
BackgroundHospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care. Timely and effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight. Little is known about ACSHs among resettled refugee populations. With the aim of examining the hypothesis that people from refugee backgrounds have higher ACSHs than people born in the country of hospitalisation, this study analysed a six-year state-wide hospital discharge dataset to estimate ACSH rates for residents born in refugee-source countries and compared them with the Australia-born population.MethodsHospital discharge data between 1 July 1998 and 30 June 2004 from the Victorian Admitted Episodes Dataset were used to assess ACSH rates among residents born in eight refugee-source countries, and compare them with the Australia-born average. Rate ratios and 95% confidence levels were used to illustrate these comparisons. Four categories of ambulatory care sensitive conditions were measured: total, acute, chronic and vaccine-preventable. Country of birth was used as a proxy indicator of refugee status.ResultsWhen compared with the Australia-born population, hospitalisations for total and acute ambulatory care sensitive conditions were lower among refugee-born persons over the six-year period. Chronic and vaccine-preventable ACSHs were largely similar between the two population groups.ConclusionContrary to our hypothesis, preventable hospitalisation rates among people born in refugee-source countries were no higher than Australia-born population averages. More research is needed to elucidate whether low rates of preventable hospitalisation indicate better health status, appropriate health habits, timely and effective care-seeking behaviour and outpatient care, or overall low levels of health care-seeking due to other more pressing needs during the initial period of resettlement. It is important to unpack dimensions of health status and health care access in refugee populations through ad-hoc surveys as the refugee population is not a homogenous group despite sharing a common experience of forced displacement and violence-related trauma.
Highlights
Hospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care
Ambulatory Care Sensitive Conditions (ACSCs) have been defined as those conditions for which "the provision of timely and effective outpatient care can help to reduce the risks of hospitalization by either preventing the onset of an illness or condition, controlling an acute episodic illness or condition, or managing a chronic disease or condition" [4](p.163)
And effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight [13,14]
Summary
Hospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care [1,2,3]. Ambulatory Care Sensitive Conditions (ACSCs) have been defined as those conditions for which "the provision of timely and effective outpatient care can help to reduce the risks of hospitalization by either preventing the onset of an illness or condition, controlling an acute episodic illness or condition, or managing a chronic disease or condition" [4](p.163). Given the challenges of the growing problem of forced displacement, and in view of the internationalisation of refugee resettlement [12], it is important for governments, public health professionals, and health service providers in resettlement countries to obtain evidence on humanitarian arrivals' access to primary care and preventable hospitalisation. Australia has a publicly-funded universal health care scheme for all citizens and permanent residents, including humanitarian entrants, which provides access to free treatment in public hospitals, and free or subsidised treatment by general practitioners, specialists and optometrists
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