Abstract
BackgroundAmbulatory care-sensitive conditions, including asthma, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization.ObjectiveThis study assessed the relationship between market competition, continuity of care (COC), and hospital admissions in asthmatic children according to their health care provider.MethodsA longitudinal design was employed with a 5-year follow-up period, between 2009 and 2013, under a Korean universal health insurance program. A total of 253 geographical regions were included in the analysis, according to data from the Korean Statistical Office. Data from 9,997 patients, aged ≤ 12 years, were included. We measured the COC over a 5-year period using the Usual Provider Continuity (UPC) index. Random intercept models were calculated to assess the temporal and multilevel relationship between market competition, COC, and hospital admission rate.ResultsOf the 9,997 patients, 243 (2.4%) were admitted to the hospital in 2009. In the multilevel regression analysis, as the Herfindahl–Hirschman Index increased by 1,000 points (denoting decreased competitiveness), UPC scores also increased (ß = 0.001; p < 0.0001). In multilevel logistic regression analysis, the adjusted odds ratio (OR) for hospital admissions for individuals with lower COC scores (≥ 2 ambulatory visits and a UPC index score of < 1) was 3.61 (95% CI: 2.98–4.38) relative to the reference group (≥ 2 ambulatory visits and a UPC index score of 1).ConclusionsMarket competition appears to reduce COC; decreased COC was associated with a higher OR for hospital admissions.
Highlights
Ambulatory care-sensitive conditions (ACSCs), such as asthma, diabetes, hypertension, chronic heart failure, and chronic obstructive pulmonary disease, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization [1]
In multilevel logistic regression analysis, the adjusted odds ratio (OR) for hospital admissions for individuals with lower continuity of care (COC) scores (! 2 ambulatory visits and a Usual Provider Continuity (UPC) index score of < 1) was 3.61 relative to the reference group (! 2 ambulatory visits and a UPC index score of 1)
Market competition appears to reduce COC; decreased COC was associated with a higher OR for hospital admissions
Summary
Ambulatory care-sensitive conditions (ACSCs), such as asthma, diabetes, hypertension, chronic heart failure, and chronic obstructive pulmonary disease, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization [1]. In the case of South Korea, NHI is the single insurer that manages the NHI program and the costs of medical service; health care providers do not compete in the perspective of cost but in the perspectives of providing amenities, friendly service, and detailed explaining in order to attract more patients. Individual’s freedom of choice may improve quality of care[20] In contrast this may cut off continuous care in the perspective of information flow and the relationship between health care providers and patients. Ambulatory care-sensitive conditions, including asthma, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization
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