Abstract
This study analyses expenditure trends in Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) in children. It is an ecological time-series study, including hospitalizations of children under five in Bahia, between 2000 and 2012. We calculate the annual ACSC rates, as well as the total and average expenditure on these hospitalizations. We construct linear regression analysis models for the temporal trends. Between 2000 and 2012, 810,831 ACSC hospitalizations for the under-fives were recorded in Bahia. Hospitalization rates dropped 24.7% over this period, falling from 44.6 to 33.6 per 1,000 children. The total expenditure on such admissions is estimated to be 155.8 million Brazilian Reals. When we compare the first with the last year of the series, we note a reduction of 50.4% in total expenditure. The linear regression analysis demonstrates a reduction trend in average ACSC expenditure (β = -1.20, p = 0.014), (β = -3.45, p <0.01) and total expenditure (β = -0,46, p <0.01). Despite the reductions in these indicators, ACSC rates remain high, which has a significant impact on the volume of resources spent on avoidable hospitalizations. To this end, it is important to reduce ACSC expenditure, to both improve population health and reduce hospital costs.
Highlights
Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) refer to a series of health problems in which effective primary care action may reduce the risk of hospitalizations[1]
Bahia is composed of 417 municipalities, its geographical area is more than 564 thousand km[2] and, according to the 2010 Census of the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística: IBGE), its 2010 population was over 14 million inhabitants[12]
We considered Hospitalizations for Ambulatory Care Sensitive Conditions to be those hospitalizations for any one of the diagnoses that form the 19 groups of causes on the Brazilian ACSC list, of which the most frequently observed in the under-fives were vaccine-preventable diseases, infectious gastroenteritis and its complications, nutritional deficiencies, bacterial pneumonia, asthma, lung diseases and pre-natal and childbirth related diseases[5]
Summary
Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) refer to a series of health problems in which effective primary care action may reduce the risk of hospitalizations[1]. It is further considered that, if such events are detected early and properly treated, reducing the severity of the clinical picture, the need for hospitalization can be reduced or avoided[3] These primary healthcare failures are of paramount importance, given that the Unified Health Service (Sistema Único de Saúde: SUS) does not have a stable income adequate for its needs, and limited public resources are available to support the population’s health[4]. In this sense, avoidable hospitalizations burden the public health budget and waste resources that could be used to fund other health activities
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