Abstract
BackgroundHospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000–2014), and their associated financial burden.MethodsWe modeled municipality-level ACSC hospitalization rates per 1000 inhabitants and ACSC hospitalization-related costs per inhabitant, for the 2000–2014 period (n = 4170), as a function of SE indicators (illiteracy and purchasing power, in quintiles), controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and time trend. The evolution of inequalities was measured interacting SE indicators with a time trend. Costs attributable to ACSC related hospitalization inequalities were measured by the predicted values for each quintile of the SE indicators.ResultsHospitalization rate for ACSC was significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 1.97; p < 0.01), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = − 1.19; p < 0.05). ACSC hospitalization-related costs were also significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 4.04€; p < 0.05), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = − 4,69€; p < 0.01). The SE gradient significantly increased over the 2000–2014 period, and the annual cost of inequalities were estimated at more than 15 million euros for the Portuguese NHS.ConclusionThere was an increasing SE patterning in ACSC related hospitalizations, possibly reflecting increasing SE inequalities in early and preventive high-quality care, imposing a substantial financial burden to the Portuguese NHS.
Highlights
Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics
ACSC related hospitalizations are defined as specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis, early treatment, and by appropriate chronic disease management, i.e., by “timely and effective Primary Care (PC)” [2, 3]
We modeled the ACSC hospitalization rates (Model I) and the ACSC-related costs per inhabitant (Model II) as a function of year-specific quintiles for the SE indicators, controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and for the time trend
Summary
Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. Many studies have found a strong SE gradient in the rates of hospitalizations for ACSC, showing that people from low-income areas, people living in rural and/or more deprived areas, and people from areas with higher proportions of uneducated people have a much higher risk of being hospitalized for these conditions [3, 8,9,10] These SE disparities have been described in countries without universal health coverage, like the US, but were found in countries like Canada [11], Italy [12], the United Kingdom [13], and Sweden [14], where there are little financial barriers in access to PC
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