Hospitalizations of Children and Access to Primary Care: A Cross-National Comparison

Abstract

In the United States, hospital admissions for conditions sensitive to primary care are related to socioeconomic characteristics. The authors compare the prevalence of avoidable hospital admissions and their relationship to socioeconomic and primary care characteristics in Spain and the United States. A case-control analysis of the relationship between avoidable hospitalizations and socioeconomic characteristics (illiteracy, unemployment, income) and primary care characteristics (type of physician and facilities for primary care) of children's area of residence was conducted in Spain. Bivariate statistical tests and conditional logistic regression were used to test the strength of the association among the variables, and to calculate the probability of being admitted to hospital for treatment of an ambulatory care sensitive (ACS) condition. Neither socioeconomic nor primary care characteristics affected this probability, and the rate of admission for ACS conditions was lower in Spain than in the United States. The provision of universal financial access to care and the availability of a consistent and accountable primary care provider are associated with lower hospitalization rates for conditions that are preventable with good primary care.

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References

Kleinman

J. C.

Results by Income and Insurance. National Center for Health Statistics, Hyattsville, Md., 1980.

Egbuonu

Starfield

Child health and social status. Pediatrics 69(5): 550–557, 1982.

Newacheck

P. W.

Starfield

Morbidity and use of ambulatory care services among poor and nonpoor children. Am. J. Public Health 78: 927–933, 1988.

Newacheck

P. W.

Characteristics of children with high and low usage of physician services. Med. Care 30(1): 30–42, 1992.

Davis

Gold

Makuc

Access to health care for the poor: Does the gap remain?

Annu. Rev. Public Health 2: 159–182, 1981.

Kovar

M. G.

Health status of U.S. children and use of medical care. Public Health Rep. 97(1): 3–15, 1982.

Starfield

Family income, ill health and medical care of U.S. children. J. Public Health Policy 3(3): 244–259, 1982.

Newacheck

P. W.

Access to ambulatory care for poor persons. Health Serv. Res. 23(3): 401–119, 1988.

Orr

S. T.

Emergency room use by low income children with a regular source of health care. Med. Care 29(3): 283–286, 1991.

10.

Starfield

Primary Care: Concept, Evaluation and Policy, pp. 231–234. Oxford University Press, New York, 1992.

11.

Billings

Hasselblad

Use of Small Area Analysis to Assess the Performance of the Outpatient Delivery System in New York City. New York Health Systems Agency, New York, 1989.

12.

Silvestre

Marco

Estudio de atraccíon en un hospital comarcal: Hospital de Sagunto. Mongrafíes Sanitaries Serie A, no. 8. Generalität Valenciana. Conselleria de Sanitat i Consum, Valencia, 1988.

13.

Starfield

Utilization and morbidity: Random or tandem?

Pediatrics 75(2): 241–247, 1985.

14.

International Classification of Disease, Ninth Revision, Clinical Modification. C.P.H.A. Edwards Bro, Ann Arbor, Mich., 1986.

15.

Padro Municipal D'Habitants 1986. Conselleria D'Hissenda. Generalitat Valencia. Valencia, 1986.

16.

Indicadores Socioeconomicos. Comunidad Valenciana (C.A.V.) Prevasa. Valencia, 1987.

17.

Cartografaia de los Recursos Sanitarios de la Comunidad Valenciana. Conselleria de Sanitat i Consum. Generalitat Valenciana. Valencia, 1990.

18.

EGRET: Statistics and Epidemiology. Research Corporation and Cytel Software Corporation, 1991.

19.

Breslow

N. E.

Day

N. E.

Statistical Methods in Cancer Research. Vol. 1: The Analysis of Case-Control Studies, pp. 248–278. International Agency for Research on Cancer, Lyon, 1980.

20.

Graves

E. J.

Detailed diagnoses and procedures. National Hospital Discharge Survey, 1988. National Center for Health Statistics. Vital Health Stat. 13(107), 1991.

21.

Weissman

Gatsonis

Epstein

Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA 268: 2388–2394, 1992.

22.

Perrin

J. M.

Variations in rates of hospitalization of children in three urban communities. N Engl. J. Med. 320: 1183–1187, 1989.

23.

Encuesta de Morbilidad Hospitalaria, 1984–1989. I.N.E. Madrid, 1986–1992.

24.

Graves

E. J.

Kozak

L. J.

National Hospital Discharge Survey: Annual Summary, 1989. National Center for Health Statistics. Vital Health Stat. 13(109), 1992.

25.

Billings

Analysis of variation in hospital admission rates associated with area income in New York City. Health Aff. 12(1): 162–173, 1993.

26.

Billings

Teicholz

Uninsured patients in District of Columbia Hospitals. Health Aff. 9(4): 158–165, 1990.

27.

Morgenstern

Uses of ecologic analysis in epidemiological research. Am. J. Public Health 72(12): 1336–1344, 1982.

28.

Gonnella

Use of outcome measures in ambulatory care evaluation. In Ambulatory Medicare Care—Quality Assurance 1977, edited by Giebink

White

Short

, La Jolla Science Publications, La Jolla, Calif., 1977.

29.

Krieger

Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology. Am. J. Public Health 82(5): 703–710, 1992.

30.

Morgan

Chinn

ACORN group, social class and child health. J. Epidemiol. Community Health 37: 196–203, 1983.

31.

Curtis

S. E.

Use of survey data and small area statistics to assess the link between individual morbidity and neighborhood deprivation. J. Epidemiol. Community Health 44: 62–68, 1990.