Rates of admission for ambulatory care sensitive conditions in France in 2009–2010: trends, geographic variation, costs, and an international comparison

Abstract

Background

Admissions for ambulatory care sensitive conditions (ACSCs) are considered preventable and indicators of poor access to primary care. We wondered whether per-capita rates of admission for ACSCs in France demonstrated geographic variation, were changing, were related to other independent variables, or were comparable to those in other countries; further, we wanted to quantify the resources such admissions consume.

Methods

We calculated per-capita rates of admission for five categories (chronic, acute, vaccination preventable, alcohol-related, and other) of ACSCs in 94 departments in mainland France in 2009 and 2010, examined measures and causes of geographic variation in those rates, computed the costs of those admissions, and compared rates of admission for ACSCs in France to those in several other countries.

Results

The highest ACSC admission rates generally occurred in the young and the old, but rates varied across French regions. Over the 2-year period, rates of most categories of ACSCs increased; higher ACSC admission rates were associated with lower incomes and a higher supply of hospital beds. We found that the local supply of general practitioners was inversely associated with rates of chronic and total ACSC admission rates, but that this relationship disappeared if we accounted for patients’ use of general practitioners in neighboring departments. ACSC admissions cost 4.755 billion euros in 2009 and 5.066 billion euros in 2010; they consumed 7.86 and 8.74 million bed days of care, respectively. France had higher rates of ACSC admissions than most other countries examined.

Conclusions

Because admissions for ACSCs are generally considered a failure of outpatient care, cost French taxpayers substantial monetary and hospital resources, and appear to occur more frequently in France than in other countries, policymakers should prioritize targeted efforts to reduce them.

Appendix: an example of bed reassignment

In 2009 and 2010, hospitals in the Ain department (department 01) used 581 medical beds to provide 14,399 hospitalizations for ACSCs. Although 12,968 admissions were for patients who lived in Ain, the balance of patients lived in 66 different French departments; for example, 437 admissions were for patients from the neighboring Jura department (department 39). Those 437 bed days represented 3.1 % of all 14,092 admissions for ACSCs that were provided by hospitals in Jura, a department with 549 medical beds. Therefore, we reallocated 17.02 medical beds from Ain to Jura for the purposes of determining bed supply for Jura patients. However, 12,140 admissions for patients who lived in Ain occurred in hospitals outside of Ain, 6683 of which were obtained in Rhône (department 69). Using its 3759 medical beds, Rhône hospitals provided 90,073 hospitalizations for ACSCs in 2009–2010. Therefore, we reallocated 7.4 % of these beds, or 278.9 surgical beds from Rhône to Ain. After allocation from and to other French departments, we calculated that Ain had an adjusted supply of 1033 medical beds, while Jura had an adjusted supply of 614 medical beds, and Rhône had an adjusted supply of 3053 surgical beds.