Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply

BMC Health Serv Res. 2019 Apr 27;19(1):259. doi: 10.1186/s12913-019-4098-x.


Background: Ambulatory care sensitive conditions (ACSC) hospitalization is a widely accepted measure of the access to primary care. However, given its discretionary characteristics, the ACSC hospitalization can be a measure reflecting the influence of hospital bed supply. In Korea, where the quality of primary care and oversupply of hospital beds are coexistent concerns, ACSC hospitalization can be used to examine the impact of both factors. This study was performed to investigate the ACSC hospitalization rate as a measure of the hospital bed supply as well as access to primary care.

Methods: Data were obtained from the National Health Insurance Database for 2015. We calculated the age-sex standardized hospitalization rates for ACSC in the total population and crude rates of ACSC hospitalization for three different age groups in 252 districts in Korea. We calculated the variation statistics of ACSC hospitalization rates, and we estimated a linear regression model to investigate the factors for ACSC hospitalization.

Results: There was a very high geographic variation in ACSC hospitalization rates. Higher density of primary care physicians was associated with a decreased ACSC hospitalization rate while a higher density of hospital beds in small to medium sized hospitals was associated with an increased rate. The deprivation index score had a strongly positive association with the ACSC hospitalization rates.

Conclusion: ACSC hospitalization, while being a negative index of primary care access, can also be a measure indicating the impact of the hospital bed supply, and it is still a valid measure of the disparity of health care, the original motivation for this topic.

Keywords: ACSC; Ambulatory care sensitive condition; Beds; Geographic variation; Hospitalization; Korea; Primary care; Socioeconomic factors.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / statistics & numerical data*
  • Child
  • Databases, Factual
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Health Services Research
  • Healthcare Disparities / statistics & numerical data*
  • Hospital Bed Capacity / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infant, Newborn
  • Male
  • Primary Health Care*
  • Republic of Korea