TY - JOUR
T1 - Potentially avoidable hospitalizations and socioeconomic status in Switzerland
T2 - A small area-level analysis
AU - Spycher, Jacques
AU - Morisod, Kevin
AU - Moschetti, Karine
AU - Le Pogam, Marie Annick
AU - Peytremann-Bridevaux, Isabelle
AU - Bodenmann, Patrick
AU - Cookson, Richard
AU - Rodwin, Victor
AU - Marti, Joachim
N1 - Publisher Copyright:
© 2023
PY - 2024/1
Y1 - 2024/1
N2 - The Swiss healthcare system is well known for the quality of its healthcare and population health but also for its high cost, particularly regarding out-of-pocket expenses. We conduct the first national study on the association between socioeconomic status and access to community-based ambulatory care (CBAC). We analyze administrative and hospital discharge data at the small area level over a four-year time period (2014 – 2017). We develop a socioeconomic deprivation indicator and rely on a well-accepted indicator of potentially avoidable hospitalizations as a measure of access to CBAC. We estimate socioeconomic gradients at the national and cantonal levels with mixed effects models pooled over four years. We compare gradient estimates among specifications without control variables and those that include control variables for area geography and physician availability. We find that the most deprived area is associated with an excess of 2.80 potentially avoidable hospitalizations per 1,000 population (3.01 with control variables) compared to the least deprived area. We also find significant gradient variation across cantons with a difference of 5.40 (5.54 with control variables) between the smallest and largest canton gradients. Addressing broader social determinants of health, financial barriers to access, and strengthening CBAC services in targeted areas would likely reduce the observed gap.
AB - The Swiss healthcare system is well known for the quality of its healthcare and population health but also for its high cost, particularly regarding out-of-pocket expenses. We conduct the first national study on the association between socioeconomic status and access to community-based ambulatory care (CBAC). We analyze administrative and hospital discharge data at the small area level over a four-year time period (2014 – 2017). We develop a socioeconomic deprivation indicator and rely on a well-accepted indicator of potentially avoidable hospitalizations as a measure of access to CBAC. We estimate socioeconomic gradients at the national and cantonal levels with mixed effects models pooled over four years. We compare gradient estimates among specifications without control variables and those that include control variables for area geography and physician availability. We find that the most deprived area is associated with an excess of 2.80 potentially avoidable hospitalizations per 1,000 population (3.01 with control variables) compared to the least deprived area. We also find significant gradient variation across cantons with a difference of 5.40 (5.54 with control variables) between the smallest and largest canton gradients. Addressing broader social determinants of health, financial barriers to access, and strengthening CBAC services in targeted areas would likely reduce the observed gap.
KW - Equity in access to community based ambulatory care
KW - Potentially avoidable hospitalizations
KW - Socioeconomic deprivation
KW - Socioeconomic gradient
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U2 - 10.1016/j.healthpol.2023.104948
DO - 10.1016/j.healthpol.2023.104948
M3 - Article
C2 - 38096621
AN - SCOPUS:85179822792
SN - 0168-8510
VL - 139
JO - Health policy
JF - Health policy
M1 - 104948
ER -