Potentially avoidable hospitalizations and socioeconomic status in Switzerland: A small area-level analysis

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 - Funding Information: This article is based on a methodology developed in a report entitled “Indicators on Healthcare Equity in Switzerland” mandated and funded by the Swiss Federal Office of Public Health . The report is available here: https://www.bag.admin.ch/bag/en/home/strategie-und-politik/nationale-gesundheitsstrategien/gesundheitliche-chancengleichheit/chancengleichheit-in-der-gesundheitsversorgung/chancengerechtigkeit-messen.html Publisher Copyright: © 2023 The Authors.

PY - 2024/1/1

Y1 - 2024/1/1

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

UR - http://www.scopus.com/inward/record.url?scp=85179822792&partnerID=8YFLogxK

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 -