Geographic variation in potentially avoidable hospitalizations in France.
Potentially avoidable hospitalizations are studied as an indirect measure of access to primary care. Understanding the determinants of these hospitalizations can help improve the quality, efficiency, and equity of health care delivery. Few studies have tackled the issue of potentially avoidable hospitalizations in France, and none has done so at the national level. We assessed disparities in potentially avoidable hospitalizations in France in 2012 and analyzed their determinants. The standardized rate of potentially avoidable hospitalizations ranged from 0.1 to 44.4 cases per 1,000 inhabitants, at the ZIP code level. Increased potentially avoidable hospitalizations were associated with higher mortality, lower density of acute care beds and ambulatory care nurses, lower median income, and lower education levels. This study unveils considerable variation in the rate of potentially avoidable hospitalizations in spite of France's mandatory, publicly funded health insurance system. In addition to epidemiological and sociodemographic factors, this study suggests that primary care organization plays a role in geographic disparities in potentially avoidable hospitalizations that might be addressed by increasing the number of nurses and enhancing team work in primary care. Policy makers should consider measuring potentially avoidable hospitalizations in France as an indicator of primary care organization.
Gregoire Mercier (g-mercier@chu-montpellier.fr) is head of the economic evaluation unit at Centre Hospitalier Régional Universitaire de Montpellier (CHRU), in France.
Gregoire
G
Mercier
Vera Georgescu is a biostatistician in the economic evaluation unit at CHRU.
Vera
V
Georgescu
Jean Bousquet is a professor of pulmonary medicine at CHRU.
Jean
J
Bousquet
D005602:France; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D009026:Mortality; D011320:Primary Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D019371:Topography, Medical / Q000706:statistics & numerical data*
France; Health care utilization; Potentially avoidable hospitalizations; Primary Care; Regional Variation