title: Impact of Market Competition on Continuity of Care and Hospital Admissions for Asthmatic Children: A Longitudinal Analysis of Nationwide Health Insurance Data 2009-2013.
abstract: BACKGROUND
  Ambulatory care-sensitive conditions, including asthma, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization.
  
  
  OBJECTIVE
  This study assessed the relationship between market competition, continuity of care (COC), and hospital admissions in asthmatic children according to their health care provider.
  
  
  METHODS
  A longitudinal design was employed with a 5-year follow-up period, between 2009 and 2013, under a Korean universal health insurance program. A total of 253 geographical regions were included in the analysis, according to data from the Korean Statistical Office. Data from 9,997 patients, aged ≤ 12 years, were included. We measured the COC over a 5-year period using the Usual Provider Continuity (UPC) index. Random intercept models were calculated to assess the temporal and multilevel relationship between market competition, COC, and hospital admission rate.
  
  
  RESULTS
  Of the 9,997 patients, 243 (2.4%) were admitted to the hospital in 2009. In the multilevel regression analysis, as the Herfindahl-Hirschman Index increased by 1,000 points (denoting decreased competitiveness), UPC scores also increased (ß = 0.001; p < 0.0001). In multilevel logistic regression analysis, the adjusted odds ratio (OR) for hospital admissions for individuals with lower COC scores (≥ 2 ambulatory visits and a UPC index score of < 1) was 3.61 (95% CI: 2.98-4.38) relative to the reference group (≥ 2 ambulatory visits and a UPC index score of 1).
  
  
  CONCLUSIONS
  Market competition appears to reduce COC; decreased COC was associated with a higher OR for hospital admissions.
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.|Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Kyoung Hee
authors.initials: KH
authors.lastname: Cho
authors.affiliation: Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea.|Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
authors.affiliation: Department of Quality Assessment, Health Insurance Review & Assessment Service, Wonju, Korea.
authors.forename: Young Soon
authors.initials: YS
authors.lastname: Nam
authors.affiliation: Department of Nursing Science, College of Nursing, Gachon University, Seongnam, Korea.
authors.forename: Seon-Heui
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.affiliation: Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea.|Graduate School of Public Health, Yonsei University, Seoul, Korea.
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D001249:Asthma; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male