Impact of Market Competition on Continuity of Care and Hospital Admissions for Asthmatic Children: A Longitudinal Analysis of Nationwide Health Insurance Data 2009-2013

• Published in: PloS one Vol. 11; no. 3; p. e0150926
• Main Authors: Cho, Kyoung Hee, Park, Eun-Cheol, Nam, Young Soon, Lee, Seon-Heui, Nam, Chung Mo, Lee, Sang Gyu
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.03.2016; Public Library of Science (PLoS)
• Subjects: Ambulatory care; Ambulatory Care - statistics & numerical data; Asthma; Biology and Life Sciences; Care and treatment; Child; Child, Preschool; Childhood asthma; Children; Children's hospitals; Chronic illnesses; Chronic obstructive pulmonary disease; Competition; Competitiveness; Continuity (mathematics); Continuity of care; Continuity of Patient Care - statistics & numerical data; Data processing; Diabetes; Diagnostic tests; Emergency medical services; Female; Health care; Health care expenditures; Health insurance; Health services; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Hypertension; Infant; Infant, Newborn; Insurance; Insurance, Health - statistics & numerical data; Longitudinal Studies; Male; Markets; Medical diagnosis; Medicine and Health Sciences; Multilevel; Patient admissions; Patient satisfaction; Patients; People and Places; Physicians; Population; Preventive medicine; Public health; Quality; Regression analysis; Social Sciences; Statistical analysis; Statistics; User statistics; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0150926

Ambulatory care-sensitive conditions, including asthma, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization. This study assessed the relationship between market competition, continuity of care (COC), and hospital admissions in asthmatic children according to their health care provider. 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. 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). Market competition appears to reduce COC; decreased COC was associated with a higher OR for hospital admissions.