The LSE Companion to Health Policy
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The LSE Companion to Health Policy

Edited by Alistair McGuire and Joan Costa-Font

The LSE Companion to Health Policy covers a wide range of conceptual and practical issues from a number of different perspectives introducing the reader to, and summarising, the vast literature that analyses the complexities of health policy. The Companion also assesses the current state of the art.
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Chapter 4: Quality of Ambulatory Care: Hospitalisations for Ambulatory Care Sensitive Conditions

Lucia Kossarova


Lucia Kossarova 1. INTRODUCTION Performance measurement in the different areas of health care has become increasingly important in recent decades. Primary care and the hospital sector have been addressed extensively in the literature (Lester and Roland, 2009; McKee and Healy, 2002). With the increasing burden of chronic diseases, there has also been growing interest in measuring the performance of chronic care (McKee et al., 2009) where indicators may capture the care patients receive at both the ambulatory and hospital level for the selected chronic conditions. Less attention has been given to measuring the performance of ambulatory or outpatient care. This chapter looks at how hospitalisations for ambulatory care sensitive conditions (ACSCs) can be used as a performance indicator of the quality of ambulatory care. Measuring the performance of ambulatory care1 is important for several reasons. First, health care is generally more expensive to provide in inpatient than outpatient settings, and potential savings can be made from reduced hospital admissions (Kovner and Knickman, 2008); the hospital sector usually absorbs as much as 50 per cent of national expenditure on the health care system (Rechel et al., 2009). Besides the cost of hospital care, a hospital admission is likely to cause disruptions in the patient’s life, as well as in his or her family’s (Rechel et al., 2009). Also, repeated hospitalisations may lead to the overall deterioration of the patient’s condition (Chu et al., 2004). Therefore quality ambulatory care and reduced hospital admissions are not only a potential cost-reduction strategy but also...

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