Impact of market competition on continuity of care and hospital admissions for asthmatic children: A longitudinal analysis of nationwide health insurance data 2009-2013

Kyoung Hee Cho, Euncheol Park, Young Soon Nam, Seon Heui Lee, Chung Mo Nam, Sang Gyu Lee

Research output: Contribution to journalReview article

2 Citations (Scopus)

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 (β = 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.

Original languageEnglish
Article numbere0150926
JournalPloS one
Volume11
Issue number3
DOIs
Publication statusPublished - 2016 Mar 1

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market competition
Health insurance
health insurance
Continuity of Patient Care
Health Insurance
Regression analysis
odds ratio
Ambulatory Care
regression analysis
Geographical regions
Odds Ratio
Regression Analysis
Multilevel Analysis
asthma
health care workers
Health care
Logistics
Health Personnel
Hospitalization
Asthma

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

@article{acfea55269cd4df9a63b8f7d2d75f448,
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 (β = 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.",
author = "Cho, {Kyoung Hee} and Euncheol Park and Nam, {Young Soon} and Lee, {Seon Heui} and Nam, {Chung Mo} and Lee, {Sang Gyu}",
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Impact of market competition on continuity of care and hospital admissions for asthmatic children : A longitudinal analysis of nationwide health insurance data 2009-2013. / Cho, Kyoung Hee; Park, Euncheol; Nam, Young Soon; Lee, Seon Heui; Nam, Chung Mo; Lee, Sang Gyu.

In: PloS one, Vol. 11, No. 3, e0150926, 01.03.2016.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Impact of market competition on continuity of care and hospital admissions for asthmatic children

T2 - A longitudinal analysis of nationwide health insurance data 2009-2013

AU - Cho, Kyoung Hee

AU - Park, Euncheol

AU - Nam, Young Soon

AU - Lee, Seon Heui

AU - Nam, Chung Mo

AU - Lee, Sang Gyu

PY - 2016/3/1

Y1 - 2016/3/1

N2 - 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 (β = 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.

AB - 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 (β = 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.

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