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Medical Care Research and Review, Vol. 63, No. 6, 719-741 (2006)
DOI: 10.1177/1077558706293637
© 2006 SAGE Publications

Access to Health Care and Hospitalization for Ambulatory Care Sensitive Conditions

Zahid Ansari

Victorian State Government, Department of Human Services, Australia

James N. Laditka

University of South Carolina

Sarah B. Laditka

University of South Carolina

Hospitalization for Ambulatory Care Sensitive Conditions (ACSH) is an accepted indicator of access to health care and avoidable morbidity. Accessible care of reasonable quality should reduce ACSH. Little research has examined the indicator’s external validity. We calculated standardized ACSH rates for 32 areas of Victoria, Australia (population 4.4 million). A representative survey measured access, disease prevalence, propensity to seek care, disease burden, social determinants of health services use, and behavioral risk factors. Regression analyses compared self-rated access with ACSH rates. Independent of prevalence, propensity to seek care, disease burden, and physician supply, better access was associated with lower ACSH rates. Results provide support for the ACSH indicator. When rural residence was considered, the covariate measuring access was not significant. However, rural residence also may contribute importantly to access. Results suggest both the complexity of the meaning of access and the desirability of further research to validate the ACSH indicator.

Key Words: ambulatory care sensitive conditions • preventable hospitalization • access to medical care • primary health care • physician supply


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