Hospitalization costs for Ambulatory Care Sensitive Conditions : time series 2008-2015

Objective: to evaluate the costs of hospitalizations for ambulatory care sensitive conditions in the 2008-2015 time series. Methods: ecological study with records of the Hospital Information System. The sample was composed of records of admissions for diagnoses of the Brazilian List hospitalizations for ambulatory care sensitive conditions. Polynomial regressions were used to analyze the temporal trend of rates. Results: there was a decrease in the rates per 10,000 inhabitants (67.38 to 51.99) (r2=0.9783; p<0.001). The most costly causes were asthma, heart failure, cystitis, and pneumonia. There was a decreasing trend in hospitalizations (β=-2.15; p<0.001) and expenditures (β=-2243.24; p=0.169). Conclusion: the diagnosis asthma caused greater expenses, while inflammatory disease of the cervix reached caused lower expenses. In the time series, there was a trend towards reduction of expenses evidenced by the difference between the highest cost in 2009 and the lowest in 2015. Descriptors: Primary Health Care; Basic Health Services; Health Care Quality, Access, and Evaluation; Hospital Information Systems; Ecological Studies. RESUMO Objetivo: avaliar os custos com Internações por Condições Sensíveis à Atenção Primária, ponderando as séries temporais de 2008-2015. Métodos: estudo ecológico que se utilizou dos registros do Sistema de Informação Hospitalar. Amostra composta pelos registros de internações de diagnósticos incluídos na Lista Brasileira de Internações por Condições Sensíveis à Atenção Primária. Regressões polinomiais foram utilizadas para análise da tendência temporal das taxas ao longo do período. Resultados: houve decréscimo nas taxas por 10.000 habitantes (67.38 a 51.99) (r2=0,9783; p<0,001). As causas mais onerosas foram: asma, insuficiência cardíaca, cistite e pneumonia. Evidenciou-se tendência de redução das internações (β=-2,15; p<0,001) e dispêndios médios (β=-2243,24; p=0,169). Conclusão: o diagnóstico asma obteve maior consumo, enquanto que a doença inflamatória do colo do útero atingiu menor quantitativo. Na série temporal, observou-se tendência de redução de gastos evidenciada pela diferença entre o maior custo no ano de 2009 e o menor, em 2015. Descritores: Atenção Primária à Saúde; Serviços Básicos de Saúde; Qualidade, Acesso e Avaliação da Assistência à Saúde; Sistemas de Informação Hospitalar; Estudos Ecológicos. 1Universidade Federal do Piauí. Picos, PI, Brazil. 2Universidade Estadual do Ceará. Fortaleza, CE, Brazil. 3Universidade Federal do Ceará. Fortaleza, CE, Brazil. Corresponding author: Francisco Gilberto Fernandes Pereira Rua Cicero Eduardo, 956. Junco. CEP: 64607-670. Picos, PI, Brazil. E-mail: gilberto.fp@hotmail.com Maria Evely Ferreira de Sousa1 Eduardo Carvalho de Sousa2 Geórgia Alcântara Alencar Melo3 Rhanna Emanuela Fontenelle Lima de Carvalho2 Maria Rocineide Ferreira da Silva2 Francisco Gilberto Fernandes Pereira1 How to cite this article: Sousa MEF, Sousa EC, Melo GAA, Carvalho REFL, Silva MRF, Pereira FGF. Hospitalization costs for Ambulatory Care Sensitive Conditions: time Series 2008-2015. Rev Rene. 2020;21:e42091. DOI: https://doi.org/10.15253/2175-6783.20202142091 Sousa MEF, Sousa EC, Melo GAA, Carvalho REFL, Silva MRF, Pereira FGF Rev Rene. 2020;21:e42091. 2 Introduction Since its emergence, the Unified Health System has been undergoing profound transformations, marked by advances, and also overcoming of important obstacles, such as the quality of services and care provided to the population at all levels of complexity, ie. primary, secondary, tertiary, and nowadays also quaternary(1). In order to operationalize the organization of these levels within the health system, indicators of quality of care and user access are measured to ensure the principles of equity and comprehensiveness(2). However, due to difficulties related to geography, human resources, budget and infrastructure of the system itself, secondary and tertiary levels have to receive cases resulting from health problems aggravated because of poor resolution in primary care(3). Primary care is the gateway used by the population to access health services, acting in the promotion and protection of health. It is important for public health because it guides the system to avoid overcrowding in hospitals. Thus, primary care is a qualified care category to benefit society’s health indicators(1). In this context, the Brazilian Ministry of Health defines ambulatory care sensitive conditions as a cluster of health problems for which appropriate primary care interventions are designed to minimize the risk of hospitalizations. Actions such as prevention, diagnosis and early treatment of acute diseases, as well as control and monitoring of chronic diseases should result in the reduction of hospitalizations for ambulatory care sensitive conditions (HACSC)(4-5). High rates of HACSC in a population sample result from difficult access to health services, lack of adequate and satisfactory attention to health issues, low registration in primary care, spontaneous search for specialized or urgent care, or little remediability of the actions taken in service. Thus, increasing number of hospitalizations requires vigilance and careful investigation of the causes of this outcome(6). Thus, the public health system offers Primary Care service with weaknesses in terms of access to users, with a tendency towards low indicators of quality and resolution, and consequent generation of unnecessary hospitalizations. On the other hand, when primary care actions are offered in a planned and timely manner, chronic diseases and their severe conditions and, consequently, the number of hospitalizations, tend to decrease(7). Hospitalizations for ambulatory care sensitive conditions, indicated as parameters of admission and quality, began to recognize primary health care, as they became an instrument to investigate the efficiency of the services, directly reflecting on the planning of the health budget(8). Based on this premise, investigations were conducted on this theme. In the countryside of São Paulo, HACSC between 2008 and 2010 were responsible for an expenditure of R$ 30,370,691.08, representing 17.0% of total investments in health(9). In Santa Catarina, there was a decrease in the percentage of expenditures between 2001 and 2011, with a regression coefficient of 0.97, leading to a reduction in the HACSC rate of 3.0% per year, and a seven-fold reduction in the per capita financial investments in health(10). Although investments in all levels of health care in Brazil are scarce, there is a disparity in the distribuition of financial resources among the levels of health care, as there is a biased impression that tends to cover primary care with a lower level of complexity and, therefore, less need for technological, therapeutic and diagnostic resources(11). In this scenario, the present study is innovative and important for public health, as it will enable the identification of costs incurred by HACSC. The study will allow to direct actions to reduce total hospital expenditures, for the analysis of these indicators make it possible to plan strategies to reduce this type of hospitalizations, and also assist managers in the detection of critical areas in the municipality. Therefore, the objective was to evaluate the costs of HACSC, considering the time series of 2008-2015.