Background
Avoidable hospitalizations (AHs) are defined as hospitalizations that could have been prevented through timely and effective services. AHs are, therefore, an indicator used to evaluate the access and effectiveness of primary health care services.
Methods
A retrospective time-series study spanning 8 years (2006–2013) was conducted to determine the relationship between AHs and gender, age, and access to primary health care physicians in rural areas in Tehran province, the capital of Iran. The total number of avoidable hospitalizations was 22,570; logistic regression was estimated for each year separately.
Results
Total hospitalizations and AHs increased during the study period, especially during the first 3 years of the study. AHs, as a percentage of total hospitalizations, did not change significantly throughout the study years. This value was 22.3% during the first year of study and varied between 17% and 19.6% from 2007 to 2013. No statistically significant relationship was seen between AH occurrence and access to a physician during the study years.
Conclusion
Increasing access to primary health care physicians cannot necessarily result in decreased AHs. Considering the factors influencing AHs while designing and implementing the family physicians program is important to achieve the expected results regarding the effectiveness of primary health care services.

Citations

• Government purchasing initiatives involving private providers in the Eastern Mediterranean Region: a systematic review of impact on health service utilisation
  Shehla Zaidi, Jai K Das, Wafa Jamal, Ammarah Ali, Faareha Siddiqui, Aya Thabet, Hassan Salah, Awad Mataria
  BMJ Open.2023; 13(2): e063327.     CrossRef

Background
: This study aims to find the direction of health care and health insurance system reform to strengthen primary care in Korea.

Methods : A comparative analysis was performed on health care system and health insurance system between Korea, Japan, and Taiwan.

Results : (1) Functional differentiation between the hospital and the clinic is unclear and many clinics run beds for in-patient care. However, Japan and Taiwan have clear rule on the function of the hospital and the clinic, and only temporary observation beds are allowed for the clinic. (2) Health service delivery system is not defined in the Korean Health care Act. However, Japan and Taiwan have rules on health service delivery system in their health care act. (3) The system of co-payment ceiling is operated in Japan and Taiwan, but not in Korea. And Taiwan has various co-payment system including exemption of co-payment to fulfill the mission of health security. (4) Japan and Taiwan have many fee schedules for enforcing primary care, while Korea has little.

Conclusion : Health care and health insurance system should be reformed in order to strengthen primary care. Most of all, the role of the hospital and the clinic should be classified. Fee schedule for primary care should be changed to encourage coordinated management of chronic diseases. Reform of co-payment system is also required.