The Effect of Spatial Access to Primary Care on Potentially Avoidable Hospitalizations of the Elderly: Evidence from Chishui City, China

Potentially avoidable hospitalizations are associated with high and rising costs, and they have been widely considered as important performance indicators of the healthcare system, particularly in primary care. This study explored the relationship between spatial access to primary care and potentially avoidable hospitalizations of the elderly based on data from Chishui City, China, from 2014 to 2017. The enhanced two-step floating catchment area method was used to measure spatial access to care, while the relationship was estimated by a two-level logistic regression model with random effects, controlling for individual and household characteristics. We found a significantly negative association between potentially avoidable hospitalizations and spatial access to primary care, showing that the improvement of spatial access to primary care for the elderly would significantly reduce their potentially avoidable hospitalizations. Our results emphasized that the strategies to promote qualified, adequate and appropriate spatial distribution of primary care would substantially improve the healthcare system performance in China, also providing implications for other developing countries facing similar challenges.