2025 Volume 74 Issue 2 Pages 169-180
Objectives: Primary care plays a crucial role in preventing the exacerbation of non-communicable diseases and managing them effectively. Ambulatory care sensitive conditions (ACSCs) are defined as conditions where hospitalizations can be avoided through appropriate ambulatory care. Although health insurance reimbursement schemes in primary care include a “fee for a comprehensive review on care for outpatients,” the impact of this financial incentive on healthcare outcomes remains unclear. The present study aimed to determine whether this fee schedule was associated with reduction in hospitalizations due to ACSCs primarily treated in clinics. Methods: This study included patients who were i) aged 65 years or older, ii) diagnosed with and treated for heart failure, hypertension, diabetes, or hyperlipidemia, and iii) reimbursed for “fee for medication for the specific lifestyle-related diseases” for three consecutive months from the first follow-up examination in a clinic. We conducted a one-to-four propensity score matching between patients with and without the “fee for a comprehensive review on care for outpatients.” The primary outcome was hospitalizations related to chronic ACSCs that could be prevented with appropriate ambulatory care. Results: The propensity score matched cohort included 5,188 patients with the fee and 1,297 patients without the fee. No significant difference was observed in hospitalizations related to chronic ACSCs (1.4% vs. 1.7%, p=0.472) between the two groups. Conclusion: The incentive scheme was not associated with hospitalizations related to chronic ACSCs among older outpatients with stable conditions who received treatment for either heart failure, hypertension, diabetes, or hyperlipidemia in clinics.
