Regional variation of avoidable hospitalisations in a universal health care system: a register-based cohort study from Finland 1996−2013

OBJECTIVES: A persistent finding in research concerning healthcare and hospital use in Western countries has been regional variation in the medical practices. The aim of the current study was to examine trends in the regional variation of avoidable hospitalisations, that is, hospitalisations due to conditions treatable in ambulatory care in Finland in 1996–2013 and the influence of different healthcare levels on them. SETTING: Use of hospital inpatient care in 1996–2013 among the total population in Finland. PARTICIPANTS: Altogether 1 931 012 hospital inpatient care episodes among all persons residing in Finland identified from administrative registers in Finland in 1996−2013 and alive in 1 January 1996. OUTCOME MEASURES: We examined hospitalisations due to avoidable causes including vaccine-preventable hospitalisations, hospitalisations due to complications of chronic conditions and acute conditions treatable in ambulatory care. We calculated annual age-adjusted rates per 10 000 person-years. Multilevel models were used for studying time trends in regional variation. RESULTS: There was a steep decline in avoidable hospitalisation rates during the study period. The decline occurred almost exclusively in hospitalisations due to chronic conditions, which diminished by about 60%. The overall correlation between hospital district intercepts and slopes in time was −0.46 (p<0.05) among men and −0.20 (ns) among women. Statistically highly significant diminishing variation was found in hospitalisations due to chronic conditions among both men (−0.90) and women (−0.91). The variation was mainly distributed to the hospital district level. CONCLUSIONS: The results suggest that chronic conditions are managed better in primary care in the whole country than before. Further research is needed on whether this is the case or whether this has more to do with supply of hospital care.