Evaluating health systems through ambulatory care-sensitive conditions

Ambulatory care-sensitive conditions are those for which effective primary health care services could prevent hospitalizations or mitigate severe complications. Hospital admissions for these conditions have been used to measure the effectiveness of primary health care. We review and compare lists of these conditions developed by national and international health entities to explore their applicability to diverse health care systems, the conditions included and the methodological challenges of making cross-country comparisons. While ambulatory care-sensitive conditions can provide a framework for assessing the performance of health care systems, the relevance of specific conditions or lists depends on the local epidemiological context. Countries have developed lists to address their specific context and priorities, for example, with Brazil focusing on infectious diseases and the United Kingdom emphasizing chronic conditions. We explore case studies of how analyses of these conditions can inform policy aimed at improving the effectiveness and accessibility of primary health care, provide evidence about the prevalence and sociodemographic heterogeneity of these conditions, and how they can be used for cross-country comparisons. The findings underscore the importance of developing context-specific lists of ambulatory care-sensitive conditions when evaluating the performance of primary health care services, promoting informed policy decisions and guiding resource allocation in health care systems. Standardized data collection and coding practices are required to enable meaningful cross-country comparisons and to ensure the effective use of these conditions as a tool to assess and monitor health system performance.