Schoeni-Affolter Franziska V, Widmer Marcel, Busato André
Institute for Evaluative Research in Orthopedic Surgery, MEM Center, University of Bern, Stauffacherstrasse 78, Bern, Switzerland.
BMC Health Serv Res. 2008 Dec 20;8:267. doi: 10.1186/1472-6963-8-267.
Young children are known to be the most frequent hospital users compared to older children and young adults. Therefore, they are an important population from economic and policy perspectives of health care delivery. In Switzerland complete hospitalization discharge records for children [<5 years] of four consecutive years [2002-2005] were evaluated in order to analyze variation in patterns of hospital use.
Stationary and outpatient hospitalization rates on aggregated ZIP code level were calculated based on census data provided by the Swiss federal statistical office (BfS). Thirty-seven hospital service areas for children [HSAP] were created with the method of "small area analysis", reflecting user-based health markets. Descriptive statistics and general linear models were applied to analyze the data.
The mean stationary hospitalization rate over four years was 66.1 discharges per 1000 children. Hospitalizations for respiratory problem are most dominant in young children (25.9%) and highest hospitalization rates are associated with geographical factors of urban areas and specific language regions. Statistical models yielded significant effect estimates for these factors and a significant association between ambulatory/outpatient and stationary hospitalization rates.
The utilization-based approach, using HSAP as spatial representation of user-based health markets, is a valid instrument and allows assessing the supply and demand of children's health care services. The study provides for the first time estimates for several factors associated with the large variation in the utilization and provision of paediatric health care resources in Switzerland.
与大龄儿童和青年相比，幼儿是最频繁的住院使用者。因此，从医疗保健服务的经济和政策角度来看，他们是一个重要群体。在瑞士，对连续四年（2002 - 2005年）五岁以下儿童的完整住院出院记录进行了评估，以分析住院使用模式的差异。
根据瑞士联邦统计局（BfS）提供的人口普查数据，计算邮政编码汇总层面的住院和门诊住院率。采用“小区域分析”方法创建了37个儿童医院服务区（HSAP），反映了基于用户的健康市场。应用描述性统计和一般线性模型对数据进行分析。
四年的平均住院率为每1000名儿童66.1次出院。呼吸道问题导致的住院在幼儿中最为常见（25.9%），最高住院率与城市地区的地理因素和特定语言区域相关。统计模型对这些因素得出了显著的效应估计值，以及门诊/门诊和住院住院率之间的显著关联。
以HSAP作为基于用户的健康市场的空间代表的基于利用的方法是一种有效的工具，可以评估儿童医疗保健服务的供需情况。该研究首次对与瑞士儿科医疗保健资源利用和提供的巨大差异相关的几个因素进行了估计。
