Paediatric primary care and avoidable hospitalisations in social health insurance: the Czech case

Abstract Background Ambulatory care sensitive hospitalisations (ACSHs) are commonly used to evaluate the accessibility and quality of primary care. However, their relevance under universal health coverage remains unclear, particularly among vulnerable populations. This study examines whether ACSHs among children reflect primary care access in Czechia, a country with universal coverage through social health insurance, no formal gatekeeping by general practitioners (GPs), and no geographic catchment areas. Methods We analyse panel data from 77 Czech districts over the period 2010-2019, focusing on hospitalisations for nine conditions: dehydration, epilepsy, severe ear-nose-throat infections, bacterial pneumonia, kidney and urinary tract infections, asthma, cellulitis, gastroenteritis, and vaccine-preventable diseases. We distinguish between the number of residing and registered children per paediatric GP and control for healthcare supply, socioeconomic characteristics, adult ACSH rates, and children's participation in sports clubs. Results Inter-district commuting to GPs is frequent. The average number of residing and registered children per GP varies substantially across districts: in 2019, the former ranged from 799 to 1,638 and the latter from 629 to 1,395. Neither accessibility measure significantly predicts the share of ACSHs among total child hospitalisations. The average number of preventive visits per child aged 0-11 months also varies widely between districts, from 4 to 12 per child. A negative correlation with the number of registered children per GP suggests that higher patient loads may reduce access to preventive care. Conclusions In the Czech social health insurance context, ACSHs appear to be a poor proxy for paediatric primary care accessibility. Rising GP workloads may limit preventive care provision, with potential risks to child health. Key messages • Paediatric hospitalisations for ambulatory care sensitive conditions do not reflect access to primary care in Czechia’s social health insurance system. • Higher GP workloads may reduce access to preventive care for children, potentially undermining child health.