Does community health reduce hospital utilisation? Evidence from Australia

Abstract Background International evidence on the impact of community health on health outcomes is generally positive; however, the effect on reducing hospitalisations is mixed and often depends on the specific settings and institutions. Evidence from Australia is limited. This study assesses how community health affect hospital care utilisation under the Victorian Community Health Program, which provides a range of services to priority populations at risk of poorer health under a social model of care. Methods To account for differences between community health users and non-users, this study used Propensity Score Matching to address the non-random assignment of individuals into the Community Health Program. Administrative data were extracted and linked across (i) the Community Health Minimum Dataset, (ii) the Victorian Admitted Episodes Dataset, and (iii) the Victorian Emergency Minimum Dataset. Results Compared with non-users, users of the Community Health Program had fewer unplanned hospital readmissions. In contrast, users of the Community Health Program had a longer length of stay, more potentially preventable admissions, more admissions with hospital acquired complications, and more emergency department presentations. No significant difference was found in the total number of hospital admissions. Conclusions Access to the Community Health Program was found to have mixed effects on hospital utilisation, which may reflect previously unmet health needs among users. Further research is needed to examine potential factors driving these results. A key limitation is the lack of data on primary care use, health improvements allowing hospital avoidance and changes in well-being. Access to additional linked data is necessary before these results can meaningfully inform policy decisions.