Avoidable hospital admissions depend on the primary healthcare governance model? A global health perspective from Europe countries

Primary healthcare (PHC) governance model, namely its financing scheme, might impact the health outcomes, particularly in chronic conditions, through avoidable hospital admissions (AvH). Therefore, the study aims to assess how the PHC financial governance model determines AvH, as well as how this interacts with the health system financing (HSF) scheme. An observational study comparing the GP employment type (publicly and self/privately) with asthma and COPD, and Diabetes AvH per 100,000 habitants in 26 countries of the European Region, was performed. It considered 4 regression models with structural determinants, service delivery and HSF schemes. GP self/privately employed group associated with social health insurance scheme was significantly associated with higher total AvH (OR = 28.27 [CI 95% 2.34–77.54]), and for asthma and COPD AvH (OR = 21.88 [CI 95% 6.69–180.18]). Diabetes AvH were significantly associated with increasing GP outpatient coverage (model 1) and GP availability (model 2) under a GP self/privately employed group (respectively, OR = 17.01 [CI 95% 3.67–20.63] and OR = 17.80 [CI 95% 8.12–130.35]). The study evidenced that publicly employed GPs working in a tax-based HSF scheme ensure better health outcomes for the population. Although some limitations of equity and categorisation, the results show that the governance model might influence population health outcomes.