Preventable hospitalizations due to ambulatory care sensitive conditions in Latin America (2015-2019): a multi-country descriptive analysis.

Background: In Latin America and the Caribbean (LAC), many countries face persistent gaps in access to and quality of primary care, which can result in preventable hospitalizations. Ambulatory care sensitive conditions (ACSCs) are conditions for which timely and effective primary care may reduce the risk of hospitalization. We analyze hospital discharges from public sector hospitals in Brazil, Chile, Colombia, Ecuador, El Salvador, Mexico, Paraguay, and Peru between 2015 and 2019 to describe national and subnational variation in hospitalizations due to ACSCs and to assess their contribution to inpatient service utilization. Methods: Using sex-age standardized shares of ACSC discharges and days of stay in public hospitals, we conducted descriptive analyses of patterns across and within countries. We estimated hypothetical reductions in ACSC-related hospitalizations by benchmarking departments or states against those with lower shares of ACSC-related hospitalizations under different scenarios. Findings: On average across countries, ACSCs accounted for 17.4% of discharges and days of stay, with limited variation across countries but significant subnational disparities. Chronic non-communicable diseases (NCDs) were the predominant cause of ACSCs hospitalizations (50.6%), followed by infectious diseases (45.3%). Simulated reductions in subnational variation suggest meaningfully lower ACSCs discharges and days of stay, particularly in Brazil, Ecuador, and El Salvador. Interpretation: The high share of ACSC-related hospitalizations indicated substantial use of hospital resources for conditions that could be managed with timely and effective primary care. Addressing subnational disparities and strengthening PHC can improve health outcomes, reduce avoidable hospitalizations, and save health system resources. The predominance of NCDs among ACSC hospitalizations highlights the need to adapt PHC strategies to address the high burden of chronic conditions across the region. Routine monitoring of ACSCs may help identify areas with potential PHC gaps and support targeted improvements in care delivery in LAC. Funding: This study received financial support from the Inter-American Development Bank.