Ambulatory care sensitive hospitalizations are widely considered as important measures of access to as well as quality and performance of primary care. In our study, we investigate the impact of spending, process quality and
continuity of care in the
ambulatory care sector on
ambulatory care sensitive hospitalizations in patients with
type 2 diabetes. We used observational data from Germany's major association of insurance companies from 2012 to 2014 with 55,924 patients, as well as data from additional sources. We conducted negative binomial regression analyses with random effects at the district level. To control for potential endogeneity of spending and physician density in the
ambulatory care sector, we used an instrumental variable approach. We controlled for a wide range of covariates, such as age, sex, and comorbidities. The results of our analysis suggest that spending in the
ambulatory care sector has weak negative effects on
ambulatory care sensitive hospitalizations. We also found that
continuity of care was negatively associated with hospital admissions. Patients with
type 2 diabetes are at increased risk of hospitalization resulting from
ambulatory care sensitive conditions. Our study provides some evidence that increased spending and improved
continuity of care while controlling for process quality in the
ambulatory care sector may be effective ways to reduce the rate of potentially avoidable hospitalizations among patients with
type 2 diabetes.