The statistical treatment used in order to reduce data analysis bias in comparing standardised rates was to compare HACSCs vs Non-HACSCs; after all, reductions in HACSC rates may have occurred as a result of overall reductions in admissions in Brazil.
In this case, when variations in standardised rates of HACSCs vs Non-HACSCs for the period from 2009 to 2018 are examined (Table 4), differences can be seen over the course of the decade: (a) in Brazil overall, the reductions in standardised HACSC rates were far greater (-26.6%) than in non-HACSC rates (-12.4%); (b) Rio de Janeiro municipality stands out as where the reduction in standardised HACSC rates was greatest (-13.4%), as compared with non-HACSC rates (-2.0%); (c) in the Federal District, the decrease was similar in both statistics (-15.2% and -13.7%).
Variation (%) in standardised HACSC rates for Brazil and selected areas--2009-2012, 2013-2016 and 2009-2018.
One of the indicators used worldwide to assess PHC indirectly is hospitalisations due to ambulatory care sensitive conditions (HACSCs).
The Brazilian List of HACSCs, comprising 19 groups of causes and diagnoses identified by ICD 10 codes, was then published in the form of an annex to Administrative Order SAS No.
A number of studies conducted in Brazil have adopted HACSCs for evaluating PHC access and effectiveness.
However, this question is pondered, stressing that, even with free access to ambulatory services for underprivileged populations, the latter still present an excessive number of HACSC (10).
In this sense, another study, conducted in Rio Grande do Sul as well, identified strong and positive correlation between HACSC and FHS coverage in municipalities with small-size hospitals, differently from those municipalities which did not have small-size hospitals, indicating lower rates of HACSC in medium-size cities and big centers (25).
Although the population coverage of the service is an essential component of the health system's problem-solving ability, the high HACSC rates man indicate poor access to services offered by PHC or the offering of low-quality services.