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Individual and Neighbourhood Determinants of Health Care Utilization

Implications for Health Policy and Resource Allocation

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Abstract

Objectives: To investigate the importance of both individual and neighbourhood socioeconomic characteristics for health care utilization.

Methods: Various linkage procedures generated a longitudinal dataset with information on 2,116 Nova Scotians, their residential neighbourhoods, 8 years of health care utilization and vital status. Unilevel and multilevel regression analyses were employed to examine the effects of both individual and neighbourhood characteristics on health care use.

Results: Individual income and education determined physician and hospital use. Also, neighbourhood characteristics, specifically average income and percentage of single mother families, were found to determine health care use. When considering individual and neighbourhood characteristics simultaneously, individual income and education determined physician and hospital use independently, while neighbourhood income determined physician use independently.

Conclusions: Both individual and neighbourhood socioeconomic characteristics determine health care use. Acknowledging this allows better targeting of health policy and planning, and enables more accurate needs-based resource allocation.

Résumé

Objectif: Étudier l’importance des caractéristiques socio-économiques de particuliers et d’unités de voisinage dans l’utilisation des soins de santé.

Méthode: Par diverses méthodes de couplage, nous avons produit un ensemble de données longitudinales sur 2 116 Néo-Écossais, leurs unités de voisinage, leur statut vital et huit années d’utilisation des soins de santé. À l’aide d’analyses de régression à un et à plusieurs niveaux, nous avons examiné les effets des caractéristiques des particuliers et des unités de voisinage sur l’utilisation des soins de santé.

Résultats: Le revenu et la scolarité des particuliers déterminaient le recours aux médecins et aux hôpitaux. Certaines caractéristiques des unités de voisinage (le revenu moyen et le pourcentage de familles gynoparentales) déterminaient également l’utilisation des soins de santé. Lorsqu’on tient compte simultanément des caractéristiques des particuliers et des unités de voisinage, le revenu personnel et la scolarité déterminaient séparément le recours aux médecins et aux hôpitaux, tandis que le revenu de l’unité de voisinage déterminait séparément le recours aux médecins.

Conclusions: L’utilisation des soins de santé est déterminée par les caractéristiques socioéconomiques des particuliers et des unités de voisinage. Sachant cela, on pourra mieux cibler les politiques et la planification dans le domaine de la santé et effectuer avec plus de précision la répartition des ressources selon les besoins.

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Authors and Affiliations

  1. Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5849 University Avenue, Halifax, NS, B3H 4H7, Canada

    Alexandra M. Yip MSc, OT(C), George Kephart PhD &  Paul J. Veugelers PhD

Authors
  1. Alexandra M. Yip MSc, OT(C)
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  2. George Kephart PhD
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  3. Paul J. Veugelers PhD
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Corresponding author

Correspondence to Paul J. Veugelers PhD.

Additional information

Acknowledgements: This research is made possible through funding by the Canada Foundation for Innovation, the Dalhousie Medical Research Foundation, and a Canadian Institutes of Health Research Career Award to Dr. Veugelers, and through a Nova Scotia Clinical Research Scholar Award to Dr. Kephart. Although the data analyzed herein are from the Nova Scotia Department of Health, the conclusions are solely those of the authors. An earlier version of this paper was presented at the American Public Health Association 128th Annual Meeting and Exposition in Boston, MA, November 12–16, 2000. The authors thank Mike Pennock, Mark Smith, and Chris Skedgel of the Population Health Research Unit at Dalhousie University, Shane Hornibrook, Nova Scotia Medical Services Insurance, and Nova Scotia Vital Statistics for their helpful assistance in completion of this study.

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Yip, A.M., Kephart, G. & Veugelers, P.J. Individual and Neighbourhood Determinants of Health Care Utilization. Can J Public Health 93, 303–307 (2002). https://doi.org/10.1007/BF03405022

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