Geographic variation in health services use in Nova Scotia.

To further our understanding of factors underlying geographic variation in health and the potential role of availability of and access to health services, we sought to quantify the geographic variation in health services use in the province of Nova Scotia. For the period 1996 to 1999 we examined the variation in the use of health services across 64 geographic areas in conjunction with health and socio-economic factors, using multilevel methods and empirical Bayesian estimates based on provincial physician billings and hospital separation records. We revealed moderate geographic variation in the use of family physician services and large variation in specialist and hospital services. In the two urban centres, Metropolitan Halifax and the Cape Breton Regional Municipality, use of specialist services was respectively 26.24% and 15.59% higher than the provincial average, and use of hospital services was respectively 21.55% and 37.67% higher. Geographic areas in which residents had better health were characterized by more use of family physician services and reduced use of specialist and hospital services. These associations seem to support policy strategies that aim to improve health and to reduce health care costs by investing in prevention and primary health care, and they highlight the potential implications of the shortage of family physicians across Canada.