Advertisement

Canadian Journal of Public Health

, Volume 93, Issue 4, pp 303–307 | Cite as

Individual and Neighbourhood Determinants of Health Care Utilization

Implications for Health Policy and Resource Allocation
  • Alexandra M. Yip
  • George Kephart
  • Paul J. Veugelers
Article

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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Glazier RH, Badley EM, Gilbert JE, Rothman L. The nature of increased hospital use in poor neighbourhoods: Findings from a Canadian inner city. Can J Public Health 2000;91:268–73.PubMedGoogle Scholar
  2. 2.
    Geronimus AT, Bound J. Use of census-based aggregate variables to proxy for socioeconomic group: Evidence from national samples. Am J Epidemiol 1998;148:475–86.CrossRefGoogle Scholar
  3. 3.
    Locker D, Ford J. Using area-based measures of socioeconomic status in dental health services research. J Public Health Dent 1996;56:69–75.CrossRefGoogle Scholar
  4. 4.
    Rice N, Jones A. Multilevel models and health economics. Health Economics 1997;6:561–75.CrossRefGoogle Scholar
  5. 5.
    Von Korff M, Koepsell T, Curry S, Diehr P. Multi-level analysis in epidemiologic research on health behaviors and outcomes. Am J Epidemiol 1992;135:1077–82.CrossRefGoogle Scholar
  6. 6.
    Greenland S. Principles of multilevel modelling. Int J Epidemiol 2000;29:158–67.CrossRefGoogle Scholar
  7. 7.
    Mackenbach, JP. Multilevel ecoepidemiology and parsimony. J Epidemiol Community Health 1998;52:614–15.CrossRefGoogle Scholar
  8. 8.
    Austin PC, Goel V, van Walraven C. An introduction to multilevel regression models. Can J Public Health 2001;92:150–54.PubMedGoogle Scholar
  9. 9.
    Diez-Roux AV, Nieto FJ, Muntaner C, et al. Neighborhood environments and coronary heart disease: A multilevel analysis. Am J Epidemiol 1997;146:48–63.CrossRefGoogle Scholar
  10. 10.
    O’Campo P, Xue X, Wang MC, Caughy MO. Neighborhood risk factors for low birthweight in Baltimore: A multilevel analysis. Am J Public Health 1997;87:1113–18.CrossRefGoogle Scholar
  11. 11.
    Yen IH, Kaplan, GA. Neighborhood social environment and risk of death: Multilevel evidence from the Alameda County Study. Am J Epidemiol 1999;149:898–907.CrossRefGoogle Scholar
  12. 12.
    Lochner K, Pamuk E, Makuc D, et al. State-level income inequality and individual mortality risk: A prospective, multilevel study. Am J Public Health 2001;91:385–91.CrossRefGoogle Scholar
  13. 13.
    Ross NA, Wolfson MC, Dunn JR, et al. Relation between income inequality and mortality in Canada and in the United States: Cross sectional assessment using census data and vital statistics. BMJ 2000;320:898–902.CrossRefGoogle Scholar
  14. 14.
    Veugelers PJ, Yip AM, Kephart G. Proximal and contextual socioeconomic determinants of mortality: Multilevel approaches in a setting with universal health care coverage. Am J Epidemiol 2001;154:725–32.CrossRefGoogle Scholar
  15. 15.
    Carr-Hill R, Eastwood A, Stephenson P. Resource allocation review [letter]. Lancet 1988;2(8603):168.CrossRefGoogle Scholar
  16. 16.
    Roos NP, Fransoo R, Carrière KC, et al. Needsbased planning: The case of Manitoba. CMAJ 1997;157:1215–21.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Roos NP, Fransoo R, Bogdanovic B, et al. Needs-based planning for generalist physicians. Med Care 1999;37(6 Suppl):JS206–28.PubMedGoogle Scholar
  18. 18.
    Sutton M, Lock P. Regional differences in health care delivery: Implications for a national resource allocation formula. Health Econ 2000;9:547–59.CrossRefGoogle Scholar
  19. 19.
    Hutchison B, Hurley J, Reid R, et al. Capitation Formulae for Integrated Health Systems: A Policy Synthesis. Ottawa, Ontario: Canadian Health Services Research Foundation, 2000.Google Scholar
  20. 20.
    Nova Scotia Heart Health Program. Report of the Nova Scotia Nutrition Survey. Halifax: Nova Scotia Department of Health, 1993.Google Scholar
  21. 21.
    Roos NP, Shapiro E, Tate R. Does a small minority of elderly account for a majority of health care expenditures?: A sixteen-year perspective. Milbank Q 1989;67:347–69.CrossRefGoogle Scholar
  22. 22.
    Korn EL, Graubard, BI. Epidemiologic studies utilizing surveys: Accounting for the sampling design. Am J Public Health 1991;81:1166–73.CrossRefGoogle Scholar
  23. 23.
    Stata Corporation. Intercooled Stata 6.0 for Windows (computer software). College Station, TX: Stata Corporation, 1999.Google Scholar
  24. 24.
    Scientific Software International Inc. HLM 5 for Windows (computer software). Lincolnwood, IL: Scientific Software International Inc., 2000.Google Scholar
  25. 25.
    Kephart G, Thomas VS, MacLean DR. Socioeconomic differences in the use of physician services in Nova Scotia. Am J Public Health 1998;88:800–3.CrossRefGoogle Scholar
  26. 26.
    Veugelers PJ, Guernsey, JR. Health deficiencies in Cape Breton County, Nova Scotia, Canada, 1950–1995. Epidemiology 1999;10:495–99.CrossRefGoogle Scholar
  27. 27.
    Veugelers PJ, Yip AM, Mo D. The north-south gradient in health: Analytic applications for public health. Can J Public Health 2001;92:95–98.PubMedGoogle Scholar
  28. 28.
    Kephart G, Pennock M, Skedgel C, et al. Federal Funding for Health Care: Are Provinces Getting Their Fair Share? Halifax, NS: Population Health Research Unit, Dalhousie University, 2000.Google Scholar
  29. 29.
    Johansen H, Millar, WJ. Health care services–recent trends. Health Reports 1999 Winter;11(3):91–109.Google Scholar
  30. 30.
    Roos NP, Mustard, CA. Variation in health and health care use by socioeconomic status in Winnipeg, Canada: Does the system work well? Yes and no. Milbank Q 1997;75:89–111.CrossRefGoogle Scholar
  31. 31.
    Fitzgerald AL, MacLean DR, Veugelers PJ. Dietary reference intakes: A comparison with the Nova Scotia Nutrition Survey. Can J Diet Pract Res Fall or Summer 2002, in press.Google Scholar
  32. 32.
    Bosma H, van de Mheen HD, Borsboom GJJM, Mackenbach, JP. Neighborhood socioeconomic status and all-cause mortality. Am J Epidemiol 2001;153:363–71.CrossRefGoogle Scholar
  33. 33.
    Lynch JW, Kaplan GA, Salonen, JT. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med 1997;44:809–19.CrossRefGoogle Scholar
  34. 34.
    Statistics Canada. Canadian Community Health Survey Documentation. Ottawa, 2000.Google Scholar
  35. 35.
    Krasnik A. The concept of equity in health services research. Scand J Soc Med 1996;24:2–7.CrossRefGoogle Scholar
  36. 36.
    Andersen R, Newman, JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc 1973;51:95–124.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2002

Authors and Affiliations

  • Alexandra M. Yip
    • 1
  • George Kephart
    • 1
  • Paul J. Veugelers
    • 1
  1. 1.Department of Community Health and Epidemiology, Faculty of MedicineDalhousie UniversityHalifaxCanada

Personalised recommendations