Individual and neighbourhood determinants of health care utilization. Implications for health policy and resource allocation.
OBJECTIVE
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.
Yip
Alexandra M
AM
Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5849 University Avenue, Halifax, NS B3H 4H7, Canada.
Kephart
George
G
Veugelers
Paul J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D005260:Female; D015276:Health Care Rationing; D006291:Health Policy; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012111:Residence Characteristics; D012959:Socioeconomic Factors