Health Services Utilization

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At the present time it is difficult to acquire reliable data to illustrate sub-provincial health care utilization patterns for all of Canada. This topic, therefore, shows two selected categories of utilization using a map of Canada with provincial boundaries only. For the most part, the information discussed were computed from the National Population Health Survey (primarily cycle 3 of NPHS, 1998 to 1999). Excluded from the NPHS dataset employed here were persons living in the territories, on Indian Reserves on Canadian Forces bases, and people living in some remote areas of Canada.

The two indicators selected for the topic of health care utilization discussion present an interesting contrast. For physician utilization, universal coverage for most medical services is available across Canada; however, this is not the case for dental services. In addition to differential access to service providers, variations in utilization could reflect ways of funding health care.

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Some Demographic and Economic Influences on Health Services Utilization

Health services utilization patterns, both for individuals and for regions, are complex. They reflect need, health care personnel availability, as well as numerous demographic and economic characteristics.

Age

Age is clearly one of the strongest determinants of health care utilization. Lifespan utilization trends are shown in Figures 1 and 2. As one might expect, a newborn will most likely need and gain access to a family physician but rarely see a dentist. This is the age where the difference in utilization of family physicians and dentists is most dramatic, but differential patterns persist throughout an individual's life. Physician/dental use is closest for youngsters approximately 6 years of age and older, and for young teens. Thereafter, the utilization patterns separate again with fewer and fewer dental visits as people age compared with an increase in visits to the doctor.

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Figure 1. Lifespan Utilization of Physician and Dental Services

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Figure 2. 1998/99 Physician & Dental Services Utilization by Age Groupings

Gender

Gender tends to be much more influential on physician utilization than on dental services utilization (Figure 3). In the 12 months preceding the National Population Health Survey (NPHS, 1998/1999), only 74% of men compared with 85% of women visited a family physician. The differential percentages for dental services utilization were much smaller, 58% and 62% for men and women, respectively.

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Figure 3. 1998/99 Physician & Dental Services Utilization by Gender

Self-rated Health

Intriguing differences in utilization of physicians and dentists based on self-rated health status are illustrated in Figures 4 and 5. People in excellent health visit family physicians less frequently than those who are not in excellent health. This no doubt reflects need much more than the pattern of dental services utilization (as people in excellent health tend to go to a dentist more frequently than those who do not rate their health as excellent). However, as suggested below, the dental visiting pattern may reflect other influences.

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Figure 4. Lifespan (from 12 years of age) Physician Utilization by Self-Rated Health Status Categories

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Figure 5. Lifespan (from 12 years of age) Dental Services Utilization by Self-Rated Health Status Categories

Education and Income

For example, in earlier sections of the Atlas discussions on health indicators it has been shown that education and income significantly impact health outcomes. But those influences are complex. Educational attainment levels (Figure 6) and income (Figures 7 to 9) are important determinants of health services utilization but influence dental services utilization much more than the use of family physicians. Only marginal differences (± 1%) in family physician utilization were observed with the 1998/99 NPHS compared with differences greater than 10% for dental services utilization (i.e. 51% for people with less than a secondary education visited a dentist compared with 68% for people with college diplomas or university degrees). Similarly, small differences (± 1%) can be seen in family physician utilization patterns across income adequacy categories compared with dental services utilization: in 1998/99, just 40% of Canadians with low incomes visited a dentist compared with almost 78% with high incomes.

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Figure 6. 1998/99 Physician & Dental Services Utilization by Highest Level of Education

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Figure 7. Lifespan Physician Utilization by Income Categories

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Figure 8. Lifespan Utilization of Dental Services by Income Categories

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Figure 9. 1998/99 Physician & Dental Services Utilization by Income Adequacy Categories

Dental Plan Insurance

Having a dental plan insurance is clearly one of the strongest non-medical determinants of utilization of dentists and orthodontists (Figures 10 and 11). But having dental coverage is, in turn, strongly related to parameters that we employ to describe the socioeconomic status of the population, particularly income. As shown in Figure 11, having dental coverage not only increases the likelihood of visiting a dentist/orthodontist, it increases the likelihood of making two or more visits. In 1998/99, only 48% of Canadians with less than secondary education had dental insurance coverage compared with almost 65% with college diplomas or university degrees. Similarly, only 35% of low income Canadians carried dental insurance coverage compared with 80% of high income earners (Figure 12).

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Figure 10. Lifespan Utilization of Dental Services by Dental Insurance Coverage

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Figure 11. Frequency of Dental Services Utilization by Dental Insurance Coverage

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Figure 12. 1998/99 Proportions of Canadians with Dental Insurance by Income Adequacy Categories

Differences in regional variations in the utilization of medical and dental services are primarily a function of contacts made with dentists, not physicians (Pitblado and Pong (1995)). Although these variations cannot be illustrated for sub-provincial areas across Canada at the present time, regional differences are likely to reflect the differences in demographic and economic variations within Canada that have been shown elsewhere in the Atlas of Canada.