Influence of local provision of specialty health care service on patient access to care.

introductionThe impact of local provision of specialty service on patients' access to care was studied in Canada's 13 health care jurisdictions where distance may be a barrier limiting access.

methodsA cross-sectional study of routinely collected registry data in Ontario and Nova Scotia was performed. Liver transplant was chosen as an indicator service. Transplant rate, disease severity, urgency and outcome were studied in adult recipients of first liver transplants from 1993 to 2002. Provinces that provided liver transplants were compared with those that did not; Ontario regions that provided the service were compared with those that did not; and the period of time when liver transplants were available in Nova Scotia was compared with the time when they were not.

resultsUse varied widely between jurisdictions but was consistently higher in provider provinces, at 10.9 per million population (pmp) compared with 8.9 pmp in nonprovider provinces (p < 0.005). Use was higher in district health councils of Ontario that provided transplantation. A larger proportion of patients in provider regions had viral or alcoholic etiologies of disease than did those from nonprovider regions, who tended to have superior survival after transplant. Service interruption in Nova Scotia did not change use rates, with transplant rates remaining above average, at 12.0 pmp.

conclusionsDifferences in use between provider and nonprovider regions may reflect local service availability as well as local patterns of disease and patient referral. Expectations of patients that are established by local service availability persist after service is removed.