Medical services and health status in the northwest health region of British Columbia: a three year perspective

Providing efficient and effective health services to the residents of rural and remote regions of Canada has been the focus of much research since the implementation of universal medical care in 1967. A great deal research has been carried out by the individual provinces regarding physician supply and physician services utilisation, as well as attempts to determine an appropriate measure of population health status. While many of these measures have been assessed individually for several regions there are very few examples of integration of the measures to assess the degree to which they might influence one another. This thesis presents a descriptive analysis of measures of physician supply, physician services utilisation, and population health status, and includes a correlational analysis of the relationship between these variables. The focus of this study is specific to the Northwest Health Region of British Columbia and the eight Local Health Areas of which it is comprised since this area is characterised as having a shortage of physicians and their services, as well as having poor health status. Measures of physician supply are used to determine if there is an adequate supply of general practitioner and medical specialist practitioners in the Northwest compared to other Local Health Areas in the province and the provincial median. Utilisation of and accessibility to physician services is also examined to determine if there is reasonable access to physician services in the Northwest as compared to other areas in the province. A health status index is formulated from standardised mortality ratios and other rates in an attempt to describe the population health status of the 79 British Columbia Local Health Areas and, more specifically, of those in the Northwest Health Region. The values derived from this health status index are correlated with physician supply and utilisation values to assess whether or not any association exists. The study found that despite the many difficulties in recruiting and retaining physicians in the Northwest there seemed to be a reasonable supply of both general practitioner and medical specialist physicians in the Region at the time of the study. It was also shown that the ability of residents to access general practitioner services within the Region was also deemed to be reasonable. Access to medical specialist services, however, was shown to be lacking in most Local Health Areas and an area of concern for the Region as a whole. The population health status of the region was found to be dichotomous with two Local Health Areas enjoying a reasonable level of health status while the six others had values that rated as some of the worst in the province. The association between health status and physician supply and utilisation was shown to be weak with only a few significant values that did not suggest a definitive relationship between these variables. This lends strength to the argument of the 'determinants of health' model which criticises the contribution that medical services makes to population health. This study has discovered some important uses for the various measures of physician supply, physician utilisation, and population health status for the Northwest Health Region. However, there is still a need for further research in this area and a need for the assessment of other Local Health Areas, Health Regions and provinces.