Inequalities in health and health services delivery: A multilevel study of primary care and hypertension control

Delivery of health services is an important determinant of health. Restricted availability and access may result in health inequalities. To determine the extent of geographic variation in the delivery of health services and its effect on the health of community residents in terms of under-diagnosis and wider-treatment of hypertension, we carried out a multilevel study of participants in the 1995 Nova Scotia Heart Health Survey (n=3,094). We used individual level survey data and health status measurements linked to geographical level information to examine the importance of adequate delivery of health services to the diagnosis and treatment of hypertension in the universal health care setting of the province of Nova Scotia. The delivery of primary care services across Nova Scotia varied moderately with physician visit rates ranging from 3.3 to 5.5 visits per resident per year. There were neither substantial nor statistically significant differences in the diagnosis and treatment of hypertension among residents of communities varying in the delivery of health services. We concluded that a geographic variation in the delivery of primary care services is a public health concern that is not consistent with the objectives of universal coverage of health services; however, it was not confirmed to result in health inequalities.