Utilization of physician resources for ambulatory care

This article describes the utilization of ambulatory physician services by Manitoba residents during the fiscal year 1991/1992. Care was assigned to the patient's residence in one of eight administrative regions, whether the care was received in or out of the region of residence. Disparities in physician supply across regions did not correspond with differences in the use of services: the Winnipeg region had twice as many physicians per 1000 residents as the largely rural non-Winnipeg regions and was home to most specialists. With their rich supply of physicians, particularly specialists, Winnipeg residents had somewhat higher contact rates (16%), and the province spent 26% more per resident providing physician services, despite the fact that our indicators of health status and socioeconomic risk suggest no increased need for physician services among Winnipeg residents. Despite the concentration of physicians in Winnipeg, there was remarkably good access to physicians across the province, with 78% or more of the residents in every region making at least one contact with a physician during the year. The differences in use between Winnipeg and non-Winnipeg residents were almost entirely accounted for by intensive users, (individuals making eight or more visits per year). Although residents 75 years of age and older (6% of the population) made twice as many visits per capita compared to younger adults, their actual demand on the system was small, accounting for just less than 10% of expenditures on physician services. Population-based health information provides important insight for needs-based planning of physician services.