Does the regionalization of health services lead to variations in care?

Adrian Levy, James Ted McDonald, Juergen Krause


Regionalizing, or centralizing, health services involves the concentration of health care resources at fewer locations with the aim of reducing wait times, increasing quality of care, and lowering service costs. However, there is the possibility that regionalization can result in geographical barriers to care, as some individuals may need to travel further for services or may need to rely on limited local treatment options.

Even though each Maritime province operates under slightly different health care models, they have some things in common. Each province offers some regionalized services, and each province offers non-regionalized orthopaedic surgeries, which are accessible at many different hospitals. 

In this report, researchers from the Maritime SPOR SUPPORT Unit (MSSU) and the New Brunswick Institute for Research, Data and Training (NB-IRDT) examine variations in surgery rates and surgery types in the Maritime provinces, focusing specifically on three kinds of surgery:

  • coronary artery bypass grafts (CABGs) (regionalized service)
  • hip replacements (not regionalized)
  • knee replacements (not regionalized)

Using data from the Canadian Institute for Health Information Discharge Abstract Database, the authors estimate the types and rates of surgery for adults who had a CABG or a hip or knee replacement surgery between 2001 and 2013, as well as changes in those rates over time.

Study results show that rates of CABGs remained stable over time, while rates of orthopaedic surgery increased. Rates of cardiac surgery were higher for men, whereas rates of orthopaedic surgery were higher for women. 
Findings also show regional variations in surgical rates, with CABG showing the least, variation and knee replacements the highest amount of variation. This suggests that some patients may be choosing to undergo orthopaedic surgeries out of province.

Report - Geographic variation in coronary artery bypass surgery and hip and knee replacement surgeries in the Maritime Provinces (2016)