Health services use of Manitoba First Nations people: is it related to underlying need?

BACKGROUND To compare health status and health services use of Registered First Nations to all other Manitobans (AOM). If the Canadian health care system is meeting underlying need, those experiencing the greatest burden of morbidity and mortality should show the highest rates of health service use. METHODS Registered First Nations' (n = 85,959) hospitalization and physician visit rates were compared to rates of all other Manitobans (n = 1,054,422) for fiscal year 1998/99. The underlying "need" for health care was measured using premature mortality (PMR), an age- and sex-adjusted rate of death before age 75. Data were derived from Manitoba's Population Health Research Data Repository, linked to federal Status Verification System files to determine Registered First Nations status. RESULTS Registered First Nations' PMR was double the rate of all other Manitobans (6.61 vs. 3.30 deaths per thousand, p < 0.05). Registered First Nations ambulatory physician visit rates (6.13 vs. 4.85 visits per person, p < 0.05), hospital separation rates (0.348 vs. 0.156 separations per person, p < 0.05) and total days of hospital care (1.75 vs. 1.05 days per person, p < 0.05) were higher than AOM rates. Consultation rates (first visit to a specialist) were slightly higher for Registered First Nations (0.29 vs. 0.27 visits per person, p < 0.05), and overall specialist visit rates were lower (0.895 vs. 1.284 visits per person, p < 0.05) compared with AOM. CONCLUSION Although hospitalization and ambulatory physician visit rates for First Nations reflect their poorer health status, consult and specialist rates do not reflect the underlying need for health care services.