Children and core-periphery differences

Abstract

This study examines the differences between children's (0–15 yr of age) use of primary care services in core and peripheral municipalities in Uusimaa province in southern Finland following the implementation of the Primary Health Care Act (1972). In the ecological study (municipality-based), children's total use of primary health care services during 1973–1979 was continuously lower in peripheral municipalities than in core areas in spite of the Primary Health Care Act, the express purpose of which was to reduce regional differences. Some equalization of utilization of private practitioners occured during this period. The individual-based study material collected in 1979 enabled us to control for the influences of (1) distance to the core of the municipality, (2) age of the child, (3) socio-economic status of the family, (4) type of visit and (5) diagnosis. These factors somewhat modified the influence of the core/periphery dichotomy, but the overall picture that children in the core use more primary health care services remained the same. This suggests that health care policy should be quite specific and based on detailed regional analysis, if equalization between core and peripheral municipalities is to be achieved.