A relatively large proportion of the elderly will probably have substantial needs for labor-intensive long-term care (Chatterji et al. 2015). In addition, the Norwegian population is centralizing (Leknes and Løkken 2022). The population of cities and surrounding areas are growing, whereas rural areas tend to shrink. Both aging and centralization have consequences for regional demand for healthcare services.

This report consists of two parts. The first part investigates whether there are regional differences in usage of municipal healthcare services among the elderly. The second part studies the relationship between formal and informal care conditional on individuals' demographic characteristics and state of health. Health condition is directly related to healthcare use but may also pick up the influence of socio-economic conditions such as level of education.

In the analyses, we use data for the period 2018-2020 from the Norwegian Registry for Primary Health Care (KPR). It is full-count population data, which include detailed information about use of the different municipal healthcare services.

We show that there are significant geographical differences in the use of municipal healthcare services, also when controlling for health status. The highest estimated use is found for Finnmark, whereas Oslo has the lowest use. We know little about what drives the differences.

We also find that users who receive informal care generally use less formal care. This is especially the case for users with lighter healthcare needs. For heavy-users, informal care seems to be more of a supplement.

The negative relationship between informal and formal care may be explained by both supply and demand factors. The former is relevant if formal care is perceived to be inadequate and causes family and friends to provide more informal care. The latter is relevant if assistance from family and friends replace municipal healthcare services. This study is not able to separate between supply and demand factors and reveal their relative importance but shows the correlation between informal and formal healthcare usage.

A limitation of the analysis is that the results are descriptive as opposed to causal. This means that results must be interpreted with care, as the underlying mechanisms are unclear. Further exploration of the sources of regional differences in resource use and implementation of causal designs to determine the effect of informal care on formal care represent promising avenues for future work.