Background: In comparison with the national average, and particularly in comparison with the region Helse Vest, which it forms part of, Sogn og Fjordane county has a high level of specialist health care utilization. Apart from the fact that it has two small community hospitals, little is known that could explain this county's high expenditure, and especially whether contrasts exist between its municipalities.
Materials and methods: Based on data from the National Patient Registry and the administrative hospital registry DIPS for the year 2009, age and sex-adjusted utilization rates are compared at municipality level and at the level of the primary health care doctor.
Results: Marked contrasts between the municipalities were observed, both with respect to contact and DRG point rates. A further comparison of three comparable municipalities with different utilization rates revealed high and concurrent differences in referral rates between primary health doctors in the three municipalities.
Interpretation: The high and diverse utilization rates of specialist health care between municipalities in Sogn og Fjordane seem to be associated with correspondingly high and even more pronounced differences in referral rates from primary health care doctors.