Acute care regionalization has been pursued in health systems throughout the industrial world as a means of achieving better patient outcomes for specialized services. The evidence in support of this policy direction is compelling, but is primarily based on highly specialized care, such as coronary and cancer treatments. There exists another, largely unintended, form of regionalization that involves the flow of patients from smaller urban and rural settings to major urban centres to obtain routine procedures. Using data from the Nova Scotia Discharge Abstract Database, this paper presents an analysis of cross-district utilization of secondary level acute care. In particular, we examine spatial, demographic and individual healthcare seeking characteristics of those residents who obtained relatively routine hospital care in a different district in 2000/2001, even though an equivalent level of service was available within their home district. Implications of cross-district utilization for the viability of medical service provision in smaller centres in the province and elsewhere are discussed.