Differences between immigrant and non-immigrant groups in the use of primary medical care; a systematic review

Ellen Uiters,Peter Spreeuwenberg,Marleen Foets,Walter Devillé,Peter P Groenewegen

doi:10.1186/1472-6963-9-76

Ellen Uiters, Peter Spreeuwenberg + Show 3 more

Open Access

https://doi.org/10.1186/1472-6963-9-76

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Abstract

BackgroundStudies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Therefore, our study aimed to provide a systematic overview of the existing research on differences in primary care utilization between immigrant groups and the majority population.MethodsFor this review PubMed, PsycInfo, Cinahl, Sociofile, Web of Science and Current Contents were consulted. Study selection and quality assessment was performed using a predefined protocol by 2 reviewers independently of each other. Only original, quantitative, peer-reviewed papers were taken into account. To account for this hierarchical structure, logistic multilevel analyses were performed to examine the extent to which differences are found across countries and immigrant groups. Differences in primary care use were related to study characteristics, strength of the primary care system and methodological quality.ResultsA total of 37 studies from 7 countries met all inclusion criteria. Remarkably, studies performed within the US more often reported a significant lower use among immigrant groups as compared to the majority population than the other countries. As studies scored higher on methodological quality, the likelihood of reporting significant differences increased. Adjustment for health status and use of culture-/language-adjusted procedures during the data collection were negatively related to reporting significant differences in the studies.ConclusionOur review underlined the need for careful design in studies of differences in health care use between immigrant groups and the majority population. The results from studies concerning differences between immigrant and the majority population in primary health care use performed within the US might be interpreted as a reflection of a weaker primary care system in the US compared to Europe and Canada.

Highlights

Studies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use
Our review underlined the need for careful design in studies of differences in health care use between immigrant groups and the majority population
The results from studies concerning differences between immigrant and the majority population in primary health care use performed within the United States (US) might be interpreted as a reflection of a weaker primary care system in the US compared to Europe and Canada

Summary

Introduction

Studies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Equity refers to the extent to which access is determined by 'medical need' as proxied by health status as opposed to socio-economic factors such ethnicity, income and insurance status [1] Research addressing this issue often focuses on the variation in health care use according to social categories such as gender, immigrant status and socio-economic position. With respect to immigrant status, a substantial body of literature has documented differences between immigrant groups and non-immigrant groups in health care utilization [2,3,4,5,6,7,8,9,10,11,12,13] These studies do not always agree about the extent and direction of differences in health care use or the relative importance of the explaining variables, which makes it difficult to draw general conclusions.

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