Abstract
BackgroundImmigrants often encounter barriers in the health system that may affect their health care outcomes. In order to better cater to the needs of immigrants, many health care institutions have increased their efforts in recent years to provide services which are more sensitive to the needs of an increasingly diverse population. Little is known about whether these efforts are successful. This study examines difference in outcomes of tertiary prevention between immigrants and the autochthonous population in Germany over the period of 2006–2014.MethodsThe analysis is based on a 10% random sample of routine data on completed tertiary preventive treatments in Germany during 2006–2014. Four different indicators of treatment effectiveness were compared between patients with a nationality from Germany, Portugal/Spain/Italy/Greece, Turkey and Former Yugoslavia using logistic regression adjusted for demographic/socioeconomic factors. Interaction terms for year were modeled to examine group differences over time.ResultsDepending on the outcome, Turkish and Former Yugoslavian nationals had an 23%-69% higher chance of a poor treatment effectiveness than Germans (OR = 1.23 [95%-CI = 1.15,1.32] and OR = 1.69 [95%-CI = 1.55,1.83], respectively). Fewer differences were observed between nationals from Portugal/Spain/Italy/Greece and Germans. Disparities did not significantly differ between the years in which services were utilized.ConclusionMeasures implemented by health care institutions did not reduce existing health care disparities between immigrants and the majority population in Germany. One potential reason is that existing approaches are unsystematic and often not properly evaluated. More targeted strategies and a thorough evaluation is needed in order to improve health care for immigrants sustainably.
Highlights
In many European countries large proportions of the populations are immigrants
Measures implemented by health care institutions did not reduce existing health care disparities between immigrants and the majority population in Germany
Immigrants often differ from the majority populations of the countries they reside in terms of health status, health behavior and health care outcomes
Summary
In many European countries large proportions of the populations are immigrants. In Germany, more than 20% of the population is considered to be of immigrant origin. Aside from poor working conditions and a lower socioeconomic status, barriers immigrants encounter in the health system contribute to this differential by affecting the access to health care This results in a lower utilization of preventive services such as screening [5,6,7], vaccination [8,9,10] and rehabilitative care [11,12,13,14]. A study from Germany found out that while 15.5% of all Germans who underwent rehabilitation in 2006 were reported to have a poor occupational performance after treatment, the respective proportions were considerably larger for non-German nationals, being 23.0% for Turkish nationals, 25.1% for Former Yugoslavian nationals and 19.6% for nationals from Portugal, Spain, Italy or Greece This difference was independent of demographic and socioeconomic covariates [11]. This study examines difference in outcomes of tertiary prevention between immigrants and the autochthonous population in Germany over the period of 2006–2014
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