Abstract
BackgroundThe healthcare of immigrants is an important aspect of equity of care provision. Understanding how immigrants use the healthcare services based on their needs is crucial to establish effective health policy.MethodsThis retrospective, observational study included the total population of Aragon, Spain (1,251,540 individuals, of whom 11.9 % were immigrants). Patient-level data on the use of primary, specialised, hospital, and emergency care as well as prescription drug use in 2011 were extracted from the EpiChron Cohort and compared between immigrants and nationals. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden.ResultsThe annual visit rates of immigrants were lower than those of nationals for primary care (3.3 vs 6.4), specialised care (1.3 vs 2.7), planned hospital admissions/100 individuals (1.6 vs 3.8), unplanned hospital admissions/100 individuals (2.7 vs 4.7), and emergency room visits/10 individuals (2.3 vs 2.8). Annual prescription drug costs were also lower for immigrants (€47 vs €318). These differences were only partially attenuated after adjusting for age, sex and morbidity burden.ConclusionIn a universal coverage health system offering broad legal access to immigrants, the global use of healthcare services was lower for immigrants than for nationals. These differences may be explained in part by the healthy migration effect, but also reveal possible inequalities in healthcare provision that warrant further investigation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3127-5) contains supplementary material, which is available to authorized users.
Highlights
The healthcare of immigrants is an important aspect of equity of care provision
According to the World Health Organisation (WHO), governments must ensure that migrants are entitled to health services, that services are appropriate to their needs, and that information systems are in place to monitor utilisation and detect inequities [3, 4]
In a universal coverage health system accessible to all immigrants, global use of the healthcare system is lower in the immigrant population
Summary
The healthcare of immigrants is an important aspect of equity of care provision. Understanding how immigrants use the healthcare services based on their needs is crucial to establish effective health policy. A review by Norredam and coworkers found higher utilisation rates in immigrants as compared with nationals [7], but noted a lack of appropriate epidemiological data and inconsistencies in the methods used to categorise immigrants across studies. These differences may be due to socio-economic disparities across immigrant groups in different countries [19], varying health levels or health cultures [20, 21], and/or differing barriers to access at patient, provider and system levels [22, 23]. One of the main pitfalls of the existing literature is the inclusion of only one level of healthcare
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