Overuse or underuse? Use of healthcare services among irregular migrants in a north-eastern Spanish region

Luis Andrés Gimeno-Feliu,Amaia Calderón-Larrañaga,Esperanza Díaz,Marta Pastor-Sanz,Beatriz Poblador-Plou,Alexandra Prados-Torres

doi:10.1186/s12939-020-01373-3

Abstract

BackgroundThere is little verified information on global healthcare utilization by irregular migrants. Understanding how immigrants use healthcare services based on their needs is crucial to establish effective health policy. We compared healthcare utilization between irregular migrants, documented migrants, and Spanish nationals in a Spanish autonomous community.MethodsThis retrospective, observational study included the total adult population of Aragon, Spain: 930,131 Spanish nationals; 123,432 documented migrants; and 17,152 irregular migrants. Healthcare utilization data were compared between irregular migrants, documented migrants and Spanish nationals for the year 2011. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden.ResultsThe average annual use of healthcare services was lower for irregular migrants than for documented migrants and Spanish nationals at all levels of care analyzed: primary care (0.5 vs 4 vs 6.7 visits); specialized care (0.2 vs 1.8 vs 2.9 visits); planned hospital admissions (0.3 vs 2 vs 4.23 per 100 individuals), unplanned hospital admissions (0.5 vs 3.5 vs 5.2 per 100 individuals), and emergency room visits (0.4 vs 2.8 vs 2.8 per 10 individuals). The average annual prescription drug expenditure was also lower for irregular migrants (€9) than for documented migrants (€77) and Spanish nationals (€367). These differences were only partially attenuated after adjusting for age, sex, and morbidity burden.ConclusionsUnder conditions of equal access, healthcare utilization is much lower among irregular migrants than Spanish nationals (and lower than that of documented migrants), regardless of country of origin or length of stay in Spain.

Highlights

There is little verified information on global healthcare utilization by irregular migrants
The findings may be of interest to policymakers and researchers seeking to improve healthcare systems and ensure health equity for the most disadvantaged populations. This cross-sectional population-based retrospective study analyzed clinical and administrative data from individuals assigned to all public primary care (PC) centres in Aragon, Spain, in 2011
The percentage of women was lower among migrants than Spanish nationals, and was lowest among irregular migrants

Summary

Introduction

There is little verified information on global healthcare utilization by irregular migrants. The term irregular migrant refers to “a person who, owing to unauthorized entry, breach of a condition of entry, or the expiry of his or her visa, lacks legal status in a transit or host country” [2]. It includes persons who (a) lack the necessary documentation to legally enter a country but do so clandestinely; (b) enter or stay in a country using fraudulent documentation; or (c) after entering a country with valid legal documentation, stay beyond the period authorized or otherwise violate the terms of entry and remain without authorization [2]. In 2008 an estimated 1.9–3.8 million irregular migrants were living in the European Union [4]

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