Use of health care services among Syrian refugees migrating to Norway: a prospective longitudinal study

Jasmin Haj-Younes,Jannicke Igland,Elisabeth Marie Strømme,Wegdan Hasha,Bernadette Kumar,Esperanza Diaz,Eirik Abildsnes

doi:10.1186/s12913-021-06571-5

Jasmin Haj-Younes, Jannicke Igland + Show 5 more

Open Access

https://doi.org/10.1186/s12913-021-06571-5

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Abstract

BackgroundUnderstanding the differential utilization of healthcare services is essential to address the public health challenges. Through the migration process, refugees move from one set of health risk factors to another and can face multiple healthcare challenges along their journey. Yet how these changing risk factors influence refugees’ use of health care services is poorly understood.MethodsA longitudinal survey assessing health care utilization of 353 adult Syrian refugees was conducted; first in a transit setting in Lebanon and after one year of resettlement in Norway. The main outcomes are the utilization of general practitioner services, emergency care, outpatient and/or specialist care and hospitalization during the previous 12 months. Associations between use of healthcare services and several sociodemographic, migration-related and health status variables at both time points were found using regression analysis. We also analyzed longitudinal changes in utilization rates using generalized estimating equations.ResultsThe use of general practitioner and emergency care increased after resettlement while outpatient/specialist care markedly dropped, and hospitalization rates remained the same. Undocumented status and poor self-rated health (SRH) prior to resettlement were identified as predictors for use of health care after arrival. After resettlement, higher health literacy, higher education, higher social support and poor SRH and quality of life were significantly associated with use of healthcare services.ConclusionsUtilization of health services changes post migration to the destination country and are associated with migration-related and socio-demographic factors. Poor SRH is associated with use of services, both pre-arrival and post-resettlement. Our findings have implications for future resettlements, health care policies and service provision to newly arrived refugees with regard to both health needs as well as delivery of services.

Highlights

Many countries in Europe have long humanitarian tradition of receiving and resettling forcibly displaced individuals [1] and should provide equitable healthcare services to an increasingly diverse population [2]
We focus on persons recognized as refugees by the United Nations High Commissioner for Refugees (UNHCR) accepted for third-country resettlement [1]
When looking at health status, we found that poor self-rated health (SRH) was significantly associated with the use of both emergency care (EC) and hospitalizations

Summary

Introduction

Many countries in Europe have long humanitarian tradition of receiving and resettling forcibly displaced individuals [1] and should provide equitable healthcare services to an increasingly diverse population [2]. Factors related to access to services have been conceptualized in many ways, and commonly includes aspects on both the provider side and the user side such as accessibility, affordability, availability and appropriateness [6]. One might argue that additional factors related to the migration experience affect the use of health care services for forced migrants given the risk of exposure to external factors such as persecution, food insecurity, and violence. Refugees move from one set of health risk factors to another and can face multiple healthcare challenges along their journey How these changing risk factors influence refugees’ use of health care services is poorly understood

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