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

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.

Inequalities in healthcare access by type of visa in a context of restrictive health insurance policy: the case of Ukrainians in Czechia

“…On the other hand, even permanently settled immigrants, despite their legal access in equal conditions, still have a lower utilization of specialized care and prescribed drugs than native Czechs. Lack of differences in hospitalisations and GP visits between natives and permanently settled immigrants coincides with findings from most studies in European countries with universal public healthcare coverage, where, if any, a higher use of GP by migrants has been reported (Cooper et al 1998;Stronks et al 2001;Saxena et al 2002;Regidor et al 2009;Uiters et al 2009;Norredam et al 2010). Immigrants' lower use of specialist services has also been reported by some (Stronks et al 2001) but not all studies in the Netherlands (Norredam et al 2010), and has been a constant finding in Spain (Regidor et al 2009) where, as in Czechia, immigration has been a more recent phenomenon and newly arrived migrants may have more difficulties sorting out organizational barriers to access this level of care.…”

Lifestyle Characteristics Assessment of Japanese in Pittsburgh, USA

“…Additionally, for those who move to different countries, access to care including health maintenance and disease prevention largely remains the issues [9,10]. Based on our clinical observations, the access to care is suspected to be associated with poor health status among Japanese in Pittsburgh.…”

Differences in the Use of Primary Care Services Between Spanish National and Immigrant Patients

“…This may even allow us to discover the part of the population that has not made use of health services in a given period. Three recent reviews have pointed out the need for this type of studies [5, 6, 10]. This approach is quite important because it will give us real evidence of possible inequities in access to health services and health outcomes in the immigrant population, particularly when legal access is acknowledged and encouraged by Spanish law.…”