Healthcare utilization among migrants to the UK: cross-sectional analysis of two national surveys

Abstract

Objective To contribute objective evidence on health care utilization among migrants to the UK to inform policy and service planning. Methods We analysed data from Understanding Society, a household survey with fieldwork from 2015 to 2017, and the European Health Interview Survey with data collected between 2013 and 2014. We explored health service utilization among migrants to the UK across primary care, inpatient admissions and maternity care, outpatient care, mental health, dental care and physiotherapy. We adjusted for age, sex, long-term health conditions and time since moving to the UK. Results Health care utilization among migrants to the UK was lower than utilization among the UK-born population for all health care dimensions except inpatient admissions for childbirth; odds ratio (95%CI) range 0.58 (0.50–0.68) for dental care to 0.88 (0.78–0.98) for primary care). After adjusting for differences in age and self-reported health, these differences were no longer observed, except for dental care (odds ratio 0.57, 95%CI 0.49–0.66, P < 0.001). Across primary care, outpatient and inpatient care, utilization was lower among those who had recently migrated, increasing to the levels of the nonmigrant population after 10 years or more since migrating to the UK. Conclusions This study finds that newly arrived migrants tend to utilize less health care than the UK population and that this pattern was at least partly explained by better health, and younger age. Our findings contribute nationally representative evidence to inform public debate and decision-making on migration and health.

Ethnic Inequalities in Healthcare Use and Care Quality among People with Multiple Long-Term Health Conditions Living in the United Kingdom: A Systematic Review and Narrative Synthesis

“…Another reported that international migrants were less likely to have used secondary care than established residents and within-England migrants [ 77 ]. These findings mirror those of Saunders and colleagues (2021), who found that newly arrived migrants have lower healthcare utilisation levels than the UK-born population, a pattern partially explained by younger age and lower levels of ill health [ 78 ]. However, these studies do not explicitly focus on populations with MLTCs.…”

“…With different migration histories, the length of residence in the UK among those born outside the UK will vary and may impact healthcare utilisation. Interestingly, studies exploring the association between healthcare use and the number of years spent in the UK have found mixed evidence [ 77 , 78 , 79 ]. One study found no differences in healthcare use between non-UK-born migrants and the UK-born population [ 79 ].…”

Migrants’ primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series

“…Migrants in young and middle adulthood attended fewer consultations than non-migrants, while the opposite was seen in children and older adults. Higher rates in older adults aligns with previous research (12) and could be explained by the diminishing ‘healthy migrant effect’ over time (27) and increasing primary care consultation rates with time post-migration (11).…”

“…For migrants who do register, there are barriers to accessing care, including insufficient translation support, discrimination, and transportation costs (8)(9)(10). However, differences in primary care utilisation between migrants and the UKborn population are poorly understood and have relied on self-reported surveys with limited sample sizes and mixed results (11,12). Examining these differences is of particular importance for service planning given the UK is home to the fifth largest number of international migrants in the world (13).…”

Migrant diversity and determinants of health care access and use

“…1 The current magnitude and diversity of global human mobility across and within country borders have considerable implications and challenges for policies and the provision of health care in migrant receiving contexts. 2 In this issue of the journal, Saunders et al 3 examine the utilisation of health care among international migrants to the United Kingdom in comparison with the UK-born population, through cross-sectional analysis of two recent nationally representative surveys, and encompassing a wide range of health care domains. They show that lower health care utilisation among migrants compared to the UK-born is evident in all domains except in inpatient maternity care, but was eliminated except in dental care after adjustment for sex, age and longterm health conditions.…”