Inequalities in health care utilization among migrants and non-migrants in Germany: a systematic review

Abstract

BackgroundDespite the growing number of people with migrant background in Germany, a systematic review about their utilization of health care and differences to the non-migrant population is lacking. By covering various sectors of health care and migrant populations, the review aimed at giving a general overview and identifying special areas of potential intervention.MethodsA systematic review was conducted in PubMed database including records that were published until 1st of June 2017. Further criteria for eligibility were a publication in a peer-reviewed journal written in English or German language. The studies have to report quantitative and original data of a population residing in Germany. The appropriateness of the studies was judged by both authors. Studies were excluded if native controls were not originated from the same sample. Moreover, indicators of health care utilization have to assess individual behaviour like consultation or participation rates. 63 studies met the inclusion criteria for a qualitative synthesis of the findings.ResultsThe overall findings indicate a lower utilization among migrants, although the results vary in terms of health care sector, indicator of health care utilization and migrant population. For specialist care, medication use, therapist consultations and counselling, rehabilitation as well as disease prevention (early cancer detection, prevention programs for children and oral health check-ups) a lower utilization among people with migrant background was found. The lower usage was particularly shown for migrants of the 1st generation, people with two-sided migrant background, children/adolescents and women. Due to the methodological heterogeneity a meta-analysis was not feasible. As most of the studies were cross-sectional, no causal interpretations could be drawn.ConclusionsThe inequalities in utilization could not substantially be explained by differences in the socioeconomic status. Other reasons of lower utilization could be due to differences in need, preferences, information, language and formal access barriers (e.g. charges, waiting times, travel distances or lost wages). Different migrant-specific and migrant-sensitive strategies are relevant to address the problem for certain health care sectors and migrant populations.Trial registrationThe review protocol was registered on PROSPERO (CRD42014015162).Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0876-z) contains supplementary material, which is available to authorized users.

Personen mit Migrationshintergrund in der NAKO Gesundheitsstudie – soziodemografische Merkmale und Vergleiche mit der autochthonen deutschen Bevölkerung

“…Personen zu verzeichnen [2]. Für das Gesundheitssystem ergeben sich Herausforderungen durch diese wachsende Bevölkerungsgruppe aufgrund von Unterschieden in der Mortalität [3][4][5], Morbidität [6] und einem unterschiedlichen Bedarf und Inanspruchnahmeverhalten medizinischer Dienstleistungen zwischen PmM und Personen ohne Migrationshintergrund (PoM; [7][8][9]).…”

“…Der in vielen Studien vorgenommene Vergleich zwischen PmM und PoM vernachlässigt jedoch die Heterogenität in der Gruppe der PmM [11]. Deutsche Studien zur Inanspruchnahme medizinischer Dienstleistungen unterscheiden in 12 Fällen zwischen verschiedenen Migrantengruppen wie türkeistämmigen Personen oder Aussiedlern und der autochthonen Bevölkerung, in 10 Fällen werden Migranten nach erster/ zweiter Migrantengeneration oder ein-/zweiseitigem Migrationshintergrund eingeteilt, während 40 Studien lediglich zwischen Migranten und Nichtmigranten unterscheiden [9]. Zudem wird als problematisch angesehen, dass verschiedene europäische Länder unterschiedliche Kriterien für die Definition des Migrationsstatus wie das Geburtsland oder die Nationalität verwenden [11].…”

Equity in Health Care: A Qualitative Study with Refugees, Health Care Professionals, and Administrators in One Region in Germany

“…Different reviews showed that migrant populations in particular suffer disadvantages in accessing health care [2,5]. A lower utilization of specialist care, the use of medication, and therapist consultation were found amongst migrant populations [6]. e special challenge for health care in this population group was also recognised by the World Organisation of Family Doctors (WONCA) which is reflected in the following statement "Refugees should have access to equitable, affordable and high-quality health care services in all Europe" [7].…”

La migración sur/sur como un determinante social de impacto en las desigualdades e inequidades en salud bucal en Latinoamérica

“…Una búsqueda en PubMed (https://www.ncbi.nlm.nih.gov/ pubmed/), usando lenguaje libre mediante las palabras «immigrant OR migrant» AND «health», sin la aplicación de términos MeSH, da cuenta de 212 revisiones sistemáticas de diversos temas en salud en los últimos cinco años. De éstas, siete (3,3%) se ocupan de investigar temas relacionados con migración y salud bucal (10)(11)(12)(13)(14)(15)(16) . Esto da pie a la necesidad de analizar la situación de salud bucal desde un enfoque de los determinantes sociales que permita identificar las necesidades específicas en diferentes grupos sociales como la población migrante.…”