Understanding differences in access and use of healthcare between international immigrants to Chile and the Chilean-born: a repeated cross-sectional population-based study in Chile

Abstract

IntroductionInternational evidence indicates consistently lower rates of access and use of healthcare by international immigrants. Factors associated with this phenomenon vary significantly depending on the context. Some research into the health of immigrants has been conducted in Latin America, mostly from a qualitative perspective. This population-based study is the first quantitative study to explore healthcare provision entitlement and use of healthcare services by immigrants in Chile and compare them to the Chilean-born.MethodsData come from the nationally representative CASEN (Socioeconomic characterization of the population in Chile) surveys, conducted in 2006 and 2009. Self-reported immigrants were compared to the Chilean-born, by demographic characteristics (age, sex, urban/rural, household composition, ethnicity), socioeconomic status (SES: education, household income, contractual status), healthcare provision entitlement (public, private, other, none), and use of primary services. Weighted descriptive, stratified and adjusted regression models were used to analyse factors associated with access to and use of healthcare.ResultsThere was an increase in self-reported immigrant status and in household income inequality among immigrants between 2006 and 2009. Over time there was a decrease in the rate of immigrants reporting no healthcare provision and an increase in reporting of private healthcare provision entitlement. Compared to the Chilean-born, immigrants reported higher rates of use of antenatal and gynaecological care, lower use of well-baby care, and no difference in the use of Pap smears or the number of attentions received in the last three months. Immigrants in the bottom income quintile were four times more likely to report no healthcare provision than their equivalent Chilean-born group (with different health needs, i.e. vertical inequity). Disabled immigrants were more likely to have no healthcare provision compared to the disabled Chilean-born (with similar health needs, i.e. horizontal inequity). Factors associated with immigrants’ access to, and use of, healthcare were sex, urban/rural status, education and country of origin.ConclusionThere were significant associations between SES, and access to and use of healthcare among immigrants in Chile and a higher prevalence of no health care provision entitlement among poor and disabled immigrants compared to the Chilean-born. Changing associations between access and use of healthcare and SES among immigrants in Chile over time may reflect changes in their socio-demographic composition or in the survey methodology between 2006 and 2009.ResumenIntroducciónLa evidencia internacional indica menor acceso y uso de servicios de salud por parte de inmigrantes, pero sus factores desencadenantes varían significativamente dependiendo del contexto. Algunas investigaciones se han desarrollado en este tema en América Latina, desde una perspectiva cualitativa. Este estudio cuantitativo exploró el auto-reporte de acceso y uso de servicios de salud de inmigrante...

Desafíos en la atención sanitaria de migrantes internacionales en Chile

“…La vulnerabilidad social de la población migrante regular e irregular en Chile tiene impacto directo en su salud y la de sus familias (6,7) , tanto por procesos de migración (8) , por condiciones sociales de vida al arribo (9) , o por barreras de acceso al sistema de salud formal (10) . El acceso a servicios de salud otorgado a la comunidad migrante residente en Chile, en la actualidad, depende -para ciertos servicios-de factores como trabajo, RUT y tipo de visa.…”

Applying Multivariate Clustering Techniques to Health Data: The 4 Types of Healthcare Utilization in the Paris Metropolitan Area

“…Many studies have previously addressed the use of the healthcare system (either individual services, or globally) by the general population or by specific population subgroups. For example, several studies have examined healthcare system utilisation from a systemic point of view or from a decision-making approach [2] – [4] , or by subgroups of the population, such as cancer survivors [5] , migrants [6] , [7] , or the underserved and low-income people [8] – [10] . In addition, determinants of utilisation of specific healthcare services have been investigated, including mental healthcare services [11] , emergency care units [12] , primary care resources [13] , dental care [14] and specialist consultations [15] .…”

Salud y migración: análisis descriptivo comparativo de los egresos hospitalarios de la población extranjera y chilena

“…La migración es un reconocido determinante social en el mundo (Davies, Mosca y Frattini, 2010) y en Chile (Cabieses, Pickett y Tunstall, 2012). Las condiciones que rodean al proceso de migración hacen que esta población sea potencialmente vulnerable y que su movimiento transfronterizo tenga gran impacto en la salud pública (Akhavan y Bildt, 2004;Alver, Meyer, Falch, Sogaard, 2005 Migration, 2012).…”

“…Datos de las encuestas CASEN 2009 y 2011 indican que este grupo ha reportado un uso variable de prestaciones de salud dental, salud mental y especialista a nivel primario según nivel socioeconómico en los últimos años Cabieses, Tunstall, Pickett y Gideon, 2012). Poco se ha estudiado, sin embargo, respecto del uso del servicio de salud de especialistas.…”

“…En cuanto a la investigación, es importante mencionar que la información sobre la salud de los inmigrantes en Chile y Latinoamérica es escasa, especialmente la de aquellos en situación irregular (Cabieses, Pickett y Tunstall, 2012). Hoy se desconocen importantes factores relacionados con la salud, como razones de migración, nivel socioeconómico y de salud antes de migrar, efectos en segundas y terceras generaciones de inmigrantes, y variaciones en estatus contractual y legal en el tiempo.…”