Understanding transnational healthcare use in immigrant communities from a cultural systems perspective: a qualitative study of Dutch residents with a Turkish background

Abstract

ObjectivesTransnational utilisation of healthcare by people with an immigrant background carries risks, including medicalisation and adverse iatrogenic outcomes. We investigated the drivers behind such transnational healthcare use from a cultural perspective on health systems.DesignQualitative interview study (2018).SettingTwo primary care practices in Amsterdam, the Netherlands.ParticipantsThirteen Dutch patients of Turkish background, who had obtained healthcare in Turkey, and who in general visited the primary care practice more than once a month.ResultsIn the respondents’ stories, we observed how: (1) cross-border healthcare use was encouraged by cultural mismatches between expected and provided services and by differing explanatory models of illness upheld by patients and Dutch providers; (2) both transnationalism in patients and entitlements to insurance reimbursement facilitated the use of Turkish health services to bypass perceived barriers in the Dutch system; (3) cultural mismatches were reinforced during general practitioner consultations after the patients’ return to the Netherlands, thereby inducing further service use abroad.ConclusionsAlthough cultural system influences are difficult to bridge, measures to reduce the unwelcome consequences of transnational healthcare use may include (1) strengthening the provision of culturally sensitive care in the country of residence and (2) restricting the reimbursement of care in the country of origin while maintaining the option to obtain care abroad.

Health service behaviors of migrants: A conceptual framework

“…Some variables are immigrant-specific factors. Acculturation measured by language and communication (21, 180), discrimination experiences (188), and cultural differences (183,193) was associated with immigrants' medical locations for which the latter yielded mixed results (192). In addition, medical culture was previously mentioned in studies on immigrants (21,181,182,187).…”

“…Enrollment status in the accessible medical insurance was another factor associated with the medical locations of immigrants (21, 180, 184) and IMs (190,191,195), especially the local medical insurance (184,191). The characteristics of medical insurance, such as the location/type (18,195) and compensation rules (193) of a specific form of medical insurance, were also described in the literature concerning migrants. Second, social resources as measured by relatives living in their home country by immigrants (196) and family members living together by IMs (190) were found to be another factor associated with medical locations.…”