Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC) utilisation patterns between immigrants and the native population with regard to their morbidity burden.

Methods

This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain). Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System ^®).

Results

The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p < 0.05; adults: IRR = 0.73, p < 0.05). After adjusting for morbidity burden, this difference decreased among children (IRR = 0.94, p < 0.05) and disappeared among adults (IRR = 1.00). Further analysis considering the PC health service and type of visit revealed higher usage of routine diagnostic tests among immigrant children (IRR = 1.77, p < 0.05) and a higher usage of emergency services among the immigrant adult population (IRR = 1.2, p < 0.05) after adjusting for age, sex and case mix.

Conclusions

Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.

Related collections

Most cited references 29

Record: found
Abstract: found
Article: not found

Development and application of a population-oriented measure of ambulatory care case-mix.

J Weiner, B H Starfield, D M Steinwachs … (1991)

This article describes a new case-mix methodology applicable primarily to the ambulatory care sector. The Ambulatory Care Group (ACG) system provides a conceptually simple, statistically valid, and clinically relevant measure useful in predicting the utilization of ambulatory health services within a particular population group. ACGs are based on a person's demographic characteristics and their pattern of disease over an extended period of time, such as a year. Specifically, the ACG system is driven by a person's age, sex, and ICD-9-CM diagnoses assigned during patient-provider encounters; it does not require any special data beyond those collected routinely by insurance claims systems or encounter forms. The categorization scheme does not depend on the presence of specific diagnoses that may change over time; rather it is based on broad clusters of diagnoses and conditions. The presence or absence of each disease cluster, along with age and sex, are used to classify a person into one of 51 ACG categories. The ACG system has been developed and tested using computerized encounter and claims data from more than 160,000 continuous enrollees at four large HMOs and a state's Medicaid program. The ACG system can explain more than 50% of the variance in ambulatory resource use if used retrospectively and more than 20% if applied prospectively. This compares with 6% when age and sex alone are used. In addition to describing ACG development and validation, this article also explores some potential applications of the system for provider payment, quality assurance, utilization review, and health services research, particularly as it relates to capitated settings.

0 comments Cited 155 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979-2003.

G. Singh, Robert Hiatt (2006)

Immigrants are a growing segment of the US population. In 2003, there were 33.5 million immigrants, accounting for 12% of the total US population. Despite a rapid increase in their numbers, little information exists as to how immigrants' health and mortality profile has changed over time. In this study, we analysed trends in social and behavioural characteristics, life expectancy, and mortality patterns of immigrants and the US-born from 1979 to 2003. We used national mortality and census data (1979-2003) and 1993 and 2003 National Health Interview Surveys to examine nativity differentials over time in health and social characteristics. Life tables, age-adjusted death rates, and logistic regression were used to examine nativity differentials. During 1979-81, immigrants had 2.3 years longer life expectancy than the US-born (76.2 vs 73.9 years). The difference increased to 3.4 years in 1999-2001 (80.0 vs 76.6 years). Nativity differentials in mortality increased over time for major cancers, cardiovascular diseases, diabetes, respiratory diseases, unintentional injuries, and suicide, with immigrants experiencing generally lower mortality than the US-born in each period. Specifically, in 1999-2001, immigrants had at least 30% lower mortality from lung and oesophageal cancer, COPD, suicide, and HIV/AIDS, but at least 50% higher mortality from stomach and liver cancer than the US-born. Nativity differentials in mortality, health, and behavioural characteristics varied substantially by ethnicity. Growing ethnic heterogeneity of the immigrant population, and its migration selectivity and continuing advantages in behavioural characteristics may partly explain the overall widening health gaps between immigrants and the US-born.

0 comments Cited 109 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Ambulatory care groups: a categorization of diagnoses for research and management.

B Starfield, J. Weiner, L. Mumford … (1991)

This article describes a case-mix measure for application in ambulatory populations. The method is based primarily on categorization of diagnoses according to their likelihood of persistence. Fifty-one combinations (the ambulatory care groups or ACGs) result from applying multivariate techniques to maximize variance explained in use of services and ambulatory care charges. The method is tested in four different HMOs and a large Medicaid population. The percentage of the population in each of the 51 categories is similar across the HMOs; the Medicaid population has higher burdens of morbidity as measured by more numerous types of diagnoses. Mean visit rates for individuals within each of the 51 morbidity categories are generally similar across the five facilities, but these visit rates vary markedly from one category to another, even within groupings that are similar in the number of types of diagnoses within them. Visit rates for individuals who stay in the same ACG were similar from one year to the next. The ACG system is found useful in predicting both concurrent and subsequent ambulatory care use and charges as well as subsequent morbidity. It provides a way to specify case mix in enrolled populations for research as well as administration and reimbursement for ambulatory care.

0 comments Cited 109 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central

ISSN (Electronic): 1471-2458

Publication date Collection: 2011

Publication date (Electronic): 6 June 2011

Volume: 11

Page: 432

Affiliations

[1 ]Instituto Aragonés de Ciencias de la Salud (I+CS), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain

[2 ]San Pablo Primary Health Care Centre, Servicio Aragonés de Salud (SALUD), Zaragoza, Spain

[3 ]Fuentes de Ebro Primary Health Care Centre, Servicio Aragonés de Salud (SALUD), Zaragoza, Spain

Article

Publisher ID: 1471-2458-11-432

DOI: 10.1186/1471-2458-11-432

PMC ID: 3128023

PubMed ID: 21645335

SO-VID: 0d392677-68b7-4ce2-8b74-0ac0f4f0253d

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

Read this article at

Abstract

Background

Methods

Results

Conclusions

Related collections

Global Health Next Generation Network

Most cited references 29

Development and application of a population-oriented measure of ambulatory care case-mix.

Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979-2003.

Ambulatory care groups: a categorization of diagnoses for research and management.

Author and article information

Journal

Affiliations

Article

History

Categories

Comments

Comment on this article

Similar content 271

Cited by 22

Most referenced authors 319