Determinants of health care utilization by immigrants in Portugal

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Abstract

Background

The increasing diversity of population in European Countries poses new challenges to national health systems. There is a lack of data on accessibility and use of health care services by migrants, appropriateness of the care provided, client satisfaction and problems experienced when confronting the health care system. This limits knowledge about the multiple determinants of the utilization of health services. The aim of this study was to describe the access of migrants to health care and its determinants in Portugal.

Methods

The study sample included 1513 immigrants (53% men), interviewed at the National Immigrant Support Centre, in Lisbon. Data were collected using questionnaires. The magnitude of associations between use of National Health Service and socio-demographic variables was estimated by means of odds ratios (OR) at 95% confidence intervals, calculated using logistic regression.

Results

Among participants, 3.6% stated not knowing where to go if facing a health problem. Approximately 20% of the respondents reported that they had never used the National Health Service, men more than women. Among National Health Service users, 35.6% attended Health Centres, 12% used Hospital services, and 54.4% used both. Among the participants that ever used the health services, 22.4% reported to be unsatisfied or very unsatisfied. After adjusting for all variables, utilization of health services, among immigrant men, remained significantly associated with length of stay, legal status, and country of origin. Among immigrant women, the use of health services was significantly associated with length of stay and country of origin.

Conclusion

There is a clear need to better understand how to ensure access to health care services and to deliver appropriate care to immigrants, and that special consideration must be given to recent and undocumented migrants. To increase health services use, and the uptake of prevention programs, barriers must be identified and approaches to remove them developed, through coherent and comprehensive strategies.

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Most cited references 42

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Equity of access to health care services: theory and evidence from the UK.

M. Goddard, P. Smith (2001)

The pursuit of equity of access to health care is a central objective of many health care systems. This paper first sets out a general theoretical framework within which equity of access can be examined. It then applies the framework by examining the extent to which research evidence has been able to detect systematic inequities of access in UK, where equity of access has been a central focus in the National Health Service since its inception in 1948. Inequity between socio-economic groups is used as an illustrative example, and the extent of inequity of access experienced is explored in each of five service areas: general practitioner consultations; acute hospital care; mental health services; preventative medicine and health promotion; and long-term health care. The paper concludes that there appear to be important inequities in access to some types of health care in the UK, but that the evidence is often methodologically inadequate, making it difficult to draw firm conclusions. In particular, it is difficult to establish the causes of inequities which in turn limits the scope for recommending appropriate policy to reduce inequities of access. The theoretical framework and the lessons learned from the UK are of direct relevance to researchers from other countries seeking to examine equity of access in a wide variety of institutional settings.

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Our health and theirs: forced migration, othering, and public health.

Natalie Grove, Anthony Zwi (2006)

This paper uses 'othering' theory to explore how forced migrants are received in developed countries and considers the implications of this for public health. It identifies a variety of mechanisms by which refugees, asylum seekers and irregular migrants are positioned as 'the other' and are defined and treated as separate, distant and disconnected from the host communities in receiving countries. The paper examines how this process has the potential to affect health outcomes both for individuals and communities and concludes that public health must engage with and challenge this othering discourse. It argues that public health practitioners have a critical role to play in reframing thinking about health services and health policies for forced migrants, by promoting inclusion and by helping shape a narrative which integrates and values the experiences of this population.

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Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position?

Sijmen A. Reijneveld (1998)

Differences in health, lifestyles, and use of health care between groups of varying ethnic origin can have important implications for preventive and curative health care. This paper studies whether socioeconomic factors explain ethnic differences in these outcomes. Data on health status, lifestyles, and use of health care were obtained from interviews with 3296 people aged 16-64 years (response: 60.6%), among whom were 848 first generation immigrants. Ethnic differences in these outcomes were examined with and without adjustment for socioeconomic factors, using logistic regression. General population of Amsterdam, the Netherlands. Health status (self rated health, General Health Questionnaire, functional limitations), lifestyles (smoking, alcohol), and use of health care (general practice, pharmaceuticals, hospitalisations). Immigrants from Turkey, Morocco and (former) Dutch colonies report a poorer health and a higher use of health care, especially primary health care among the elderly. An adverse socioeconomic position partially explains the poor health of these immigrants. In turn, their poor health explains most of their higher use of health care. Cultural factors and poor living conditions seem to contribute to the poor health of immigrants, besides an adverse socioeconomic position. The pressure on various health services will increase in future because of the relatively high increase in immigrants' needs at older ages and their presently low mean age.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central

ISSN (Electronic): 1472-6963

Publication date Collection: 2008

Publication date (Electronic): 7 October 2008

Volume: 8

Page: 207

Affiliations

[1 ]Public Health Department, Institute of Hygiene and Tropical Medicine, New University of Lisbon, Lisbon, Portugal

[2 ]Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal

[3 ]Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal

Article

Publisher ID: 1472-6963-8-207

DOI: 10.1186/1472-6963-8-207

PMC ID: 2567319

PubMed ID: 18840290

SO-VID: 1b4686ab-93ae-4f41-bf89-24abe5330bea

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.

Determinants of health care utilization by immigrants in Portugal

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Abstract

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Most cited references 42

Equity of access to health care services: theory and evidence from the UK.

Our health and theirs: forced migration, othering, and public health.

Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position?

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