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Published in: BMC Health Services Research 1/2008

Open Access 01-12-2008 | Research article

Determinants of health care utilization by immigrants in Portugal

Authors: Sónia F Dias, Milton Severo, Henrique Barros

Published in: BMC Health Services Research | Issue 1/2008

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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.
Literature
1.
go back to reference Anderson JM, Tang S, Blue C: Health care reform and the paradox of efficiency: "writing in" culture. Int J Health Serv. 2007, 37 (2): 291-320. 10.2190/2416-5314-7785-70M6.CrossRefPubMed Anderson JM, Tang S, Blue C: Health care reform and the paradox of efficiency: "writing in" culture. Int J Health Serv. 2007, 37 (2): 291-320. 10.2190/2416-5314-7785-70M6.CrossRefPubMed
2.
go back to reference Gardner DB: Immigration and health care reform: shared struggles. Nurs Econ. 2007, 25 (4): 235-7.PubMed Gardner DB: Immigration and health care reform: shared struggles. Nurs Econ. 2007, 25 (4): 235-7.PubMed
3.
go back to reference OECD: International Migration Outlook: SOPEMI – 2006 Edition. 2006, Paris: OECDCrossRef OECD: International Migration Outlook: SOPEMI – 2006 Edition. 2006, Paris: OECDCrossRef
4.
go back to reference International Organization for Migration: World Migration 2005: costs and benefits of international migration. 2005, Switzerland: IOM International Organization for Migration: World Migration 2005: costs and benefits of international migration. 2005, Switzerland: IOM
5.
go back to reference Eurostat. Europe in Figures: Eurostat Yearbook 2006–07. 2006, Luxembourg: Eurostat Eurostat. Europe in Figures: Eurostat Yearbook 2006–07. 2006, Luxembourg: Eurostat
6.
go back to reference Hargreaves S, Friedland JS, Gothard P, Saxena S, Millington H, Eliahoo J, et al: Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders. BMC Health Serv Res. 2006, 6: 153-10.1186/1472-6963-6-153.CrossRefPubMedPubMedCentral Hargreaves S, Friedland JS, Gothard P, Saxena S, Millington H, Eliahoo J, et al: Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders. BMC Health Serv Res. 2006, 6: 153-10.1186/1472-6963-6-153.CrossRefPubMedPubMedCentral
7.
go back to reference Ku L, Matani S: Left Out: Immigrants' Access To Health Care And Insurance. Health Affairs. 2001, 20 (1): 247-56. 10.1377/hlthaff.20.1.247.CrossRefPubMed Ku L, Matani S: Left Out: Immigrants' Access To Health Care And Insurance. Health Affairs. 2001, 20 (1): 247-56. 10.1377/hlthaff.20.1.247.CrossRefPubMed
8.
go back to reference Carballo M, Divino JJ, Zeric D: Migration and health in the European Union. Trop Med Int Health. 1998, 3 (12): 936-44. 10.1046/j.1365-3156.1998.00337.x.CrossRefPubMed Carballo M, Divino JJ, Zeric D: Migration and health in the European Union. Trop Med Int Health. 1998, 3 (12): 936-44. 10.1046/j.1365-3156.1998.00337.x.CrossRefPubMed
9.
go back to reference Hjern A, Haglund B, Persson G, Roen M: Is there equity in access to health services for ethnic minorities in Sweden?. Eur J Public Health. 2001, 11 (2): 147-52. 10.1093/eurpub/11.2.147.CrossRefPubMed Hjern A, Haglund B, Persson G, Roen M: Is there equity in access to health services for ethnic minorities in Sweden?. Eur J Public Health. 2001, 11 (2): 147-52. 10.1093/eurpub/11.2.147.CrossRefPubMed
10.
go back to reference Politzer RM, Yoon J, Shi L, Hughes RG, Regan J, Gaston MH: Inequality in America: the contribution of health centers in reducing and eliminating disparities in access to care. Med Care Res Rev. 2001, 58 (2): 234-48. 10.1177/107755870105800205.CrossRefPubMed Politzer RM, Yoon J, Shi L, Hughes RG, Regan J, Gaston MH: Inequality in America: the contribution of health centers in reducing and eliminating disparities in access to care. Med Care Res Rev. 2001, 58 (2): 234-48. 10.1177/107755870105800205.CrossRefPubMed
11.
12.
go back to reference Stronks K, Ravelli ACJ, Reijneveld SA: Immigrants in the Netherlands: equal access for equal needs?. J Epidemiol Community Health. 2001, 55 (10): 701-7. 10.1136/jech.55.10.701.CrossRefPubMedPubMedCentral Stronks K, Ravelli ACJ, Reijneveld SA: Immigrants in the Netherlands: equal access for equal needs?. J Epidemiol Community Health. 2001, 55 (10): 701-7. 10.1136/jech.55.10.701.CrossRefPubMedPubMedCentral
13.
go back to reference Goddard M, Smith P: Equity of access to health care services: Theory and evidence from the UK. Soc Sci Med. 2001, 53: 1149-62. 10.1016/S0277-9536(00)00415-9.CrossRefPubMed Goddard M, Smith P: Equity of access to health care services: Theory and evidence from the UK. Soc Sci Med. 2001, 53: 1149-62. 10.1016/S0277-9536(00)00415-9.CrossRefPubMed
14.
go back to reference Torres-Cantero AM, Miguel AG, Gallardo C, Ippolito S: Health care provision for illegal migrants: may health policy make a difference?. Eur J Public Health. 2007, 17 (5): 483-5. 10.1093/eurpub/ckl266.CrossRefPubMed Torres-Cantero AM, Miguel AG, Gallardo C, Ippolito S: Health care provision for illegal migrants: may health policy make a difference?. Eur J Public Health. 2007, 17 (5): 483-5. 10.1093/eurpub/ckl266.CrossRefPubMed
15.
go back to reference Adamson J, Ben-Shlomo Y, Chaturvedi N, Donovan J: Ethnicity, socio-economic position and gender – do they affect reported health-care seeking behaviour?. Soc Sci Med. 2003, 57 (5): 895-904. 10.1016/S0277-9536(02)00458-6.CrossRefPubMed Adamson J, Ben-Shlomo Y, Chaturvedi N, Donovan J: Ethnicity, socio-economic position and gender – do they affect reported health-care seeking behaviour?. Soc Sci Med. 2003, 57 (5): 895-904. 10.1016/S0277-9536(02)00458-6.CrossRefPubMed
16.
go back to reference DuBard CA, Massing MW: Trends in emergency Medicaid expenditures for recent and undocumented immigrants. Jama. 2007, 297 (10): 1085-92. 10.1001/jama.297.10.1085.CrossRefPubMed DuBard CA, Massing MW: Trends in emergency Medicaid expenditures for recent and undocumented immigrants. Jama. 2007, 297 (10): 1085-92. 10.1001/jama.297.10.1085.CrossRefPubMed
17.
go back to reference Scheppers E, van Dongen E, Dekker J, Geertzen J, Dekker J: Potential barriers to the use of health services among ethnic minorities: a review. Family Practice. 2006, 23 (3): 325-48. 10.1093/fampra/cmi113.CrossRefPubMed Scheppers E, van Dongen E, Dekker J, Geertzen J, Dekker J: Potential barriers to the use of health services among ethnic minorities: a review. Family Practice. 2006, 23 (3): 325-48. 10.1093/fampra/cmi113.CrossRefPubMed
18.
go back to reference Fennely K: Listening to the experts: provider recommendations on the health needs of immigrants and refugees. 2004, Malmo: Malmo University Fennely K: Listening to the experts: provider recommendations on the health needs of immigrants and refugees. 2004, Malmo: Malmo University
19.
go back to reference Fenta H, Hyman I, Noh S: Health service utilization by Ethiopian immigrants and refugees in Toronto. J Immigr Minor Health. 2007, 9 (4): 349-57. 10.1007/s10903-007-9043-0.CrossRefPubMed Fenta H, Hyman I, Noh S: Health service utilization by Ethiopian immigrants and refugees in Toronto. J Immigr Minor Health. 2007, 9 (4): 349-57. 10.1007/s10903-007-9043-0.CrossRefPubMed
20.
go back to reference Kelaher M, Manderson L: Migration and mainstreaming: matching health services to immigrants" needs in Australia. Health Policy. 2000, 54 (1): 1-11. 10.1016/S0168-8510(00)00098-1.CrossRefPubMed Kelaher M, Manderson L: Migration and mainstreaming: matching health services to immigrants" needs in Australia. Health Policy. 2000, 54 (1): 1-11. 10.1016/S0168-8510(00)00098-1.CrossRefPubMed
21.
go back to reference Reijneveld SA: Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position?. J Epidemiol Community Health. 1998, 52 (5): 298-304.CrossRefPubMedPubMedCentral Reijneveld SA: Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position?. J Epidemiol Community Health. 1998, 52 (5): 298-304.CrossRefPubMedPubMedCentral
22.
go back to reference Llacer A, Zunzunegui MV, del Amo J, Mazarrasa L, Bolumar F: The contribution of a gender perspective to the understanding of migrants' health. J Epidemiol Community Health. 2007, 61 (Suppl_2): ii4-10. 10.1136/jech.2007.061770.PubMedPubMedCentral Llacer A, Zunzunegui MV, del Amo J, Mazarrasa L, Bolumar F: The contribution of a gender perspective to the understanding of migrants' health. J Epidemiol Community Health. 2007, 61 (Suppl_2): ii4-10. 10.1136/jech.2007.061770.PubMedPubMedCentral
23.
go back to reference Razum O, Zeeb H, Rohrmann S: The healthy migrant effect'-not merely a fallacy of inaccurate denominator figures. Int J Epidemiol. 2000, 29 (1): 191-2. 10.1093/ije/29.1.191.CrossRefPubMed Razum O, Zeeb H, Rohrmann S: The healthy migrant effect'-not merely a fallacy of inaccurate denominator figures. Int J Epidemiol. 2000, 29 (1): 191-2. 10.1093/ije/29.1.191.CrossRefPubMed
24.
go back to reference Lenz K, Bauer-Dubau K, Jelinek T: Delivery of Medical Care for Migrants in Germany: Delay of Diagnosis and Treatment. J Travel Med. 2006, 13 (3): 133-7. 10.1111/j.1708-8305.2006.00030.x.CrossRefPubMed Lenz K, Bauer-Dubau K, Jelinek T: Delivery of Medical Care for Migrants in Germany: Delay of Diagnosis and Treatment. J Travel Med. 2006, 13 (3): 133-7. 10.1111/j.1708-8305.2006.00030.x.CrossRefPubMed
25.
go back to reference Kandula NR, Kersey M, Lurie N: Assuring the health of immigrants: what the leading health indicators tell us. Annu Rev Public Health. 2004, 25: 357-76. 10.1146/annurev.publhealth.25.101802.123107.CrossRefPubMed Kandula NR, Kersey M, Lurie N: Assuring the health of immigrants: what the leading health indicators tell us. Annu Rev Public Health. 2004, 25: 357-76. 10.1146/annurev.publhealth.25.101802.123107.CrossRefPubMed
26.
go back to reference Lamkaddem M, Spreeuwenberg P, Deville W, Foets M, Groenewegen P: Changes in health and primary health care use of Moroccan and Turkish immigrants between 2001 and 2005: a longitudinal study. BMC Public Health. 2008, 8 (1): 40-10.1186/1471-2458-8-40.CrossRefPubMedPubMedCentral Lamkaddem M, Spreeuwenberg P, Deville W, Foets M, Groenewegen P: Changes in health and primary health care use of Moroccan and Turkish immigrants between 2001 and 2005: a longitudinal study. BMC Public Health. 2008, 8 (1): 40-10.1186/1471-2458-8-40.CrossRefPubMedPubMedCentral
27.
28.
go back to reference WHO: International Migration, Health and Human Rights. Health and human rights publication series. 2003, Geneva: WHO, 4 WHO: International Migration, Health and Human Rights. Health and human rights publication series. 2003, Geneva: WHO, 4
29.
go back to reference Wolff H, Stalder H, Epiney M, Walder A, Irion O, Morabia A: Health care and illegality: a survey of undocumented pregnant immigrants in Geneva. Soc Sci Med. 2005, 60 (9): 2149-54. 10.1016/j.socscimed.2004.12.007.CrossRefPubMed Wolff H, Stalder H, Epiney M, Walder A, Irion O, Morabia A: Health care and illegality: a survey of undocumented pregnant immigrants in Geneva. Soc Sci Med. 2005, 60 (9): 2149-54. 10.1016/j.socscimed.2004.12.007.CrossRefPubMed
30.
go back to reference McKee M: What can health services contribute to the reduction of inequalities in health?. Scand J Public Health. 2002, 30 (3): 54-8.CrossRef McKee M: What can health services contribute to the reduction of inequalities in health?. Scand J Public Health. 2002, 30 (3): 54-8.CrossRef
31.
go back to reference Cots F, Castells X, Garcia O, Riu M, Felipe A, Vall O: Impact of immigration on the cost of emergency visits in Barcelona (Spain). BMC Health Serv Res. 2007, 7: 9-10.1186/1472-6963-7-9.CrossRefPubMedPubMedCentral Cots F, Castells X, Garcia O, Riu M, Felipe A, Vall O: Impact of immigration on the cost of emergency visits in Barcelona (Spain). BMC Health Serv Res. 2007, 7: 9-10.1186/1472-6963-7-9.CrossRefPubMedPubMedCentral
32.
go back to reference Norredam M, Krasnik A, Moller Sorensen T, Keiding N, Joost Michaelsen J, Sonne Nielsen A: Emergency room utilization in Copenhagen: a comparison of immigrant groups and Danish-born residents. Scand J Public Health. 2004, 32 (1): 53-9. 10.1080/14034940310001659.CrossRefPubMed Norredam M, Krasnik A, Moller Sorensen T, Keiding N, Joost Michaelsen J, Sonne Nielsen A: Emergency room utilization in Copenhagen: a comparison of immigrant groups and Danish-born residents. Scand J Public Health. 2004, 32 (1): 53-9. 10.1080/14034940310001659.CrossRefPubMed
33.
go back to reference Leduc N, Proulx M: Patterns of health services utilization by recent immigrants. J Immigr Health. 2004, 6 (1): 15-27. 10.1023/B:JOIH.0000014639.49245.cc.CrossRefPubMed Leduc N, Proulx M: Patterns of health services utilization by recent immigrants. J Immigr Health. 2004, 6 (1): 15-27. 10.1023/B:JOIH.0000014639.49245.cc.CrossRefPubMed
34.
go back to reference Uiters E, Deville WLJM, Foets M, Groenewegen PP: Use of health care services by ethnic minorities in The Netherlands: do patterns differ?. Eur J Public Health. 2006, 16 (4): 388-93. 10.1093/eurpub/ckl040.CrossRefPubMed Uiters E, Deville WLJM, Foets M, Groenewegen PP: Use of health care services by ethnic minorities in The Netherlands: do patterns differ?. Eur J Public Health. 2006, 16 (4): 388-93. 10.1093/eurpub/ckl040.CrossRefPubMed
35.
36.
go back to reference Ngui EM, Flores G: Satisfaction with care and ease of using health care services among parents of children with special health care needs: the roles of race/ethnicity, insurance, language, and adequacy of family-centered care. Pediatrics. 2006, 117 (4): 1184-96. 10.1542/peds.2005-1088.CrossRefPubMed Ngui EM, Flores G: Satisfaction with care and ease of using health care services among parents of children with special health care needs: the roles of race/ethnicity, insurance, language, and adequacy of family-centered care. Pediatrics. 2006, 117 (4): 1184-96. 10.1542/peds.2005-1088.CrossRefPubMed
37.
go back to reference Grove NJ, Zwi AB: Our health and theirs: forced migration, othering, and public health. Soc Sci Med. 2006, 62 (8): 1931-42. 10.1016/j.socscimed.2005.08.061.CrossRefPubMed Grove NJ, Zwi AB: Our health and theirs: forced migration, othering, and public health. Soc Sci Med. 2006, 62 (8): 1931-42. 10.1016/j.socscimed.2005.08.061.CrossRefPubMed
38.
go back to reference Kulwicki AD, Miller J, Schim SM: Collaborative partnership for culture care: enhancing health services for the arab community. J Transcult Nurs. 2000, 11 (1): 31-9. 10.1177/104365960001100106.CrossRefPubMed Kulwicki AD, Miller J, Schim SM: Collaborative partnership for culture care: enhancing health services for the arab community. J Transcult Nurs. 2000, 11 (1): 31-9. 10.1177/104365960001100106.CrossRefPubMed
39.
go back to reference Wolffers I, Verghis S, Marin M: Migration, human rights, and health. Lancet. 2003, 362 (9400): 2019-20. 10.1016/S0140-6736(03)15026-X.CrossRefPubMed Wolffers I, Verghis S, Marin M: Migration, human rights, and health. Lancet. 2003, 362 (9400): 2019-20. 10.1016/S0140-6736(03)15026-X.CrossRefPubMed
40.
go back to reference Blais R, Maïga A: Do ethnic groups use health services like the majority of the population? A study from Quebec, Canada. Soc Sci Med. 1999, 48 (9): 1237-45. 10.1016/S0277-9536(98)00423-7.CrossRefPubMed Blais R, Maïga A: Do ethnic groups use health services like the majority of the population? A study from Quebec, Canada. Soc Sci Med. 1999, 48 (9): 1237-45. 10.1016/S0277-9536(98)00423-7.CrossRefPubMed
41.
go back to reference Eshiett M, Parry E: Migrants and health: a cultural dilemma. Clin Med. 2003, 3 (3): 229-31.CrossRef Eshiett M, Parry E: Migrants and health: a cultural dilemma. Clin Med. 2003, 3 (3): 229-31.CrossRef
Metadata
Title
Determinants of health care utilization by immigrants in Portugal
Authors
Sónia F Dias
Milton Severo
Henrique Barros
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2008
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-8-207

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