Primary health care utilization by immigrants as compared to the native population: a multilevel analysis of a large clinical database in Catalonia

Abstract

Background: Immigration is a relevant public health issue and there is a great deal of controversy surrounding its impact on health services utilization.

Objective: To determine differences between immigrants and non-immigrants in the utilization of primary health care services in Catalonia, Spain.

Methods: Population based, cross-sectional, multicentre study. We used the information from 16 primary health care centres in an area near Barcelona, Spain. We conducted a multilevel analysis for the year 2008 to compare primary health care services utilization between all immigrants aged 15 or more and a sample of non-immigrants, paired by age and sex.

Results: Overall, immigrants living in Spain used health services more than non-immigrants (Incidence Risk Ratio (IRR) 1.16 (95% Confidence Interval (CI): 1.15 – 1.16) and (IRR 1, 26, 95% CI: 1.25–1.28) for consultations with GPs and referrals to specialized care, respectively. People coming from the Maghreb and the rest of Africa requested the most consultations involving a GP and nurses (IRR 1.34, 95% CI: 1.33–1.36 and IRR 1.06, 95% CI: 1.03–1.44, respectively). They were more frequently referred to specialized care (IRR 1.44, 95% CI: 1.41–1.46) when compared to Spaniards. Immigrants from Asia had the lowest numbers of consultations with a GP and referrals (IRR 0.76, 95% CI: 0.66–0.88 and IRR 0.76, 95% CI: 0.61–0.95, respectively.

Conclusion: On average, immigrants living in Catalonia used the health services more than non-immigrants. Immigrants from the Maghreb and other African countries showed the highest and those from Asia the lowest, number of consultations and referrals to specialized care.

Key words::

• Health services utilization
• primary care
• immigrants

ACKNOWLEDGEMENTS

The authors are grateful to Maria José Torras for her contribution in facilitating data access and Stephanie Lonsdale for reviewing the English version of the manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.