Skip to main content

Advertisement

SpringerLink
Log in

Inequalities in the use of health services between immigrants and the native population in Spain: what is driving the differences?

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

In Spain, a growing body of literature has drawn attention to analysing the differences in health and health resource utilisation of immigrants relative to the autochthonous population. The results of these studies generally find substantial variations in health-related patterns between both population groups. In this study, we use the Oaxaca-Blinder decomposition technique to explore to what extent disparities in the probability of using medical care use can be attributed to differences in the determinants of use due to, e.g. a different demographic structure of the immigrant collective, rather than to a different effect of health care use determinants by nationality, holding all other factors equal. Our findings show that unexplained factors associated to immigrant status determine to a great extent disparities in the probability of using hospital, specialist and emergency services of immigrants relative to Spaniards, while individual characteristics, in particular self-reported health and chronic conditions, are much more important in explaining the differences in the probability of using general practitioner services between immigrants and Spaniards.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. Hence, only those individuals registered in the census (either Spanish nationals or foreigners) are included in the dataset.

  2. In Spain, the long waiting lists for specialised attention or to be admitted to hospital has induced a demand for supplementary private insurance that permits direct access to specialists. Private insurance also provides an alternative modality of care for some population groups such as civil servants, who have the possibility to opt out between the NHS or private insurance companies [2].

References

  1. INE (National Statistics Institute). Key population series from 1998. From http://www.ine.es/jaxi/menu.do?type=pcaxis&path=/t20/e245/p08/&file=pcaxis. (2009)

  2. Durán, A., Lara, J. L., van Waveren, M.: Health Care Systems in Transition. Spain, Copenhagen (2006)

  3. Hernández-Quevedo, C., Jiménez-Rubio, D.: A comparison of the health status and health care utilisation patterns between foreigners and the national population in Spain: new evidence from the Spanish national health survey. Soc. Sci. Med. 69, 370–378 (2009)

    Article  Google Scholar 

  4. Cots, F., Castells, X., García, O., Riu, M., Felipe, A., Vall, O.: Impact of immigration on the cost of emergency visits in Barcelona (Spain). BMC Health Serv. Res. 7, 9–17 (2007)

    Article  Google Scholar 

  5. García Gómez, P.: Salud y utilización de los recursos sanitarios: un análisis de las diferencias y similitudes entre población inmigrante y autónoma. Presup y Gasto Público 49(4), 67–85 (2007)

    Google Scholar 

  6. Oaxaca, R.: Male-female wage differentials in urban labor markets. Int. Econ. Rev. 14(3), 693–709 (1973)

    Article  Google Scholar 

  7. Blinder, A.S.: Wage discrimination: reduced form and structural estimates. J. Hum. Resour. 8(4), 436–455 (1973)

    Article  Google Scholar 

  8. Farley, R.: Blacks, Hispanics, and white ethnic groups: are blacks uniquely disadvantaged? Am. Econ. Rev. 80, 237–241 (1990)

    Google Scholar 

  9. Juhn, C., Murphy, K.M., Pierce, B.: Wage inequality and the rise in returns to skill. J. Polit. Econ. 101(3), 410–442 (1993)

    Article  Google Scholar 

  10. O’Donell, O., López-Nicolás, A., Van Doorslaer, E.: Growing richer and taller: explaining change in the distribution of child nutritional status during Vietnam’s economic boom. J. Dev. Econ. 88(1), 45–48 (2009)

    Article  Google Scholar 

  11. González-Álvarez, M.L., Clavero-Barranquero, A.: Inequalities in health care utlization in Spain due to double coverage: an Oaxaca-Ransom decomposition. Soc. Sci. Med. 69(5):793–801 (2009)

    Google Scholar 

  12. Hargraves, J.L., Hadley, J.: The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Serv. Res. 38(3), 809–829 (2003)

    Article  Google Scholar 

  13. Gaskin, D.J., Briesacher, B.A., Limcangco, R., Brigantti, L.B.: Exploring racial and ethnic disparities in prescription drug spending and use among medicare beneficiaries. Am. J. Geriatr. Pharm. 4(2), 96–111 (2006)

    Article  Google Scholar 

  14. Bauer, T.K., Sinning, M.: An extension of the Blinder-Oaxaca decomposition to nonlinear models. Adv. Stat. Anal. 92, 197–206 (2008)

    Article  Google Scholar 

  15. Oaxaca, R., Ransom, M.R.: On discrimination and the decomposition of wage differentials. J. Econom. 61, 5–21 (1994)

    Article  Google Scholar 

  16. Morris, S., Sutton, M., Gravelle, H.: Inequity and inequality in the use of health care in England: an empirical investigation. Soc. Sci. Med. 60, 1251–1266 (2005)

    Article  Google Scholar 

  17. Abásolo, I., Manning, R., Jones, A.: Equity in utilization of and access to public sector GPs in Spain. Appl. Econ. 33, 349–364 (2001)

    Google Scholar 

  18. Jones, A.M.: Health econometrics. In: Culyer, A.J., Newhouse, J.P. (eds.) Handbook of health economics. Elsevier North Holland, Amsterdam (2000)

    Google Scholar 

  19. Fairlie, R.W.: The absence of the African-American owned business: an analysis of the dynamics of self-employment. J. Labor Econ. 17(1), 80–118 (1999)

    Article  Google Scholar 

  20. Fairlie, R.W.: An extension of the Oaxaca-Blinder decomposition technique to logit and probit models. J. Econ. Soc. Meas. 30, 305–316 (2005)

    Google Scholar 

  21. MSC (Ministry of Health and Consumption). 2003 and 2006 National Health Surveys, http://www.msc.es/estadEstudios/estadisticas/solicitud.htm; 2009

  22. INE (National Statistics Institute). National Health Survey. Detailed methodology. From http://www.ine.es/jaxi/menu.do?type=pcaxis&path=/t15/p419&file=inebase&L=0. (2009)

  23. Álvarez, B.: La demanda atendida de consultas médicas y servicios urgentes en España. Investig. Econ. XXV(1), 93–138 (2001)

    Google Scholar 

  24. Wooldridge, J.M.: Introductory Econometrics. South-Western College, Cincinnati, OH (2006)

    Google Scholar 

  25. Jagger, C., Gillies, C., Moscone, F., Cambois, E., Van Oyen, H., Nusselder, H., Robine, W., The EHLEIS Team: Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis. Lancet 372, 2124–2131 (2008)

    Article  Google Scholar 

  26. García-Gómez, P., López-Nicolás, A.: The evolution of inequity in the access to health care in Spain: 1987–2001 Documento de Trabajo No. 10, Fundación BBVA. (2007)

  27. Mladovsky, P.: Migration and Health in the EU. Research Note. European Commission, Brussels (2007)

    Google Scholar 

  28. Cots, F., Castells, X., Ollé, C., Manzanera, R., Varela, J., Vall, O.: Perfil de la casuística hospitalaria de la población inmigrante de Barcelona. Gac Sanit 16, 376–384 (2002)

    Google Scholar 

  29. Miralles, M., Díez, E.: Análisis de la demanda asistencial de la población inmigrante en la atención neurológica ambulatoria. Neurol 23(6), 361–366 (2008)

    Google Scholar 

  30. Olsen, K.M., Dahl, S.: Health differences between European countries. Soc. Sci. Med. 64, 1665–1678 (2007)

    Article  Google Scholar 

  31. Sanz, B., Torres, A.M.: Sociodemographic characteristics and use of health services by the immigrant population residing in a district of the community of Madrid. Aten. Primaria 26, 314–318 (2000)

    Google Scholar 

  32. Diario Médico: Immigration website. From: http://medicablogs.diariomedico.com/inmigracion/ (in Spanish). (2009)

  33. Taylor, L.E., Taylor-Henley, S., Doan, L.: Older immigrants: language competencies and mental health. Can. J. Commun. Ment. Health 24, 23–34 (2005)

    Google Scholar 

Download references

Acknowledgments

Authors are grateful to Bruno Casal, MªLuz González-Álvarez and participants at the XXIX Jornadas de la Salud, Málaga (Spain) for valuable comments on earlier versions of this work. Any remaining errors are the sole responsibility of the authors. Also, the authors would like to acknowledge financial support from Fundación Alternativas, Madrid (Spain).

Author information

Authors and Affiliations

  1. Department of Applied Economics, Faculty of Economics and Business Sciences, Campus Universitario de Cartuja, University of Granada, 18071, Granada, Spain

    Dolores Jiménez-Rubio

  2. European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK

    Cristina Hernández-Quevedo

Authors
  1. Dolores Jiménez-Rubio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Hernández-Quevedo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dolores Jiménez-Rubio.

Appendix

Appendix

See Tables 5, 6 and 7.

Table 5 Descriptive statistics of key variables (average 2003–2006)
Full size table
Table 6 Odds ratios for the logit specifications for health care utilisation for Spaniards (appropriate utilisation)
Full size table
Table 7 Odds ratios for the logit specifications for health care utilisation for non-Spaniards
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jiménez-Rubio, D., Hernández-Quevedo, C. Inequalities in the use of health services between immigrants and the native population in Spain: what is driving the differences?. Eur J Health Econ 12, 17–28 (2011). https://doi.org/10.1007/s10198-010-0220-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-010-0220-z

Keywords

Search

Navigation