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Health care utilization by immigrants in Italy

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Abstract

Healthcare utilization studies show how well documented disparities between migrants and non-migrants. Reducing such disparities is a major goal in European countries. However, healthcare utilization among Italian immigrants is under-studied. The objective of this study is to explore differences in healthcare use between immigrant and native Italians. Cross-sectional study using the latest available (2004/2005) Italian Health Conditions Survey. We estimated separate hurdle binomial negative regression models for GP, specialist, and telephone consultations and a logit model for emergency room (ER) use. We used logistic regression and zero-truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Adjusting for risk factors, immigrants are significantly less likely to use healthcare services with 2.4 and 2.7 % lower utilization probability for specialist and telephone consultations, respectively. First- and second-generation immigrants’ probability for specialist and telephone contact is significantly lower than natives’. Immigrants, ceteris paribus, have a much higher probability of using ERs than natives (0.7 %). First-generation immigrants show a higher probability of visiting ERs (1 %). GP visits show no significant difference. In conclusion Italian immigrants are much less likely to use specialist healthcare and medical telephone consultations than natives but more likely to use ERs. Hence, we report an over-use of ERs and under-utilization of preventive care among immigrants. We recommend improved health policies for immigrants: promotion of better information dissemination among them, simplification of organizational procedures, better communications between providers and immigrants, and an increased supply of health services for the most disadvantaged populations.

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Notes

  1. For instance, the EU paid attention to disparities in the delivery of health care to immigrants by assisting the research program named Assisting Migrants and Communities: Analysis of Social Determinants of Health and Health Inequalities in 2007.

  2. Servizio Sanitario Nazionale.

  3. In some countries (for instance, Canada) immigrants are screened for good health before entering the country. This might also result in lower health care use.

  4. This healthy effect could disappear as a result of the stress of adapting and of reallocation.

  5. In the formal literature, some empirical studies documented the existence of disparities in health care use according to country of origin (for instance, Glaesmer et al. 2011). All these countries of origin might be characterized by different religious practices. They are also culturally speaking far from each other (other Western European countries and Morocco, Albania, and Romania) as well as in some cases geographically distant.

  6. The same can be applied to our measures of self-reported indicators included in the empirical analysis that might be measured with error (for instance, see Benitez-Silva et al. 2004).

  7. In the survey, individuals are asked whether or not the disease is diagnosed by a physician.

  8. North-West includes the following regions: Piedmont, Valle d’Aosta, Lombardy, Liguria; North-East includes Veneto, Trentino Alto Adige, Friuli Venezia Giulia, Emilia Romagna; Center includes Tuscany, Lazio, Marche, Umbria; South includes Abruzzi, Campania, Apulia, Molise, Basilicata, Calabria; Islands includes Sicily and Sardinia.

  9. Results are available upon request to authors.

  10. To check the robustness of our results we have also estimated a Zero-Inflated Negative Binomial model for telephone consultations, the results concerning our variable of interests remain nearly unchanged.

  11. Although a person with formal education and in better health could tend to use more GP services for preventive care reasons. See, for instance, Birch et al. (1993).

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Authors and Affiliations

  1. Department of Economics and Statistics, University of Calabria, via Ponte Bucci, 87036, Arcavacata di Rende, CS, Italy

    Giuliana De Luca

  2. Department of Economics, University of Naples Federico II, Via Cintia Monte S. Angelo, 80126,  Napoli, Italy

    Michela Ponzo

  3. School of Business Administration (SBA), Al Akhawayn University, P.O. Box 104, Hassan II Avenue, 53000,  Ifrane, Morocco

    Antonio Rodríguez Andrés

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  1. Giuliana De Luca
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  2. Michela Ponzo
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Correspondence to Michela Ponzo.

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De Luca, G., Ponzo, M. & Andrés, A.R. Health care utilization by immigrants in Italy. Int J Health Care Finance Econ 13, 1–31 (2013). https://doi.org/10.1007/s10754-012-9119-9

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