J Epidemiol Community Health 2001;55:701-707 ( October )

Research report

Immigrants in the Netherlands: Equal access for equal needs? K Stronks^a, A C J Ravelli^a, S A Reijneveld^b

^a Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, the Netherlands, ^b TNO Prevention and Health, Department of Public Health

Correspondence to: Dr Stronks (k.stronks{at}amc.uva.nl)

Accepted for publication 26 February 2001

OBJECTIVEThis paper examines whether equal utilisation of health care services for first generation immigrant groups has been achieved in the Netherlands.
DESIGNSurvey data were linked to an insurance register concerning people aged 16-64. Ethnic differences in the use of a broad range of health care services were examined in this group, with and without adjustment for health status and socioeconomic status, using logistic regression.
SETTINGPublicly insured population in Amsterdam, the Netherlands.
PARTICIPANTS1422 people from the indigenous population, and 378 people from the four largest immigrant groups in the Netherlandsthat is, the Surinamese, the Netherlands Antilleans, and the Turkish and Moroccan.
MAIN OUTCOME MEASURESGeneral practitioner service use (past two months), prescription drug use (past three months), outpatient specialist contact (past two months), hospital admission (past year), physiotherapist contact (past two months) and contact with other paramedics (past year).
MAIN RESULTSEthnicity was found to be associated with the use of health care after controlling for health status as an indicator for need. The use of general practitioner care and the use of prescribed drugs was increased among people from Surinam, Turkey and Morocco as compared with the indigenous population. Compared with the indigenous group with corresponding health status, the use of all other more specialised services was relatively low among Turkish and Moroccan people. Among the Surinamese population, the use of more specialised care was highly similar to that found in the Dutch population after differences in need were controlled for. Among people from the Netherlands Antilles, we observed a relatively high use of hospital services in combination with underuse of general practitioner services. The lower socioeconomic status of immigrant groups explained most of the increased use of the general practitioner and prescribed drugs, but could not account for the lower use of the more specialised services.
CONCLUSIONSThe results indicate that the utilisation of more specialised health care is lower for immigrant groups in the Netherlands, particularly for Turkish and Moroccan people and to a lesser extent, people from the Netherlands Antilles. Although underuse of more specialised services is also present among the lower socioeconomic groups in the Netherlands, the analyses indicate that this only partly explains the lower utilisation of these services among immigrant groups. This suggests that ethnic background in itself may account for patterns of consumption, potentially because of limited access.


Keywords: ethnic minorities; equality

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© 2001 by Journal of Epidemiology and Community Health
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