BMC Health Services Research
Volume 7, 2007

Impact of immigration on the cost of emergency visits in Barcelona (Spain) (Article) (Open Access)

Cots F.* , Castells X. , García O. , Riu M. , Felipe A. , Vall O.
  • a Health Services Evaluation and Clinical Epidemiology, Department, Institut Municipal d'Assistència Sanitària (IMAS), Barcelona, Spain, Health Services Research Unit, IMIM-IMAS, Barcelona, Spain
  • b Health Services Evaluation and Clinical Epidemiology, Department, Institut Municipal d'Assistència Sanitària (IMAS), Barcelona, Spain, Health Services Research Unit, IMIM-IMAS, Barcelona, Spain, Departament de Pediatria, Obstetrícia I Ginecologia I Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain
  • c Paediatric Service, Institut Municipal d'Assistència Sanitària (IMAS), Barcelona, Spain, Childhood and Environment Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-IMAS), Barcelona, Spain, Departament de Pediatria, Obstetrícia I Ginecologia I Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain
  • d Health Services Evaluation and Clinical Epidemiology, Department, Institut Municipal d'Assistència Sanitària (IMAS), Barcelona, Spain, Health Services Research Unit, IMIM-IMAS, Barcelona, Spain
  • e Paediatric Service, Institut Municipal d'Assistència Sanitària (IMAS), Barcelona, Spain, Childhood and Environment Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-IMAS), Barcelona, Spain
  • f Paediatric Service, Institut Municipal d'Assistència Sanitària (IMAS), Barcelona, Spain, Childhood and Environment Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-IMAS), Barcelona, Spain, Departament de Pediatria, Obstetrícia I Ginecologia I Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain

Abstract

Background. The impact of immigration on health services utilisation has been analysed by several studies performed in countries with lower levels of immigration than Spain. These studies indicate that health services utilisation is lower among the immigrant population than among the host population and that immigrants tend to use hospital emergency services at the expense of primary care. We aimed to quantify the relative over-utilisation of emergency services in the immigrant population. Methods. Emergency visits to Hospital del Mar in Barcelona in 2002 and 2003 were analysed. The country of origin, gender, age, discharge-related circumstances (hospital admission, discharge to home, or death), medical specialty, and variable cost related to medical care were registered. Immigrants were grouped into those from high-income countries (IHIC) and those from low-income countries (ILIC) and the average direct cost was compared by country of origin. A multivariate linear mixed model of direct costs was adjusted by country of origin (classified in five groups) and by the individual variables of age, gender, hospital admission, and death as a cause of discharge. Medical specialty was considered as a random effect. Results. With the exception of gynaecological emergency visits, costs resulting from emergency visits by both groups of immigrants were lower than those due to visits by the Spanish-born population. This effect was especially marked for emergency visits by adults. Conclusion. Immigrants tend to use the emergency department in preference to other health services. No differences were found between IHIC and ILIC, suggesting that this result was due to the ease of access to emergency services and to lack of knowledge about the country's health system rather than to poor health status resulting from immigrants' socioeconomic position. The use of costs as a variable of complexity represents an opportunistic use of a highly exhaustive registry, which is becoming ever more frequent in hospitals and which overcomes the lack of clinical information related to outpatient activity. © 2007 Cots et al; licensee BioMed Central Ltd.

Author Keywords

[No Keywords available]

Index Keywords

hospital cost hospital admission patient care hospitalization economics developing country hospital discharge human Developing Countries epidemiology middle aged immigration statistics and numerical data health service Developed Countries Aged death emergency ward ethnology health care cost health economics Humans classification Adolescent Hospital Costs Infant, Newborn male Spain preschool child Aged, 80 and over Infant very elderly specialization Child, Preschool Multivariate Analysis newborn female patient satisfaction Episode of Care Article adult migration emergency health service developed country medical specialist Patient Admission utilization Economics, Medical Emergency Service, Hospital Emigration and Immigration Health Services Misuse gynecology Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-33846518323&doi=10.1186%2f1472-6963-7-9&partnerID=40&md5=8f277f5f9a9f18d8404afa41d28e078c
DOI: 10.1186/1472-6963-7-9
ISSN: 14726963
Cited by: 68
Original Language: English