Cots F, Castells X, Ollé C, Manzanera R, Varela J, Vall O
Institut Municipal d'Assistència Sanitària de Barcelona (IMAS). Unitat Docent de l'IMAS. Barcelona. Spain.
Gac Sanit. 2002 Sep-Oct;16(5):376-84. doi: 10.1016/s0213-9111(02)71946-8.
Although the immigrant population in cities such as Barcelona has tripled in the last five years, until now the impact of this group on the health system has not been rigorously evaluated. The aim of this study was to compare hospital resource utilization among the immigrant population with that among the native population through case mix, demographic characteristics and hospital day use. MATERIAL AMD METHODS: We analyzed 15,057 discharges from Hospital del Mar in Barcelona in 2000. This hospital attends 60% of admissions from the Ciutat Vella district. In 2000, 21% of the population of this district were immigrants. Socio-demographic patient characteristics and case mix were compared between the immigrant and the native population. Hospital resource use was compared according to age, case mix (diagnosis related groups) and seriousness (severity, complications and comorbidities) of the events requiring medical care.
The case mix of the immigrant population differed from that of the autochthonous population due to pronounced ge differences and a higher fertility rate. Thirty-three percent of immigrant admissions were for deliveries. The mean cost of discharge of immigrants from low-income countries was 30% lower than that for the remaining discharges. After adjusting for age, case mix and severity, length of stay among the immigrant population was significantly shorter. A 5% reduction was found after adjusting for case mix and a 10% reduction was found when all the factors were considered.
Case mix differences are due to age and socio-cultural factors. Immigrants are rejuvenating the ageing native population and the role of gynecology-obstetrics and pediatrics needs to be increased. The finding that resource use per discharge is lower among immigrants from low-income countries contradicts the expectation that lower socioeconomic status leads to higher hospital resource use intensity. Therefore, new hypotheses and analyses that explain this situation should be put forward.
尽管在过去五年里，像巴塞罗那这样的城市中移民人口增长了两倍，但迄今为止，这一群体对卫生系统的影响尚未得到严格评估。本研究的目的是通过病例组合、人口统计学特征和住院天数，比较移民人口与本地人口的医院资源利用情况。
我们分析了2000年巴塞罗那海洋医院的15057份出院病例。该医院接收了老城区60%的住院病人。2000年，该城区21%的人口为移民。比较了移民和本地人口的社会人口统计学特征及病例组合。根据年龄、病例组合（诊断相关组）以及需要医疗护理事件的严重程度（严重性、并发症和合并症），比较了医院资源利用情况。
由于显著的地理差异和较高的生育率，移民人口的病例组合与本地人口不同。33%的移民住院是因为分娩。来自低收入国家的移民出院平均费用比其他出院病例低30%。在对年龄、病例组合和严重程度进行调整后，移民人口的住院时间显著缩短。调整病例组合后缩短了5%，综合考虑所有因素后缩短了10%。
病例组合差异归因于年龄和社会文化因素。移民正在使老龄化的本地人口年轻化，妇产科和儿科的作用需要增强。来自低收入国家的移民每次出院的资源利用较低这一发现，与社会经济地位较低会导致更高的医院资源利用强度这一预期相悖。因此，应该提出解释这种情况的新假设和分析。
