Cots Francesc, Castells Xavier, García Oscar, Riu Marta, Felipe Aida, Vall Oriol
Health Services Evaluation and Clinical Epidemiology, Department, Institut Municipal d'Assistència Sanitària, Barcelona, Spain.
BMC Health Serv Res. 2007 Jan 19;7:9. doi: 10.1186/1472-6963-7-9.
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.
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.
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.
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.
一些在移民水平低于西班牙的国家开展的研究分析了移民对医疗服务利用的影响。这些研究表明，移民人群的医疗服务利用率低于东道国人口，且移民倾向于使用医院急诊服务，而牺牲了初级保健。我们旨在量化移民人群中急诊服务的相对过度利用情况。
对2002年和2003年巴塞罗那海洋医院的急诊就诊情况进行分析。记录原籍国、性别、年龄、出院相关情况（住院、出院回家或死亡）、医学专科以及与医疗护理相关的可变成本。移民被分为来自高收入国家的移民（IHIC）和来自低收入国家的移民（ILIC），并按原籍国比较平均直接成本。通过原籍国（分为五组）以及年龄、性别、住院和作为出院原因的死亡等个体变量，对直接成本的多元线性混合模型进行调整。医学专科被视为随机效应。
除妇科急诊就诊外，两组移民急诊就诊产生的费用均低于西班牙出生人口急诊就诊产生的费用。这种影响在成人急诊就诊中尤为明显。
移民倾向于优先使用急诊科而非其他医疗服务。在来自高收入国家的移民和来自低收入国家的移民之间未发现差异，这表明这一结果是由于急诊服务易于获取以及对该国卫生系统缺乏了解，而非移民社会经济地位导致的健康状况不佳。将成本作为复杂性变量使用代表了对一个高度详尽登记系统的机会主义利用，这种登记系统在医院中越来越常见，并且克服了与门诊活动相关的临床信息缺乏的问题。
