CIBER of Epidemiology and Public Health, University of Girona, Campus Montilivi, 17071 Girona, Spain.
Eur J Health Econ. 2012 Aug;13(4):419-27. doi: 10.1007/s10198-011-0313-3. Epub 2011 Apr 16.
Increased population flowing from abroad has generated an intense debate regarding the economic consequences of migration in public services such as health, where new and specific demands are being created. This new demand for health care gives rise to the need to identify those factors which influence the user's decision to contact the health services and those which determine the quantity of services consumed. The aim of this study is to identify which variables affect these two stages of the use of such services in the Girona Health Region (RSG), where immigrant population represents 21.96% of the total population.
Specification of a Hurdle model with a count response variable related to primary health care service visits in the RSG for 2006. The study data is based on a sample of users (immigrants and natives) taken from the population assigned to primary health care services in eight Basic Health Areas (ABS) of the RSG.
Contacting primary health care services is associated with variables that ought to affect use of health care such as chronic illness and taking prescribed medication as well as being aged between 46 and 55. Using primary health care services once makes users more likely to make further visits. The number of visits is related not only with variables that ought affect use of health care but also with variables that ought not to affect use of health care such as working without a contract, living in rented accommodation, or being unemployed. Additionally, if we consider the birthplace of the user, we observe the same pattern, with different directions and intensities, depending on the origin of the patient. For example, a higher likelihood of first contact is shown in Eastern Europeans, South Americans, and North Africans that suffer from cholesterol. A higher attendance is observed in natives and Eastern Europeans that take prescribed medication as well as natives, Eastern Europeans, and North Africans living in rented accommodation. On the other hand, working without a contract supposes a higher attendance in natives but a lower attendance in Eastern Europeans and sub-Saharan Africans.
We do not detect any socioeconomic barriers associated with making a first contact with primary health services for the users analyzed. However, we do note evidence of horizontal inequity in terms of attending health services, related to variables that ought to affect use of health care as well as socioeconomic factors (variables that ought not to affect use of health care). The user's origin is an important key in detecting different intensities of access and regular visits to primary health care services.
大量流动人口的涌入引发了一场激烈的辩论，即移民对公共服务（如医疗保健）的经济影响，因为新的和特定的需求正在产生。这种对医疗保健的新需求引发了人们需要确定影响用户决定联系医疗服务的因素，以及决定服务消费数量的因素。本研究的目的是确定在拥有 21.96%总人口的移民人口的赫罗纳卫生区（RSG）中，哪些变量会影响这些服务使用的两个阶段。
在 2006 年赫罗纳卫生区（RSG）的初级保健服务中，对与计数响应变量相关的障碍模型进行了规范。研究数据基于从 RSG 的八个基本保健区（ABS）分配给初级保健服务的用户（移民和本地人）样本。
接触初级保健服务与应影响医疗保健使用的变量相关，例如慢性病和服用规定的药物，以及年龄在 46 至 55 岁之间。一旦使用初级保健服务，用户就更有可能进行进一步的访问。访问次数不仅与应影响医疗保健使用的变量有关，而且还与不应影响医疗保健使用的变量有关，例如无合同工作、租用住房或失业。此外，如果我们考虑用户的出生地，我们会观察到相同的模式，不同的方向和强度，具体取决于患者的来源。例如，患有胆固醇的东欧人、南美人、北非人和东欧人首次接触的可能性更高。服用规定药物的本地人、东欧人和北非人以及租用住房的本地人、东欧人和北非人出勤率更高。另一方面，无合同工作意味着本地人出勤率更高，而东欧人和撒哈拉以南非洲人出勤率更低。
我们没有发现分析用户与首次接触初级卫生服务相关的任何社会经济障碍。然而，我们确实注意到在参加卫生服务方面存在横向不公平的证据，这与应影响医疗保健使用的变量以及社会经济因素（不应影响医疗保健使用的变量）有关。用户的来源是发现初级保健服务不同访问强度和定期访问的重要关键。
