Johns Hopkins University, Primary Care Policy Center, 624 North Broadway, Baltimore, MD 21205, USA.
Soc Sci Med. 2012 Apr;74(7):1062-72. doi: 10.1016/j.socscimed.2011.11.031. Epub 2012 Jan 25.
This study sought to examine the influence of length of stay and language proficiency on immigrants' access to and utilization of care in Canada and the United States (U.S,). Data came from the 2007-2008 Canadian Community Health Survey and the National Health Interview Survey. Analyses were limited to foreign-born, non-elderly adults in each country (n = 12,870 in Canada and n = 7440 in the U.S.). Health care indicators included having a usual source of care; annual consultation with a health professional, dentist, and eye doctor; flu shot in the past year; and Pap test in the past 3 years. Logistic regression models were employed to estimate the relative odds of access or use of care, adjusting for need, demographic factors, socioeconomic status, and insurance coverage. In general, rates of health care access and utilization were higher in Canada than the U.S. among all immigrant groups. In both countries, adjusted analyses indicated that immigrants with shorter length of stay (less than 10 years) and limited language proficiency generally had lower rates of access/use compared with those with longer length of stay (10 years or more) and proficiency in each country's official language(s), respectively. There was one exception to this pattern in the U.S.: immigrants with limited English had higher odds of having a recent Pap test relative to English-proficient immigrants. The persistence of disparities in health care experiences based on length of stay and language proficiency in Canada suggests that universal health insurance coverage may not be sufficient for ensuring access to and utilization of primary and preventive care for this population.
本研究旨在探讨在加拿大和美国，停留时间和语言熟练程度对移民获得和利用医疗服务的影响。数据来自于 2007-2008 年加拿大社区健康调查和国家健康访谈调查。分析仅限于每个国家的外国出生、非老年成年人（加拿大为 12870 人，美国为 7440 人）。医疗保健指标包括有常规医疗服务来源；每年咨询一次医疗专业人员、牙医和眼科医生；过去一年接种流感疫苗；过去 3 年进行过巴氏涂片检查。采用逻辑回归模型估计获得或使用医疗服务的相对可能性，同时调整需求、人口统计学因素、社会经济地位和保险覆盖范围。一般来说，在所有移民群体中，加拿大的医疗保健获得率和利用率都高于美国。在这两个国家，调整后的分析表明，与停留时间较长（10 年或以上）且熟练掌握两国官方语言的移民相比，停留时间较短（不到 10 年）且语言能力有限的移民获得/使用医疗服务的比率通常较低。美国有一个例外：与英语熟练的移民相比，英语能力有限的移民最近进行巴氏涂片检查的可能性更高。加拿大医疗保健体验方面基于停留时间和语言熟练程度的差异持续存在，这表明全民医疗保险可能不足以确保为该人群提供初级和预防保健服务的可及性和利用率。
