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Maldonado A, Martinez DE, Villavicencio EA, Crocker R, Garcia DO. Salud sin Fronteras: Identifying Determinants of Frequency of Healthcare Use among Mexican immigrants in Southern Arizona. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02024-x. [PMID: 38833092 DOI: 10.1007/s40615-024-02024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Guided by Andersen's Behavioral Model of Health Services Use (BMHSU), this study aimed to identify determinants of post-migration healthcare use among a sample of Mexican immigrants in a US-Mexico border region in Southern Arizona, while considering pre-migration health and healthcare experiences. METHODS A non-probabilistic convenience sample of 300 adult Mexican immigrants completed a telephone survey to assess healthcare practices. Multivariable logistic regressions were fitted to determine adjusted relationships between frequency of care and predisposing, enabling, need, and contextual factors as well as personal health practices. RESULTS Overall, participants had a 79% probability of receiving healthcare "at least once a year" after migrating to Southern Arizona. Receiving post-migration healthcare was associated with predisposing, enabling, need, contextual factors, and personal health practices (p < 0.05). DISCUSSION Consistent with BMHSU, our findings suggest that frequency of healthcare is not only a function of having post-migration health insurance but is also shaped by a complex array of other factors. The results of this study shed light onto potential areas to be leveraged by multifactorial sociocultural interventions to increase Mexican immigrants' frequency of healthcare services use.
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Affiliation(s)
- Adriana Maldonado
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, 85724, USA.
| | - Daniel E Martinez
- College of Social and Behavioral Sciences, School of Sociology, University of Arizona, Tucson, AZ, 85724, USA
| | - Edgar A Villavicencio
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, 85724, USA
| | | | - David O Garcia
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, 85724, USA
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Amaro E, Rodriguez J, Jackson D, Popovich D, Frias KM, Castañeda E. The Impact of Cultural Health Capital on Market Choice Along the Texas-Mexico Border. J Racial Ethn Health Disparities 2024; 11:1139-1151. [PMID: 37278954 DOI: 10.1007/s40615-023-01593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/15/2023] [Accepted: 03/31/2023] [Indexed: 06/07/2023]
Abstract
Transnational cultural health capital (CHC) includes individual resources such as skills and behaviors patients use to manage healthcare exclusion and negotiate care. This study examines the impact of CHC on decisions by Hispanic people who live in El Paso, Texas, to utilize one or more markets for healthcare. We expand on the current literature and present novel findings by quantifying several aspects of CHC that may contribute to cross-border health-seeking behaviors in this vulnerable group which tends to suffer various health disparities and limited access to health insurance. Results support the hypotheses related to how the various cultural, social, and economic resources that comprise CHC affect market choices. This research has significant implications for understanding how border residents may mitigate a lack of accessibility and affordability for healthcare, developing transnational health policy, and aiding healthcare providers to understand their patients' choice(s) of healthcare markets.
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LaPelusa M, Verduzco-Aguirre H, Diaz F, Aldaco F, Soto-Perez-de-Celis E. Cross-border utilization of cancer care by patients in the US and Mexico - a survey of Mexican oncologists. Global Health 2023; 19:78. [PMID: 37891675 PMCID: PMC10612194 DOI: 10.1186/s12992-023-00983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The US-Mexico border is the busiest in the world, with millions of people crossing it daily. However, little is known about cross-border utilization of cancer care, or about the reasons driving it. We designed a cross sectional online survey to understand the type of care patients with cancer who live in the US and Mexico seek outside their home country, the reasons why patients traveled across the border to receive care, and the barriers faced when seeking cross-border care. RESULTS The online survey was sent to the 248 cancer care providers working in the six Mexican border states who were registered members of the Mexican Society of Oncology. Responses were collected between September-November 2022. Sixty-six providers (response rate 26%) completed the survey. Fifty-nine (89%) reported interacting with US-based patients traveling to Mexico to receive various treatment modalities, with curative surgery (n = 38) and adjuvant chemotherapy (n = 31) being the most common. Forty-nine (74%) reported interacting with Mexico-based patients traveling to the US to receive various treatment modalities, with immunotherapy (n = 29) and curative surgery (n = 27) being the most common. The most frequently reported reason US-based patients sought care in Mexico was inadequate health insurance (n = 45). The most frequently reported reason Mexico-based patients sought care in the US was patients' perception of superior healthcare (n = 38). CONCLUSIONS Most Mexican oncologists working along the Mexico-US border have interacted with patients seeking or receiving binational cancer care. The type of care sought, as well as the reasons for seeking it, differ between US and Mexico-based patients. These patterns of cross-border healthcare utilization highlight unmet needs for patients with cancer in both countries and call for policy changes to improve outcomes in border regions.
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Affiliation(s)
- Michael LaPelusa
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Haydeé Verduzco-Aguirre
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Diaz
- Lineberger Comprehensive Cancer Center, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States
| | - Fernando Aldaco
- Servicio de Oncología Medica, Centro Médico Nacional 20 de Noviembre, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14080, Tlalpan, Mexico City, Mexico.
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Merry L, Kim YN, Urquia ML, Goulet J, Villadsen SF, Gagnon A. Transnational prenatal care among migrant women from low-and-middle-income countries who gave birth in Montreal, Canada. BMC Pregnancy Childbirth 2023; 23:292. [PMID: 37101137 PMCID: PMC10131434 DOI: 10.1186/s12884-023-05582-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVES There is little research examining transnational prenatal care (TPC) (i.e., prenatal care in more than one country) among migrant women. Using data from the Migrant-Friendly Maternity Care (MFMC) - Montreal project, we aimed to: (1) Estimate the prevalence of TPC, including TPC-arrived during pregnancy and TPC-arrived pre-pregnancy, among recently-arrived migrant women from low- and middle-income countries (LMICs) who gave birth in Montreal, Canada; (2) Describe and compare the socio-demographic, migration and health profiles and perceptions of care during pregnancy in Canada between these two groups and migrant women who received no TPC (i.e., only received prenatal care in Canada); and (3) Identify predictors of TPC-arrived pre-pregnancy vs. No-TPC. METHODS The MFMC study used a cross-sectional design. Data were gathered from recently-arrived (< 8 years) migrant women from LMICs via medical record review and interview-administration of the MFMC questionnaire postpartum during the period of March 2014-January 2015 in three hospitals, and February-June 2015 in one hospital. We conducted a secondary analysis (n = 2595 women); descriptive analyses (objectives 1 & 2) and multivariable logistic regression (objective 3). RESULTS Ten percent of women received TPC; 6% arrived during pregnancy and 4% were in Canada pre-pregnancy. The women who received TPC and arrived during pregnancy were disadvantaged compared to women in the other two groups (TPC-arrived pre-pregnancy and No-TPC women), in terms of income level, migration status, French and English language abilities, access barriers to care and healthcare coverage. However, they also had a higher proportion of economic migrants and they were generally healthier compared to No-TPC women. Predictors of TPC-arrived pre-pregnancy included: 'Not living with the father of the baby' (AOR = 4.8, 95%CI 2.4, 9.8), 'having negative perceptions of pregnancy care in Canada (general experiences)' (AOR = 1.2, 95%CI 1.1, 1.3) and younger maternal age (AOR = 1.1, 95%CI 1.0, 1.1). CONCLUSION Women with more capacity may self-select to migrate during pregnancy which results in TPC; these women, however, are disadvantaged upon arrival, and may need additional care. Already-migrated women may use TPC due to a need for family and social support and/or because they prefer the healthcare in their home country.
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Affiliation(s)
- Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Canada.
| | - Ye Na Kim
- Faculty of Nursing, University of Montreal, Montreal, Canada
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Goulet
- School of Psychoeducation, University of Montreal, Montreal, Canada
| | | | - Anita Gagnon
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Canada
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Peng B, Ling L. Health service behaviors of migrants: A conceptual framework. Front Public Health 2023; 11:1043135. [PMID: 37124818 PMCID: PMC10140430 DOI: 10.3389/fpubh.2023.1043135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.
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Affiliation(s)
- Boli Peng
- Department of Actuarial Science, School of Insurance, Guangdong University of Finance, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Li Ling,
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Glass LT, Schlachta CM, Hawel JD, Elnahas AI, Alkhamesi NA. Cross-border healthcare: A review and applicability to North America during COVID-19. HEALTH POLICY OPEN 2022; 3:100064. [PMID: 35036910 PMCID: PMC8744400 DOI: 10.1016/j.hpopen.2021.100064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/20/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022] Open
Abstract
Cross-border healthcare is an international agreement for the provision of out of country healthcare for citizens of partnered countries. The European Union (EU) has established itself as a world leader in cross-border healthcare. During the Coronavirus disease of 2019 (COVID-19) pandemic, the EU used this system to maximize utilization of resources. Countries with capacity accepted critically ill patients from overwhelmed nations, borders remained open to healthcare workers and those seeking medical care in an effort to share the burden of this pandemic. Significant research into the challenges and successes of cross-border healthcare was completed prior to COVID-19, which demonstrated significant benefit for patients. In North America, the response to the COVID-19 crisis has been more isolationist. The Canada-United States border has been closed and bans placed on healthcare workers crossing the border for work. Prior to COVID-19, cross-border healthcare was rare in North America despite its need. We reviewed the literature surrounding cross-border healthcare in the EU, as well as the need for a similar system in North America. We found the EU cross-border healthcare agreements are generally mutually beneficial for participating countries. The North American literature suggested a cross-border healthcare system is feasible. A number of challenges could be identified based on the EU experience. A prior agreement may have been beneficial during the COVID-19 crisis as many Canadian healthcare institutions-maintained capacity to accept critically ill patients.
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Legal status and health disparities: An examination of health insurance coverage among the foreign-born. DEMOGRAPHIC RESEARCH 2022. [DOI: 10.4054/demres.2022.47.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kim YN, Urquia M, Villadsen SF, Merry L. A scoping review on the measurement of transnationalism in migrant health research in high-income countries. Global Health 2021; 17:126. [PMID: 34715897 PMCID: PMC8555176 DOI: 10.1186/s12992-021-00777-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants commonly maintain transnational ties as they relocate and settle in a new country. There is a growing body of research examining transnationalism and health. We sought to identify how transnationalism has been defined and operationalized in migrant health research in high income countries and to document which populations and health and well-being outcomes have been studied in relation to this concept. METHODS We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI). We searched nine electronic databases; no time restrictions were applied. Studies published in English or French in peer-reviewed journals were considered. Studies were eligible if they included a measure of transnationalism (or one of its dimensions; social, cultural, economic, political and identity ties and/or healthcare use) and examined health or well-being. RESULTS Forty-seven studies, mainly cross-sectional designs (81%), were included; almost half were conducted in the United States. The majority studied immigrants, broadly defined; 23% included refugees and/or asylum-seekers while 36% included undocumented migrants. Definitions of transnationalism varied according to the focus of the study and just over half provided explicit definitions. Most often, transnationalism was defined in terms of social connections to the home country. Studies and measures mainly focused on contacts and visits with family and remittance sending, and only about one third of studies examined and measured more than two dimensions of transnationalism. The operationalization of transnationalism was not consistent and reliability and validity data, and details on language translation, were limited. Almost half of the studies examined mental health outcomes, such as emotional well-being, or symptoms of depression. Other commonly studied outcomes included self-rated health, life satisfaction and perceived discrimination. CONCLUSION To enhance comparability in this field, researchers should provide a clear, explicit definition of transnationalism based on the scope of their study, and for its measurement, they should draw from validated items/questions and be consistent in its operationalization across studies. To enhance the quality of findings, more complex approaches for operationalizing transnationalism (e.g., latent variable modelling) and longitudinal designs should be used. Further research examining a range of transnationalism dimensions and health and well-being outcomes, and with a diversity of migrant populations, is also warranted.
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Affiliation(s)
- Ye Na Kim
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
| | - Marcelo Urquia
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada. .,SHERPA University Institute, West-Central Montreal CIUSSS, Montreal, Quebec, Canada. .,InterActions Centre de recherche et de partage des savoirs, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada.
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9
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Zhao J, Kong F, Li S. Association between social integration and medical returns among the migrant elderly following children to Jinan City China. BMC Public Health 2021; 21:1822. [PMID: 34627226 PMCID: PMC8501928 DOI: 10.1186/s12889-021-11901-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Studies had shown that social integration was related to the utilization of medical services. Few studies investigated the relationship between social integration and medical returns among the elderly. None research had ever clarified the effect of social integration on medical returns among the migrant elderly following children (MEFC) to new cities. This study aimed to explore the association between social integration and medical returns among the MEFC in Jinan, China. Method This cross-sectional study included 627 MEFC in Jinan China. Social integration was evaluated by economic integration, acculturation, and identification. Medical return was assessed by asking the subjects whether go back to hometown to use the medical services when ill. Chi-squared test and multivariable logistic regression were applied to analyze the association between social integration and medical returns of the MEFC. Results and discussion It was found that 20.3% of the MEFC had a medical return. As for social integration, those who had not joined local medical insurance (OR = 3.561, 95% CI 1.577–8.039, p = 0.002) and were unwilling to stay for a long time (OR = 2.600, 95% CI 1.620–4.174, p = 0.001) were more likely to have a medical return. Furthermore, our findings showed that the MEFC who were accompanied by one or more (OR = 1.568, 95% CI 1.027–2.392, p = 0.037) were more likely to have a medical return than those who migrated alone. Conclusion Negative relationship between social integration and medical returns was found among the MEFC, which means the better social integration of the MEFC would generally have fewer medical return, as well as the better refunding connections of the medical insurance between the current residence and hometown.
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Affiliation(s)
- Jinfeng Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Fanlei Kong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
| | - Shixue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
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Liu Y, Siddiqi KA, Cook RL, Bian J, Squires PJ, Shenkman EA, Prosperi M, Jayaweera DT. Optimizing Identification of People Living with HIV from Electronic Medical Records: Computable Phenotype Development and Validation. Methods Inf Med 2021; 60:84-94. [PMID: 34592777 PMCID: PMC8672443 DOI: 10.1055/s-0041-1735619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Electronic health record (EHR)-based computable phenotype algorithms allow researchers to efficiently identify a large virtual cohort of Human Immunodeficiency Virus (HIV) patients. Built upon existing algorithms, we refined, improved, and validated an HIV phenotype algorithm using data from the OneFlorida Data Trust, a repository of linked claims data and EHRs from its clinical partners, which provide care to over 15 million patients across all 67 counties in Florida. METHODS Our computable phenotype examined information from multiple EHR domains, including clinical encounters with diagnoses, prescription medications, and laboratory tests. To identify an HIV case, the algorithm requires the patient to have at least one diagnostic code for HIV and meet one of the following criteria: have 1+ positive HIV laboratory, have been prescribed with HIV medications, or have 3+ visits with HIV diagnostic codes. The computable phenotype was validated against a subset of clinical notes. RESULTS Among the 15+ million patients from OneFlorida, we identified 61,313 patients with confirmed HIV diagnosis. Among them, 8.05% met all four inclusion criteria, 69.7% met the 3+ HIV encounters criteria in addition to having HIV diagnostic code, and 8.1% met all criteria except for having positive laboratories. Our algorithm achieved higher sensitivity (98.9%) and comparable specificity (97.6%) relative to existing algorithms (77-83% sensitivity, 86-100% specificity). The mean age of the sample was 42.7 years, 58% male, and about half were Black African American. Patients' average follow-up period (the time between the first and last encounter in the EHRs) was approximately 4.6 years. The median number of all encounters and HIV-related encounters were 79 and 21, respectively. CONCLUSION By leveraging EHR data from multiple clinical partners and domains, with a considerably diverse population, our algorithm allows more flexible criteria for identifying patients with incomplete laboratory test results and medication prescribing history compared with prior studies.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Khairul A. Siddiqi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Patrick J. Squires
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Dushyantha T. Jayaweera
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, United States
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Serrano Rodríguez P, Szempruch KR, Strassle PD, Gerber DA, Desai CS. Potential to Mitigate Disparities in Access to Kidney Transplant in the Hispanic/Latino Population With a Specialized Clinic: Single Center Study Representing Single State Data. Transplant Proc 2021; 53:1798-1802. [PMID: 33985800 DOI: 10.1016/j.transproceed.2021.03.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We sought to evaluate potential disparities in kidney transplant rates in a single state in the United States. We studied the potential to mitigate disparities with a specialized clinic using it as a model presentation. METHODS Based on data from the United States Renal Data System and Organ Procurement and Transplantation Network, we estimated the yearly end-stage renal disease and waitlist addition, stratified by race/ethnicity from 2000 to 2018. Institution rates were analyzed similarly, and the implementation of a focused Latino clinic was evaluated. RESULTS The number of patients added to the national transplant waitlist has increased by 40% in non-Latino whites and by 160% in Latinos from 2000 to 2017. Comparing the period from 2000 to 2004 to 2015 to 2018 in North Carolina, the waitlist increased for Latino patients by 482% and non-Latino whites by 23%. One year after a designated Latino transplant clinic at our institution, there was a 125% increase in the number of Latino referrals for kidney transplant evaluation, a 142% increase in the number of waitlisted Latino patients, and an increase in kidney transplants of 145%. CONCLUSION With the increasing number of patients in the Latino community who are diagnosed with end-stage renal disease, there is a direct benefit for a culturally competent program that addresses access to transplants.
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Affiliation(s)
- Pablo Serrano Rodríguez
- Department of Surgery, Division of Abdominal Transplant Surgery, University of North Carolina, Chapel Hill, North Carolina.
| | - Kristen R Szempruch
- Department of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Paula D Strassle
- Department of Surgery, Division of Abdominal Transplant Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - David A Gerber
- Department of Surgery, Division of Abdominal Transplant Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Chirag S Desai
- Department of Surgery, Division of Abdominal Transplant Surgery, University of North Carolina, Chapel Hill, North Carolina
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Raudenbush DT. "We go to Tijuana to double check everything": The contemporaneous use of health services in the U.S. and Mexico by Mexican immigrants in a border region. Soc Sci Med 2020; 270:113584. [PMID: 33360777 DOI: 10.1016/j.socscimed.2020.113584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/21/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
Research in 2009 showed that hundreds of thousands of Mexican immigrants in the U.S. return to Mexico for healthcare annually. Existing studies on the cross-border healthcare behaviors of this group are dominated by two related questions: 1) Why do Mexican immigrants go to Mexico for care? and 2) What are individual-level predictors of seeking care in Mexico? While this research has identified people's motivations for crossing the border for care and key characteristics associated with this behavior, it has underemphasized an important feature of cross-border healthcare seeking, namely that some immigrants contemporaneously use healthcare in the U.S. and Mexico. Drawing on qualitative interviews with Mexican immigrants in San Diego, CA, located on the U.S.-Mexico border, I show that for some, seeking care in Mexico is a way to supplement the care they receive in the U.S. In this region, some people combine care in the two countries in attempts to achieve what they believe to be optimal care results. Their cross-border behaviors include seeking care in the U.S. for a health condition and, if dissatisfied, going to Mexico for care; getting care in the U.S for certain health problems and Mexico for others; going to Mexico for specialist care when their U.S. doctors will not refer them to specialists; and going to Mexico for pharmaceuticals their U.S. doctors will not prescribe. For these individuals, proximity to the border changes the meanings and behaviors associated with being a patient, in that it enables them to be more actively engaged in their care. At the same time, findings raise questions about the quality of care that results from mixing care in the two countries. These findings suggest a need to understand cross-border healthcare seeking among some border residents as embedded in a larger repertoire of healthcare practices.
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Affiliation(s)
- Danielle T Raudenbush
- Department of Sociology, University of California San Diego, 9500 Gilman Drive, MC# 0533, La Jolla, CA, 92093-0533, USA.
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Ding L, Li X, Tang X, Feng Y, Wang Y, Cheng J, Sun M, Zhou C. Effect of social integration on childbirth return among internal migrant pregnant women: a nationally representative study in China. BMC Health Serv Res 2020; 20:918. [PMID: 33028334 PMCID: PMC7541329 DOI: 10.1186/s12913-020-05783-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background Social integration has been demonstrated to be associated with the health care use among migrants, but few studies have focused on migrant pregnant women. This study aims to explore the association between social integration and childbirth at woman’s hometown (childbirth return) of internal migrant pregnant women in China. Method Using the data of “Monitoring Data of Chinese Migrants” in 2014, a total of 3412 internal migrant pregnant women were included in this study. Social integration was measured by economic integration, acculturation, and identification. The childbirth locations of internal migrant pregnant women were divided into current residency and the woman’s hometown. Univariate logistic regression and two multivariable logistic regression models were employed to assess the association between social integration and childbirth return among internal migrant pregnant women. Result Our study finds that 24.56% of migrant pregnant women choose to have a childbirth return. As for social integration, those who have their own house (OR = 0.351 95% CI 0.207–0.595) in current residence, who have been staying in current residence for at least 5 years (OR = 0.449; 95% CI 0.322–0.626), and who are willing to stay in the current residence for a long time (OR = 0.731; 95% CI 0.537–0.995) are less likely to have a childbirth return. Apart from social integration, our results also show that those migrant pregnant women who are older, who have higher education level, who have at least two family members in current residence, with a migration reason of work and business, who have established health record in the current residency, and who were not covered by medical insurances, are less likely to have a childbirth return. Conclusion Social integration is negatively associated with childbirth return among internal migrant pregnant women in China. To improve the utilization of maternal care services for migrant pregnant women in current residence, targeted policies should be made to improve social integration status for migrant pregnant women.
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Affiliation(s)
- Lulu Ding
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xinying Li
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Xue Tang
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yuejing Feng
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yi Wang
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Jiejie Cheng
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Mei Sun
- School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Chengchao Zhou
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Laboratory of Health Economics and Policy Research (Shandong University), 44 Wen-hua-xi Road, Jinan, 250012, Shandong, China.
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Blaakilde AL, Jervelund SS, Yazici S, Petersen SG, Krasnik A. Use of Cross-Border Healthcare Services by Elderly Turkish Migrants in Denmark: A Qualitative Study and Some Critical Reflections about Public Health ‘Concerns’. NORDIC JOURNAL OF MIGRATION RESEARCH 2020. [DOI: 10.33134/njmr.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rural Population Aging and the Hospital Utilization in Cities: The Rise of Medical Tourism in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134790. [PMID: 32635241 PMCID: PMC7369718 DOI: 10.3390/ijerph17134790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022]
Abstract
The disparity of rural and urban hospital utilization has aroused much concern. With the improvement of their living standards, patients in rural areas have an emerging need for traveling across borders for better medical treatment in China. This paper reveals the medical tourism of rural residents towards urban hospitals driven by hospital needs and points out that such disparities may be caused by medical tourism. The ratio of people aged 65 and above in total rural populations was used to identify the potential target customers for medical tourism. Based on rural and urban datasets ranging from 2007-2017 on the provincial level, this paper presents a mobile treatment model and market concentration model with an ecological foundation. The feasible generalized least squared approach was used in the estimation of the fixed-effect regressions. The study found that there was a positive and significant relationship between rural old-age ratios and urban inpatient visits from different income groups. On average, a one percent rise in rural old-age ratio would increase the inpatient visits of urban hospitals by 138 thousand persons. There was also a positive and significant relationship between the rural old-age ratio and the market concentration of urban inpatient visits. It was found that the rural old-age ratio significantly influenced the market concentration of urban inpatient visits in the middle-high income regions. The research showed that each income group from the rural aged population had participated in medical tourism, traveled to urbanized regions and made inpatient visits to urbanized medical facilities. It was also indicated that the rural aged population, especially from the middle-high income groups had a positive and significant influence on the market concentration of urban inpatient visits in the province.
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Virani A, Wellstead AM, Howlett M. The north-south policy divide in transnational healthcare: a comparative review of policy research on medical tourism in source and destination countries. Global Health 2020; 16:37. [PMID: 32321561 PMCID: PMC7178960 DOI: 10.1186/s12992-020-00566-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/09/2020] [Indexed: 11/20/2022] Open
Abstract
Medical tourism occupies different spaces within national policy frameworks depending on which side of the transnational paradigm countries belong to, and how they seek to leverage it towards their developmental goals. This article draws attention to this policy divide in transnational healthcare through a comparative bibliometric review of policy research on medical tourism in select source (Canada, United States and United Kingdom) and destination countries (Mexico, India, Thailand, Malaysia and Singapore), using a systematic search of the Web of Science (WoS) database and review of grey literature. We assess cross-national differences in policy and policy research on medical tourism against contextual policy landscapes and challenges, and examine the convergence between research and policy. Our findings indicate major disparities in development agendas and national policy concerns, both between and among source and destination countries. Further, we find that research on medical tourism does not always address prevailing policy challenges, just as the policy discourse oftentimes neglects relevant policy research on the subject. Based on our review, we highlight the limited application of theoretical policy paradigms in current medical tourism research and make the case for a comparative policy research agenda for the field.
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Affiliation(s)
- Altaf Virani
- Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore, 259772, Singapore.
| | - Adam M Wellstead
- Department of Social Sciences, Michigan Technological University, Houghton, USA
| | - Michael Howlett
- Department of Political Science, Simon Fraser University, Burnaby, British Columbia, Canada
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17
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Mathijsen A, Mathijsen FP. Diasporic medical tourism: a scoping review of quantitative and qualitative evidence. Global Health 2020; 16:27. [PMID: 32228641 PMCID: PMC7106793 DOI: 10.1186/s12992-020-00550-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is a growing recognition of the significance of the diasporic dimension of medical travel. Explanations of medical tourism are increasingly presented in a wider context of transnationalism, diaspora and migration. Yet diaspora and cross-border travellers rarely get through the broader narrative of medical travel. Objective Our aim in this scoping review was to extend the current knowledge on the emerging subject of diasporic travels for medical purposes. Specifically, we reviewed the existing literature on what is known about the determinants and motivational factors of diasporic medical tourism; its geographic scope and its quantitative estimation. Methods Using a scoping review methodology, we conducted the search in seven electronic databases. It resulted in 210 records retrieved. Ultimately, 28 research papers and 6 non-research papers (published between 2002 and 2019) met the following criteria: 1) focus on healthcare and health-related practices, 2) transnational perspective, 3) healthcare consumption in the country of origin (homeland) while being a resident of another country, 4) published in English. Results The findings from our review highlighted the importance of diasporic medical patients who had been researched and analysed on four continents. Even though quantitative evidence has been scarce, the data analysed in the scoping review pointed to the existence of non-negligible level of diasporic medical tourism in Northern America, and in Europe. Various motivational factors were enumerated with their frequency of occurrence: medical culture (12), time availability (“by the way of being home”) (9), communication (6), dissatisfaction with the current system (6), healthcare insurance status (5), quality of healthcare (5), second opinion (3), and value for money (3). Conclusion Diasporic medical tourists constitute an attractive segment of consumers that is still not well understood and targeted. They are part of transnational communities that cultivate the links between the two nations. They simultaneously participate in bi-lateral healthcare systems via return visits which impact the health systems of sending and receiving countries in a substantial way. In the current globalised, connected and migratory context, transnationalism seems to represent an answer to many local healthcare-related barriers. Sending and receiving countries have put in place an array of programmes and policies addressed to the diasporic medical travellers.
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Affiliation(s)
- Aneta Mathijsen
- SGH Warsaw School of Economics, Collegium of the World Economy, Aleja Niepodległości 162, 02-554, Warsaw, Poland.
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18
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Qualitative Study of Latino Cancer Patient Perspectives on Care Access and Continuity in a Rural, U.S.-Mexico Border Region. J Immigr Minor Health 2019; 20:674-679. [PMID: 28584960 DOI: 10.1007/s10903-017-0605-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Access to quality cancer care for cancer patients living in the rural U.S.-Mexico border region is complex due to common binational health care-seeking behaviors and regional socio-economic and cultural characteristics. But little is known about the challenges border dwelling residents face when navigating their cancer care systems. In-depth interviews were conducted with 22 cancer patients in Southern California. Thematic analysis was applied to identify patterns of meaning in the data. Emerging themes were: (1) delays in cancer care coordination: (a) poor coordination of cancer care (b) U.S. and cross-border discordance in cancer diagnosis; (2) regional shortage of cancer specialists; and (3) financial hardship. Findings revealed that care needs distinctly involved care coordination in/outside of the patient's community and bi-national care coordination. In addition to local solutions to improve cancer coordination through community-based partnerships, efforts to bridge care in a two-nation context are also imperative.
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19
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Peng BL, Ling L. Association between rural-to-urban migrants' social medical insurance, social integration and their medical return in China: a nationally representative cross-sectional data analysis. BMC Public Health 2019; 19:86. [PMID: 30658619 PMCID: PMC6339269 DOI: 10.1186/s12889-019-6416-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Without social medical insurance in the destination areas and with low social integration, rural-to-urban migrants had barriers to health service in the destination areas, some of the migrants had to seek health service in hometown, namely medical return. This study aimed at exploring the association between rural-to-urban migrants' medical return and social medical insurance type or social integration. METHODS We analysed a secondary cross-sectional data of the 2014 National Internal Migrant Dynamic Monitoring Survey collected in May of 2014 from all provinces or regions in mainland China. The medical return was measured by the location of hospitalisation, and the social integration included economic integration and permanent settlement intention. RESULTS Four thousand eighteen rural-to-urban migrants living in current residence at least one year and used inpatient service within the last 12 months were analysed. The rate of medical return for inpatient service was 15.3%. Having medical insurance of hometown (new rural cooperative medical scheme (NRCMS)) (OR = 2.44, 95%CIs 1.80-3.30) was positively related to the medical return. The permanent settlement intention was negatively associated with the medical return (OR = 0.66, 95%CIs 0.48-0.90). CONCLUSIONS Social medical insurance of hometown (NRCMS) was positively associated with the medical return, while the permanent settlement intention was negatively associated with it. Promoting the transfer of migrants' social medical insurance across different regions might be helpful to improve rural-to-urban migrants' health access.
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Affiliation(s)
- Bo-Li Peng
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. .,Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
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20
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Cheng TC, Guo Y. Adult Immigrants’ Utilization of Physician Visits, Dentist Visits, and Prescription Medication. J Racial Ethn Health Disparities 2018; 6:497-504. [DOI: 10.1007/s40615-018-00548-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/16/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
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Read JG, Smith PB. Gender and national origin differences in healthcare utilization among U.S. Immigrants from Mexico, China, and India. ETHNICITY & HEALTH 2018; 23:867-883. [PMID: 28277018 PMCID: PMC6563819 DOI: 10.1080/13557858.2017.1297776] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/15/2017] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To examine gender and national origin differences in the healthcare utilization of immigrants from the three largest populations in the U.S. today (Mexico, China, and India) and to determine if barriers to utilization operate similarly across groups. METHODS The analysis uses nationally-representative data from the 2003 New Immigrant Survey (NIS) to compare utilization behaviors among legal permanent residents from Mexico, China, and India (n = 2244). Conceptually, the study draws on Andersen's Behavioral Model to hypothesize gender and national origin differences in utilization based on factors that might predispose, enable, or necessitate healthcare. Multivariate logistic regression models are used to predict the odds of having seen a doctor in the past year and to test whether obstacles to utilization differ across immigrant groups. RESULTS Chinese immigrants are less likely than Mexican and Indian immigrants to have seen a doctor in the past year, a finding that is largely driven by a lack of health insurance. Female immigrants are more likely than males to have done so, despite having fewer resources that enable access to care (e.g. income, English proficiency). Moreover, the relationship between gender and utilization is moderated by English language proficiency: among immigrants with low levels of proficiency, women are significantly more likely than men to have seen a doctor in the past year, while no difference exists between men and women who are proficient in English. This pattern is most evident among Mexican, and to a lesser extent, Indian immigrants. CONCLUSIONS Barriers to immigrant healthcare utilization vary by gender and national origin. Research will need to continue documenting such variation in order to better inform policy makers and health practitioners of potential solutions for improving health outcomes in increasingly diverse immigrant communities.
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Affiliation(s)
- Jen'nan Ghazal Read
- a Department of Sociology and Global Health , Duke University , Durham , USA
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22
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Şekercan A, Woudstra AJ, Peters RJG, Lamkaddem M, Akgün S, Essink-Bot ML. Dutch citizens of Turkish origin who utilize healthcare services in Turkey: a qualitative study on motives and contextual factors. BMC Health Serv Res 2018; 18:289. [PMID: 29665855 PMCID: PMC5905158 DOI: 10.1186/s12913-018-3026-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/16/2018] [Indexed: 02/04/2023] Open
Abstract
Background Dutch residents of Turkish origin frequently utilize healthcare in Turkey. Methods To investigate their motives for doing so, we conducted a qualitative study among these healthcare users using semi-structured interviews. We complemented this with informal conversations with Turkish healthcare providers and observations at the registration offices and waiting rooms of outpatient clinics in several Turkish hospitals. Results Respondents believed their perceived needs for referral to specialist care and diagnostic assessments to quantify their health were not being met in the Netherlands. Conclusions These mismatches in expectations of what constitutes “good care” led to dissatisfaction with Dutch primary care. Consequently, respondents utilized healthcare in Turkey if the opportunity arose, and were encouraged in this by their social networks. Establishing cross-border communication between healthcare providers is necessary, because there is currently no continuity of care for cross-border patients. Electronic supplementary material The online version of this article (10.1186/s12913-018-3026-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aydın Şekercan
- Department of Public Health
- Research Theme: Diversity and Quality of Care, Academic Medical Center at the University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, Netherlands. .,Department of Cardiology, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands.
| | - Anke J Woudstra
- Department of Public Health
- Research Theme: Diversity and Quality of Care, Academic Medical Center at the University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, Netherlands
| | - Ron J G Peters
- Department of Cardiology, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands
| | - Majda Lamkaddem
- Department of Public Health
- Research Theme: Diversity and Quality of Care, Academic Medical Center at the University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, Netherlands
| | - Seval Akgün
- Department of Public Health, Başkent University Hospital at Başkent University, Ankara, Turkey
| | - Marie-Louise Essink-Bot
- Department of Public Health
- Research Theme: Diversity and Quality of Care, Academic Medical Center at the University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, Netherlands
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23
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Ko E, Zúñiga ML, Peacher D, Palomino H, Watson M. Efficacy of Cancer Care Communication Between Clinicians and Latino Patients in a Rural US-Mexico Border Region: a Qualitative Study of Barriers and Facilitators to Better Communication. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:116-127. [PMID: 27558475 DOI: 10.1007/s13187-016-1100-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Quality of clinician-patient cancer communication is vital to cancer care and survivorship. Racial/ethnic minority patients in rural regions may have unique characteristics including cultural beliefs, language barriers, and low health literacy which require effective cross-cultural cancer communication. Despite the growing US population of racial/ethnic minorities and widespread emphasis on culturally appropriate health communication, little is known about challenges and facilitators of cancer communication among underserved rural Latino cancer patients in the US-Mexico border region. This study conducted secondary data analysis of interview data collected from 22 individual cancer patients living on the US side of the US-Mexico border. Thematic analysis was conducted to explore a priori questions regarding patient experiences with cancer care communication with their providers. Emerging themes included lack of language concordance, patient perspectives on clarity and accuracy of information provided, patient perceptions on provider sensitivity in giving cancer diagnosis, and improving the clinical interpersonal relationship. Practice guidelines are suggested and discussed. These findings illuminate the importance of advancing improvement of cancer communication between clinicians and Spanish language-dominant Latinos.
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Affiliation(s)
- Eunjeong Ko
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
| | - María Luisa Zúñiga
- Center for Alcohol and Drug Studies, School of Social Work, San Diego State University, 6386 Alvarado Court Ste 224, San Diego, CA, 92120, USA
| | - Diana Peacher
- Cancer Resource Center of the Desert, 444 S. 8th Street, Suite B3, El Centro, CA, 92243, USA
| | - Helen Palomino
- Cancer Resource Center of the Desert, 444 S. 8th Street, Suite B3, El Centro, CA, 92243, USA
| | - Mercedes Watson
- Cancer Resource Center of the Desert, 444 S. 8th Street, Suite B3, El Centro, CA, 92243, USA
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Abstract
In 2015, approximately 244 million people were transnational migrants, approximately half of whom were workers, often engaged in jobs that are hazardous to their health. They work for less pay, for longer hours, and in worse conditions than do nonmigrants and are often subject to human rights violations, abuse, human trafficking, and violence. Worldwide, immigrant workers have higher rates of adverse occupational exposures and working conditions, which lead to poor health outcomes, workplace injuries, and occupational fatalities. Health disparities of immigrant workers are related to environmental and occupational exposures and are a result of language/cultural barriers, access to health care, documentation status, and the political climate of the host country. Recommendations on global and local scales are offered as potential solutions to improving the health of immigrant workers.
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Affiliation(s)
- Sally C Moyce
- School of Nursing, Samuel Merritt University, Oakland, California 94609, USA;
| | - Marc Schenker
- Department of Public Health Sciences, University of California, Davis, California 95616, USA;
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25
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Peng BL, Zou GY, Chen W, Lin YW, Ling L. Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study. BMJ Open 2018; 8:e018844. [PMID: 29331968 PMCID: PMC5781153 DOI: 10.1136/bmjopen-2017-018844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation. DESIGN Cross-sectional survey between April and May 2016. SETTING Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. PARTICIPANTS We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. MAIN OUTCOME MEASURES The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups). RESULTS In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. CONCLUSIONS Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.
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Affiliation(s)
- Bo-li Peng
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Guan-yang Zou
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Wen Chen
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-wei Lin
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Hoffman L, Crooks VA, Snyder J. Pills in paradise: Exploring international lifestyle and retirement migrants' perceptions of the pharmaceutical sector on Cozumel Island, Mexico. Health Place 2017; 47:139-146. [PMID: 28886440 DOI: 10.1016/j.healthplace.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/03/2017] [Accepted: 08/22/2017] [Indexed: 11/25/2022]
Abstract
International lifestyle and retirement migration is a growing phenomenon, yet little is known about migrants' experiences of health care in destination countries. This includes use of and access to pharmaceutical selling establishments. This article explores international lifestyle and retirement migrants' experiences and perceptions of the local pharmaceutical sector on Cozumel Island, Mexico. Qualitative data, collected through semi-structured interviews (n = 26), finds that participants are concerned with accessibility, quality and communication within the island's pharmaceutical sector. Subsequent analysis suggests that these concerns arise through comparison with previous health care environments and that migrants attempt to remedy them by spatially reorganising their pharmacy engagements through practices which may contribute to adverse health outcomes.
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Affiliation(s)
- Leon Hoffman
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6.
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
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27
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Kemppainen L, Kemppainen T, Skogberg N, Kuusio H, Koponen P. Immigrants' use of health care in their country of origin: the role of social integration, discrimination and the parallel use of health care systems. Scand J Caring Sci 2017; 32:698-706. [PMID: 28869656 DOI: 10.1111/scs.12499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/28/2017] [Indexed: 11/28/2022]
Abstract
AIMS The objective of this study was to elucidate the utilisation of Russian health care by immigrants of Russian origin living in Finland (cross-border health care). The study examined the association of cross-border health care with social integration and discrimination. Moreover, it studied whether cross-border health care was used as an alternative to the host-country's healthcare system. METHODS Data from the Finnish Migrant Health and Wellbeing Survey (Maamu) were utilised. The number of respondents of Russian origin was 545. The main analytical method was logistic regression. The outcome variable was based on a survey item on seeking physician's treatment or help abroad during the last 12 months. Social integration was measured multi-dimensionally, and the indicator was extracted by multiple correspondence analysis. Ethical approval for the study was obtained from the Ethical Committee of the Uusimaa Hospital Region. RESULTS We found that 15.4% of the respondents had visited a physician in Russia during the last 12 months. 10.4% had experienced discrimination in Finnish health services during their stay in Finland. Stronger social integration predicted less frequent utilisation of cross-border health care. Experiences of discrimination or unfairness were associated with higher odds for seeking cross-border health care. Cross-border health care was typically used in parallel to the Finnish services. CONCLUSIONS Our findings on integration and discrimination emphasise the importance of general integration policy as well as cultural competence in health care. Parallel use of healthcare systems entails both risks (e.g double medication, problems of follow-up) and opportunities (e.g. sense of agency), which should be further investigated.
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Affiliation(s)
- Laura Kemppainen
- Department of Social Research, Unit of Social Policy, University of Turku, Turku, Finland
| | - Teemu Kemppainen
- Department of Social Research, Unit of Social Policy, University of Turku, Turku, Finland.,Department of Social Research, Unit of Sociology, University of Helsinki, Helsinki, Finland
| | - Natalia Skogberg
- Department of Welfare, National Institute for Health and Welfare, THL, Helsinki, Finland
| | - Hannamaria Kuusio
- Department of Welfare, National Institute for Health and Welfare, THL, Helsinki, Finland
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare, THL, Helsinki, Finland
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Lu L, Zeng J, Zeng Z. What limits the utilization of health services among china labor force? analysis of inequalities in demographic, socio-economic and health status. Int J Equity Health 2017; 16:30. [PMID: 28148264 PMCID: PMC5289053 DOI: 10.1186/s12939-017-0523-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 01/13/2017] [Indexed: 12/03/2022] Open
Abstract
Background Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy. Methods Data were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC). Results Migrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer self-perceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration (Hosmer-Lemeshow test’s P range of 0.258-0.987) and discrimination (AUC range of 0.626-0.725). Conclusions This study has shown that there are inequalities of demographic, socio-economic and health status in the utilization of health services for China labor force. Prudent health policy with equitable utilization of health services eliminating mentioned inequalities should be a priority in shaping China’s healthcare system reform.
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Affiliation(s)
- Liming Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou, 510120, China.
| | - Jingchun Zeng
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zhi Zeng
- Hunan Provincial Maternal and Child Health Care Hospital, #53 Xiangchun Road, Changsha, 410008, China
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29
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Muñoz FA, Servin AE, Garfein RS, Ojeda VD, Rangel G, Zúñiga ML. Deportation history among HIV-positive Latinos in two US-Mexico border communities. J Immigr Minor Health 2016; 17:104-11. [PMID: 24136247 DOI: 10.1007/s10903-013-9929-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Health-related vulnerabilities associated with deportation are understudied. We conducted a cross-sectional study to identify factors associated with history of deportation from the US to Mexico among HIV-positive Latinos. From 2009 to 2010, we recruited a convenience sample from HIV clinics in San Diego, US and Tijuana, Mexico. Of 283 participants, 25% reported a prior deportation. Factors independently associated with increased odds of deportation history were being male [adjusted odds ratio (AOR) 2.77; 95% CI 1.18-6.48], having ≤high-school education (AOR 3.87; 95% CI 1.84-8.14), ever using cocaine (AOR 2.46; 95% CI 1.33-4.57), and reporting personalized HIV-stigma: "some have told me HIV is what I deserve for how I lived" (AOR 2.23; 95% CI 1.14-4.37). Lower self-reported antiretroviral medication adherence (AOR 0.35; 95% CI 0.12-0.96) and perceiving HIV-stigma: "most people believe a person who has HIV is dirty" (AOR 0.49; 95% CI 0.25-0.94) were associated with decreased odds of deportation history. Deportation is associated with specific socioeconomic indicators that are known to impact the health of individuals living with HIV.
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Affiliation(s)
- Fátima A Muñoz
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
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Lokdam N, Kristiansen M, Handlos LN, Norredam M. Use of healthcare services in the region of origin among patients with an immigrant background in Denmark: a qualitative study of the motives. BMC Health Serv Res 2016; 16:99. [PMID: 27001044 PMCID: PMC4802714 DOI: 10.1186/s12913-016-1346-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 03/16/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In Denmark, immigrants have been found to have a higher use of healthcare services abroad. Since this use may have an impact on both the individual patient and the healthcare system in the country of residence, research into underlying reasons is of increasing relevance. This study therefore investigates what motives patients with an immigrant background have for seeking healthcare services in their region of origin. METHODS The study was based on 10 semi-structured interviews with 10 patients who had an immigrant background, primarily originating from Turkey and the Middle East, recruited at a clinic of immigrant medicine in Denmark. The interviews were analysed thematically to elucidate motives for seeking healthcare services abroad, with focus on identifying push and pull factors. RESULTS Four motives for seeking healthcare in the region of origin were salient in the material: the perception of availability, in terms of quantity and access; familiarity, conceptualised as feeling comfortable within the healthcare system; perception of quality of services; and finally, the perceived need for a second opinion. All motives emerged simultaneously as push factors, motivating immigrants to explore healthcare services abroad, and pull factors, attracting them to their country of origin. Affordability did not emerge as an independent motive but influenced the other factors. CONCLUSION The use of healthcare services abroad by patients with an immigrant background constitutes active health-seeking behaviours shaped by a range of factors perceived to be limiting access to high-quality services in Denmark. Further research, including quantitative studies, should be initiated to investigate the importance of these motives among larger, more diverse immigrant groups, consequences for treatment regimes, and the healthcare professionals' perspective on the use of healthcare in the region of origin among immigrant patients.
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Affiliation(s)
- Nicoline Lokdam
- />Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maria Kristiansen
- />Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Line Neerup Handlos
- />Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Marie Norredam
- />Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- />Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen K, Denmark
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31
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Torres JM, Waldinger R. Civic Stratification and the Exclusion of Undocumented Immigrants from Cross-border Health Care. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2015; 56:438-59. [PMID: 26582512 PMCID: PMC4785870 DOI: 10.1177/0022146515610617] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This paper proposes a theoretical framework and an empirical example of the relationship between the civic stratification of immigrants in the United States, and their access to healthcare. We use the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative survey of U.S. Latinos (N = 2,783 foreign-born respondents) and find that immigrants who are not citizens or legal permanent residents are significantly more likely to be excluded from care in both the United States and across borders. Legal-status differences in cross-border care utilization persisted after controlling for health status, insurance coverage, and other potential demographic and socioeconomic predictors of care. Exclusion from care on both sides of the border was associated with reduced rates of receiving timely preventive services. Civic stratification, and political determinants broadly speaking, should be considered alongside social determinants of population health and health care.
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Affiliation(s)
- Jacqueline M Torres
- University of California, San Francisco, CA, USA University of California, Berkeley, CA, USA
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Calvasina P, Muntaner C, Quiñonez C. Transnational dental care among Canadian immigrants. Community Dent Oral Epidemiol 2015; 43:444-51. [DOI: 10.1111/cdoe.12169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Paola Calvasina
- Faculty of Dentistry & Global Health Division; Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - Carles Muntaner
- Bloomberg Faculty of Nursing; Institute for Global Health Equity and Innovation; Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - Carlos Quiñonez
- Discipline of Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
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Abstract
OBJECTIVE Avoidable mortality is a well-recognized, but less studied indicator of the performance of the health system. First, the study seeks to establish whether immigrants overall and selected foreign-born ethnic groups (Western Europeans, South Asians, Chinese, and Filipinos) have an advantage over nonimmigrants in avoidable mortality. Second, it assesses the effect of sociodemographic and socioeconomic factors on any observed differences by duration of residence. DESIGN Deaths grouped by cause of death and by behavioral risk factors, namely smoking-related and alcohol-related, were derived from the 1991 Canadian Census Cohort: Mortality and Cancer Follow-up. The analysis estimated age-standardized mortality rates (ASMRs), rate ratios, and rate differences and also fitted hazard regression models for the overall Canadian-born population and for selected foreign-born ethnicities by sex. Predictors were assessed at baseline. RESULTS Compared to the Canadian-born persons, foreign-born men and women had lower ASMRs for overall avoidable mortality and also for selected causes of avoidable mortality. The only exception to this overall trend was for ischemic heart disease among South Asian women. Except for the order of prominence, the three leading causes of death for nonimmigrant and immigrant men and women overall were ischemic heart diseases, smoking-related diseases, and neoplasms. A similar pattern was observed among the ethnic groups, except for circulatory heart diseases replacing ischemic heart diseases and smoking-related diseases among Chinese and Filipino women, respectively. In the hazard regression analysis, the risk of avoidable mortality was lower for immigrants overall and selected ethnicities irrespective of the duration in Canada compared to nonimmigrants. These differences persisted even with adjustment for sociodemographic and socioeconomic factors. CONCLUSION Immigrants overall and the selected ethnicities enjoy an advantage over nonimmigrants in avoidable mortality. However, for certain causes of death especially ischemic heart disease mortality among South Asian women, immigrants appeared worse-off than nonimmigrants. The results suggest differential access to and use of health services, differences in protective health-related behavior, and the healthy immigrant effect.
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Becerra D, Androff D, Messing JT, Castillo J, Cimino A. Linguistic acculturation and perceptions of quality, access, and discrimination in health care among Latinos in the United States. SOCIAL WORK IN HEALTH CARE 2015; 54:134-157. [PMID: 25674726 DOI: 10.1080/00981389.2014.982267] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the relationship between acculturation and Latinos' perceptions of health care treatment quality, discrimination, and access to health information. The results of this study indicated that participants who had lower levels of acculturation perceived: 1) greater discrimination in health care treatment; 2) a lower quality of health care treatment; 3) less confidence filling out health related forms; and 4) greater challenges understanding written information about their medical conditions. Participants who identified as immigrants also perceived that their poor quality of medical care was due to their inability to pay and to their race/ethnicity.
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Affiliation(s)
- David Becerra
- a School of Social Work , Arizona State University , Phoenix , Arizona , USA
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Şekercan A, Lamkaddem M, Snijder MB, Peters RJG, Essink-Bot ML. Healthcare consumption by ethnic minority people in their country of origin. Eur J Public Health 2014; 25:384-90. [PMID: 25488974 DOI: 10.1093/eurpub/cku205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies from the USA, New Zealand and Denmark suggest that many ethnic minority citizens obtain healthcare in their country of origin. Their reasons for doing so and the possible consequences remain unclear. METHODS We used data from the Healthy Life in an Urban Setting study to investigate the magnitude, types, self-reported reasons and determinants of past-year healthcare consumption in the country of origin by ethnic minority people living in the Netherlands. Individuals of African Surinamese (n = 2059), South-Asian Surinamese (n = 1915), Ghanaian (n = 1426), Moroccan (n = 1516) and Turkish (n = 2245) origin were included (recruited 2011-2013). We performed descriptive and stepwise logistic regression analyses. RESULTS Respondents of Turkish origin reported the highest healthcare utilization in the country of origin (21.3%) compared with Moroccan (9.8%), Ghanaian (6.6%), African Surinamese (4.8%) and South-Asian Surinamese (3.0%) respondents. The main services used were outpatient clinics, pharmacies and health centres. The chief reported motivations were healthcare for illness, dissatisfaction with care in the residence country and seeking second opinions. Physical health status, cultural distance to the Dutch healthcare system and Turkish origin were all independently associated with healthcare use in countries of origin. CONCLUSION Both health status and attitudes towards services in the countries of residence and origin are significantly associated with cross-border healthcare use. Further research is needed to clarify the reasons for the relatively high rates shown by Turkish respondents and to explore the consequences for health and for healthcare utilization in the country of residence.
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Affiliation(s)
- Aydın Şekercan
- 1 Department of Public Health, Academic Medical Centre at the University of Amsterdam, Amsterdam, Netherlands 2 Department of Cardiology, Academic Medical Centre at the University of Amsterdam, Amsterdam, Netherlands
| | - Majda Lamkaddem
- 1 Department of Public Health, Academic Medical Centre at the University of Amsterdam, Amsterdam, Netherlands
| | - Marieke B Snijder
- 1 Department of Public Health, Academic Medical Centre at the University of Amsterdam, Amsterdam, Netherlands
| | - Ron J G Peters
- 2 Department of Cardiology, Academic Medical Centre at the University of Amsterdam, Amsterdam, Netherlands
| | - Marie-Louise Essink-Bot
- 1 Department of Public Health, Academic Medical Centre at the University of Amsterdam, Amsterdam, Netherlands
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De Jesus M, Xiao C. Predicting Health Care Utilization Among Latinos: Health Locus of Control Beliefs or Access Factors? HEALTH EDUCATION & BEHAVIOR 2014; 41:423-30. [PMID: 24707031 DOI: 10.1177/1090198114529130] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are two competing research explanations to account for Latinos' underutilization of health services relative to non-Latino Whites in the United States. One hypothesis examines the impact of health locus of control (HLOC) beliefs, while the other focuses on the role of access factors on health care use. To date, the relative strength of HLOC beliefs in explaining Latinos' use of health care services in the context of access factors is inconclusive. This study, therefore, tests and compares both explanations. We analyzed data from the 2007 Pew Hispanic Healthcare Survey, a nationally representative survey of 4,013 Latino adults. HLOC beliefs had a statistically significant but weak impact on health care use after accounting for access factors. Having continuous health insurance coverage and a usual place of care to go when sick or in need of health advice were much more influential in predicting health care use than HLOC beliefs. This study suggests that disparities in health care service use among Latinos are much more an issue of access than it is an issue of HLOC beliefs. Implications for public health research and intervention efforts that aim to reduce health disparities in health care use are discussed.
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