Health Care Utilization by Immigrants in Italy

Background: Health disparities between migrants and non-migrants are well documented in the literature on healthcare utilization and the reduction of such disparities is a major public health goal in European countries. However, little attention has been paid on healthcare utilization among immigrants in Italy. Objective: The aim of this study is to explore differences in health care use between the immigrant and the Italian population. Study Design and Data: Cross-sectional study using the latest available wave (2004/2005) of the Italian Health Conditions Survey (ISTAT-Condizioni di salute e Ricorso ai Servizi Sanitari). Method: We estimated separate Hurdle Binomial Negative regression models for GPs and specialist visits, number of telephone consultations, and a logit model for emergency room use. We used logistic regression and zero truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Results: We show that, after adjusting for risk factors, immigrants are significantly less likely to use health care services with a 2.4% and a 2.7% lower utilization probability for specialist visits and telephone consultations, respectively. Similarly, first- and second-generation immigrants have a significantly lower probability for a specialist visit and telephone contact compared to native-born citizens. For emergency care visits, immigrants, ceteris paribus, have a much higher probability of using emergency services than natives (0.7%). Similarly, first-generation immigrants show a higher probability of visiting emergency rooms than natives (1%). For GP visits, there is no statistically significant difference. Conclusion: In Italy immigrant individuals are much less likely to use specialist health care and to have medical telephone consultations than native people, while they are more likely to use emergency rooms. Hence, the study reports an over-use of emergency services and an under-utilization of preventive care services among the immigrant population. Therefore, the authors recommend improved national health policies for the immigrant population including the promotion of better information dissemination among the target population, the simplification of organizational procedures, better communications between health care providers and immigrant patients, and an increase of the supply of health services (i.e. dedicated community-based healthcare structures or consulting services) especially in areas with the most disadvantaged populations.