Immigrants in the Netherlands: Equal access for equal needs?

Objective-This paper examines whether equal utilisation of health care serv ices for first generation immigrant groups has been achieved in the Netherl ands. Design-Survey data were linked to an insurance register concerning people a ged 16-64. Ethnic differences in the use of a broad range of health care se rvices were examined in this group, with and without adjustment for health status and socioeconomic status, using logistic regression. Setting-Publicly insured population in Amsterdam, the Netherlands. Participants-1422 people from the indigenous population, and 378 people fro m the four largest immigrant groups in the Netherlands-that is, the Surinam ese, the Netherlands Antilleans, and the Turkish and Moroccan. Main outcome measures-General practitioner service use (past two months), p rescription drug use (past three months), outpatient specialist contact (pa st two months), hospital admission (past year), physiotherapist contact (pa st two months) and contact with other paramedics (past year). Main results-Ethnicity was found to be associated with the use of health ca re after controlling for health status as an indicator for need. The use of general practitioner care and the use of prescribed drugs was increased am ong people from Surinam, Turkey and Morocco as compared with the indigenous population. Compared with the indigenous group with corresponding health s tatus, the use of all other more specialised services was relatively low am ong Turkish and Moroccan people. Among the Surinamese population, the use o f more specialised care was highly similar to that found in the Dutch popul ation after differences in need were controlled for. Among people from the Netherlands Antilles, we observed a relatively high use of hospital service s in combination with underuse of general practitioner services. The lower socioeconomic status of immigrant groups explained most of the increased us e of the general practitioner and prescribed drugs, but could not account f or the lower use of the more specialised services. Conclusions-The results indicate that the utilisation of more specialised h ealth care is lower for immigrant groups in the Netherlands, particularly f or Turkish and Moroccan people and to a lesser extent, people from the Neth erlands Antilles. Although underuse of more specialised services is also pr esent among the lower socioeconomic groups in the Netherlands, the analyses indicate that this only partly explains the lower utilisation of these ser vices among immigrant groups. This suggests that ethnic background in itsel f may account for patterns of consumption, potentially because of limited a ccess.