Healthcare Services Utilization Among Migrants in Portugal: Results From the National Health Survey 2014
Migrants’ health is attracting substantial global interest. We aimed to identify barriers and differences in healthcare services utilization between migrants and natives in a nationally representative sample using data from the National Health Survey 2014. A total of 18,165 participants providing information on country of birth and nationality were included, and comparison of healthcare services utilization was made by using participants born in Portugal and with Portuguese nationality as the reference group. Migrants reported a lower frequency of medical visits, a higher consumption of medication without a prescription and less use of preventive care services. The main reasons for not attending medical consultations among migrants were the absence of need and financial difficulties. This study illustrates inequalities in healthcare use among migrants in Portugal, and provides useful information for enlightening policymakers and healthcare providers to develop health policies that can address migrants’ needs.
KeywordsDelivery of healthcare Health services Health surveys Migrants
The authors thank the Instituto Nacional de Estatística (INE) for providing the data. The Inquérito Nacional de Saúde 2014 was conducted under the supervision of the Departamento de Estatísticas Demográficas e Sociais/Serviço de Estatísticas das Condições de Vida from INE, with the collaboration of the Instituto Nacional de Saúde Doutor Ricardo Jorge and Unit F5 “Education, health and social protection” of Eurostat. This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); the PhD Grants PD/BD/128066/2016 (A. N. Shaaban) and SFRH/BD/102585/2014 (S. Morais) and the Postdoc Grant SFRH/BPD/108751/2015 (B. Peleteiro) co-funded by FCT and the POCH/FSE Program.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
- 1.O’Donnell CA, Burns N, Mair FS, et al. Reducing the health care burden for marginalised migrants: the potential role for primary care in Europe. Health Policy. 2016;120(5):495–508.Google Scholar
- 2.European Centre for Disease Prevention and Control. Migrant health. Solna, Sweden. https://ecdc.europa.eu/en/migrant-health (2017). Accessed 05 Jan 2017.
- 3.Cabral S, Duarte C. Employment and wages of immigrants in Portugal. Portugal: Banco de Portugal Eurosistema; 2010.Google Scholar
- 4.Migration Integration Policy Index Health Strand (MIPEX). Country report Portugal. Brussels: International Organization for Migration; 2015.Google Scholar
- 5.Serviço de Estrangeiros e Fronteiras. Relatório de Imigração, Fronteiras e Asilo - 2016 [Immigration, Borders and Asylum - 2016]. Lisboa: SEF/GEPF, 2017.Google Scholar
- 6.McKay L, Macintyre S, Ellaway A. Migration and health: a review of the international literature. Glasgow: MRC Social & Public Health Sciences Unit; 2003.Google Scholar
- 7.Mladovsky P. Migrant health in the EU. Eurohealth 2007;13(1):9–11.Google Scholar
- 8.Dias SF, Severo M, Barros H. Determinants of health care utilization by immigrants in Portugal. BMC Health Serv Res. 2008;8:207.Google Scholar
- 9.Ingleby D, Ethnicity migration and the ‘social determinants of health’ Agenda. Psychosoc Interv. 2012;21(3):331–41.Google Scholar
- 10.Maffla C. Health in the age of migration: migration and health in the EU. Community Pract. 2008;81(8):32.Google Scholar
- 11.Barros P, Machado S, de Almeida Simões J, Portugal health system review. Health Syst Transit. 2011;13(4):1–156.Google Scholar
- 12.de Almeida Simoes J, Augusto GF, Fronteira I, et al. Portugal: health system review. Health Syst Transit. 2017;19(2):1–184.Google Scholar
- 13.European Commission. Your social security rights in Portugal. Brussels: Employment SAI; 2013.Google Scholar
- 14.Hacker K, Anies M, Folb BL, et al. Barriers to health care for undocumented immigrants: a literature review. Risk Manag Healthc Policy. 2015;8:175.Google Scholar
- 15.Instituto Nacional de Estatística. Documento metodológico do Inquérito Nacional de Saúde 2014 [Methodological document of the National Health Survey 2014]. Lisbon: INE, 2014.Google Scholar
- 16.Instituto Nacional de Estatística. Inquérito Nacional de Saúde 2014 [National Health Survey 2014]. Lisbon: INE, 2016.Google Scholar
- 17.Stanciole AE, Huber M. Access to health care for migrants, ethnic minorities, and asylum seekers in Europe. Brussels: European Comission; 2009.Google Scholar
- 18.Bollini P, Siem H. No real progress towards equity: health of migrants and ethnic minorities on the eve of the year 2000. Soc Sci Med. 1995;41(6):819–28.Google Scholar
- 19.United Nations. Vulnerable People. New York, United States. http://www.un.org/en/letsfightracism/migrants.shtml (2016). Accessed 05 Jan 2017.
- 20.Neuman S. Are immigrants healthier than native residents? Bonn, Germany: The Institute of Labor Economics (IZA); 2014.Google Scholar
- 21.McDonald JT, Kennedy S. Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Soc Sci Med. 2004;59(8):1613–27.Google Scholar
- 22.Lu Y, Qin L. Healthy migrant and salmon bias hypotheses: a study of health and internal migration in China. Soc Sci Med. 2014;102:41–8.Google Scholar
- 23.Castro FG. Is acculturation really detrimental to health? Am J Public Health. 2007;97(7):1162.Google Scholar
- 24.Martín-López R, Jiménez-García R, Lopez-de-Andres A, et al. Inequalities in uptake of breast cancer screening in Spain: analysis of a cross-sectional national survey. Public Health. 2013;127(9):822–7.Google Scholar
- 25.Jatrana S, Pasupuleti SSR, Richardson K. Nativity, duration of residence and chronic health conditions in Australia: do trends converge towards the native-born population? Soc Sci Med. 2014;119:53–63.Google Scholar
- 26.Livingston G, Minushkin S, Cohn DV. Hispanics and health care in the United States: Hispanics and Chronic Disease in the U.S.: Pew Research Centre. http://www.pewhispanic.org/2008/08/13/ii-hispanics-and-chronic-disease-in-the-u-s/ (2008). Accessed 05 Jan 2017.
- 27.Chauvin P, Parizot I, Simonnot N. Report of the European Observatory – Médecins du Monde: Access to healthcare for undocumented migrants in 11 European countries. 2009.Google Scholar
- 28.Biswas D, Kristiansen M, Krasnik A, et al. Access to healthcare and alternative health-seeking strategies among undocumented migrants in Denmark. BMC Public Health. 2011;11(1):560.Google Scholar
- 29.Lindert J, Schouler-Ocak M, Heinz A, et al. Mental health, health care utilisation of migrants in Europe. Eur Psychiatry. 2008;23:14–20.Google Scholar
- 30.Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, et al. Influenza vaccination coverages among children, adults, health care workers and immigrants in Spain: related factors and trends, 2003–2006. J Infect. 2008;57(6):472–80.Google Scholar
- 31.Shahrabani S, Benzion U. The effects of socioeconomic factors on the decision to be vaccinated: the case of flu shot vaccination. Isr Med Assoc J. 2006;8(9):630.Google Scholar
- 32.Centers for Disease Control Prevention. Racial/ethnic disparities in influenza and pneumococcal vaccination levels among persons aged> or = 65 years—United States, 1989-2001. MMWR Morb Mortal Wkly Rep. 2003;52(40):958.Google Scholar
- 33.Poethko-Müller C, Ellert U, Kuhnert R, et al. Vaccination coverage against measles in German-born and foreign-born children and identification of unvaccinated subgroups in Germany. Vaccine. 2009;27(19):2563–9.Google Scholar
- 34.Rodríguez-Rieiro C, Hernández-Barrera V, Carrasco-Garrido P, et al. Vaccination against 2008/2009 and 2009/2010 seasonal influenza in Spain: Coverage among high risk subjects, HCWs, immigrants and time trends from the 2005/2006 campaign. Vaccine. 2011;29(35):6029–34.Google Scholar
- 35.Van der Wal M, Diepenmaat A, Pel J, et al. Vaccination rates in a multicultural population. Arch Dis Child. 2005;90(1):36–40.Google Scholar
- 36.Menvielle G, Richard J-B, Ringa V, et al. To what extent is women’s economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010. Cancer Causes Control. 2014;25(8):977–83.Google Scholar
- 37.Naoum P, Skroumpelos A, Athanasakis K, et al. Factors associated with the utilization of mammographic screening in Greece. Eur J Cancer Prev. 2018;27(1):13–9.Google Scholar
- 38.Ditzian LR, David-West G, Maza M, et al. Cervical cancer screening in low-and middle-income countries. Mt Sinai J Med. 2011;78(3):319–26.Google Scholar
- 39.Sánchez J. Self-medication practices among a sample of Latino migrant workers in South Florida. Front Public Health. 2014;2:108.Google Scholar
- 40.de Almeida JC. Portuguese national mental health plan (2007–2016) executive summary. Ment Health Fam Med. 2009;6(4):233.Google Scholar
- 41.Dental Tribune International. Survey shows impact of economic crisis on oral health in Portugal. (2015). http://www.dental-tribune.com/articles/news/europe/22901_survey_shows_impact_of_economic_crisis_on_oral_health_in_portugal.html.
- 42.Lourenço A, Barros PP. Cuidados de Saúde Oral: Universalização [Oral Healthcare: Universalization]. Lisbon: Nova Healthcare Initiative – Research/Universidade Nova de Lisboa; 2016.Google Scholar
- 43.Murphy J, Scully C. Oral healthcare implications of mass migration. Dent Update. 2015;42(10):965–71.Google Scholar
- 44.Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff (Millwood). 2001;20(1):247–56.Google Scholar
- 45.Berk ML, Schur CL, Chavez LR, et al. Health care use among undocumented Latino immigrants. Health Aff (Millwood). 2000;19(4):51–64.Google Scholar
- 46.Ku L. Health insurance coverage and medical expenditures of immigrants and native-born citizens in the United States. Am J Public Health. 2009;99(7):1322–8.Google Scholar
- 47.Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Soc Work. 1998;23(2):136–45.Google Scholar
- 48.Hayward RA, Bernard AM, Freeman HE, et al. Regular source of ambulatory care and access to health services. Am J Public Health. 1991;81(4):434–8.Google Scholar
- 49.Feinstein JS. The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 1993;71:279–322.Google Scholar
- 50.Lambrew JM, Defriese GH, Carey TS, et al. The effects of having a regular doctor on access to primary care. Med Care. 1996;34(2):138–51.Google Scholar
- 51.Kirmayer LJ, Narasiah L, Munoz M, et al. Common mental health problems in immigrants and refugees: general approach in primary care. CMAJ. 2011;183(12):E959–E67.Google Scholar
- 52.Wallace SP, Levy-Storms L, Ferguson LR. Access to paid in-home assistance among disabled elderly people: do Latinos differ from non-Latino whites? Am J Public Health. 1995;85(7):970–5.Google Scholar
- 53.Lai DW, Chau SB. Predictors of health service barriers for older Chinese immigrants in Canada. Health Soc Work. 2007;32(1):57–65.Google Scholar
- 54.Lindert J, von Ehrenstein OS, Priebe S, et al. Depression and anxiety in labor migrants and refugees—a systematic review and meta-analysis. Soc Sci Med. 2009;69(2):246–57.Google Scholar
- 55.González-López JR. Rodríguez-Gázquez MdlÁ, Lomas-Campos MdlM. Self-medication in adult Latin American immigrants in Seville. Acta Paulista de Enfermagem. 2012;25(SPE2):75–81.Google Scholar
- 56.World Health Organization. How health systems can address health inequities linked to migration and ethnicity. Copenhagen: World Health Organization; 2010.Google Scholar