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Factors determining access to and use of primary health care services in the Girona Health Region (Spain)

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Abstract

Background

Increased population flowing from abroad has generated an intense debate regarding the economic consequences of migration in public services such as health, where new and specific demands are being created. This new demand for health care gives rise to the need to identify those factors which influence the user’s decision to contact the health services and those which determine the quantity of services consumed. The aim of this study is to identify which variables affect these two stages of the use of such services in the Girona Health Region (RSG), where immigrant population represents 21.96% of the total population.

Methods

Specification of a Hurdle model with a count response variable related to primary health care service visits in the RSG for 2006. The study data is based on a sample of users (immigrants and natives) taken from the population assigned to primary health care services in eight Basic Health Areas (ABS) of the RSG.

Results

Contacting primary health care services is associated with variables that ought to affect use of health care such as chronic illness and taking prescribed medication as well as being aged between 46 and 55. Using primary health care services once makes users more likely to make further visits. The number of visits is related not only with variables that ought affect use of health care but also with variables that ought not to affect use of health care such as working without a contract, living in rented accommodation, or being unemployed. Additionally, if we consider the birthplace of the user, we observe the same pattern, with different directions and intensities, depending on the origin of the patient. For example, a higher likelihood of first contact is shown in Eastern Europeans, South Americans, and North Africans that suffer from cholesterol. A higher attendance is observed in natives and Eastern Europeans that take prescribed medication as well as natives, Eastern Europeans, and North Africans living in rented accommodation. On the other hand, working without a contract supposes a higher attendance in natives but a lower attendance in Eastern Europeans and sub-Saharan Africans.

Conclusions

We do not detect any socioeconomic barriers associated with making a first contact with primary health services for the users analyzed. However, we do note evidence of horizontal inequity in terms of attending health services, related to variables that ought to affect use of health care as well as socioeconomic factors (variables that ought not to affect use of health care). The user’s origin is an important key in detecting different intensities of access and regular visits to primary health care services.

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Acknowledgments

We express our thanks to the health care and other professionals in the Basic Health Areas of Banyoles, Blanes, Girona 3, Olot, Roses, Salt, Santa Coloma de Farners, and Sarrià de Ter for their involvement and effort in the process of identifying the population and data gathering. Also, we thank the cooperation of Catalan Health Institute in implementing the data gathering software. Finally, we would like to thank two anonymous reviewers that improved a previous version of this work. This study is partially funded by means of the Spanish Health Research Fund (FIS 04/0495 and FIS 07/0156) and the Autonomous Government of Catalonia (AMIC 10025).

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Authors and Affiliations

  1. CIBER of Epidemiology and Public Health, University of Girona, Campus Montilivi, 17071, Girona, Spain

    Carme Saurina, Laura Vall-llosera & Marc Saez

  2. Research Group on Statistics, Applied Economics and Health, GRECS, University of Girona, Girona, Spain

    Carme Saurina, Laura Vall-llosera & Marc Saez

  3. Faculty of Business and Economics, University of Girona, Campus Montilivi, 17071, Girona, Spain

    Carme Saurina

Authors
  1. Carme Saurina
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  2. Laura Vall-llosera
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  3. Marc Saez
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Correspondence to Carme Saurina.

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Saurina, C., Vall-llosera, L. & Saez, M. Factors determining access to and use of primary health care services in the Girona Health Region (Spain). Eur J Health Econ 13, 419–427 (2012). https://doi.org/10.1007/s10198-011-0313-3

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  • DOI: https://doi.org/10.1007/s10198-011-0313-3

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