Migration and Health Care Utilization in the European Context

  • Carmen Cristina Ciupitu-Plath
  • Daniela Gohl
  • Christopher Kofahl
  • Birgit Babitsch


Throughout the second half of the twentieth century, many traditional emigration countries in Western Europe gradually became receiving countries for significant numbers of immigrants, leading to an increasing ethnic diversification of their populations. Although at first a “healthy migrant effect” could be noted, in time, migrant groups were shown to generally develop a poorer health status and face important barriers in accessing health services compared to the native population. Since current evidence in the European context is inconsistent in illustrating trends in health care utilization among migrants, the present chapter aims at gaining a better understanding of this phenomenon through an in-depth analysis of selected original articles. Following a systematic literature search and evaluation process, eight publications from European countries were selected and analyzed based on Andersen’s model of health care utilization. Even in this small sample, a great diversity of migrant definitions, study designs, and target groups was noted, which arguably precludes the identification of generalizable trends on a European level. Against the background of a generally high objective need for health services among migrants, residence status, region of origin, duration of stay in the receiving country, migrant generation, local language proficiency, level of acculturation, and reason for migration were identified as explanatory variables for health services utilization in our review. Despite efforts to increase equity in health care utilization within the European Union and in individual countries, persistent barriers to health care access among migrants call for further action in health services research and delivery.


Mental Health Care Health Care Utilization Asylum Seeker Health Service Utilization Undocumented Migrant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Andersen, R. M. & Davidson, P. L. (2007). Improving access to care in America: individual and contextual indicators. In: R. M. Andersen, T. H. Rice & G. F. Kominski editors, Changing the U.S. health care system: key issues in health services, policy, and management (p. 3–31). 3rd edition. San Francisco, CA: Jossey-Bass.Google Scholar
  2. Andersen, R. M. (1995) Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav, 36, 1–10.PubMedCrossRefGoogle Scholar
  3. Baglio, G., Saunders, C., Spinelli, A. & Osborn, J. (2010) Utilisation of hospital services in Italy: a comparative analysis of immigrant and Italian citizens. J Immigr Minor Health, 12, 598–609.PubMedCrossRefGoogle Scholar
  4. Berchet, C. & Jusot, F. (2012) Immigrants’ Health Status and Use of Healthcare Services: A Review of French Research. Questions d’économie de la santé.Google Scholar
  5. Boral, S., Borde, T., Kentenich, H., Wernecke, K.D. & David, M. (2012) Migration and symptom reporting at menopause: a comparative survey of migrant women from Turkey in Berlin, German women in Berlin, and women in Istanbul. Menopause, (in press).Google Scholar
  6. Borde, T. & David, M. (2007) [Treatment of immigrants in emergency clinics]. MMW Fortschr Med, 149, 38–9.PubMedGoogle Scholar
  7. Borde, T., Dudenhausen, J.W. & David, M. (2008) [Migrants in obstetrics–psychosomatic aspects in the context of acculturation]. Psychother Psychosom Med Psychol., 58 (3–4), 183–188.PubMedCrossRefGoogle Scholar
  8. Brzoska, P., Voigtländer, S., Spallek, J. & Razum, O. (2012) [The use of routine data to study rehabilitative care in populations with a migrational background: potential and limitations]. Gesundheitswesen, 74(6), 371–378.PubMedCrossRefGoogle Scholar
  9. Castaneda, H. (2009) Illegality as risk factor: a survey of unauthorized migrant patients in a Berlin clinic. Soc Sci Med, 68, 1552–60.PubMedCrossRefGoogle Scholar
  10. Council of Europe (2006) Recommendation Rec (2006) 18 of the Committee of Ministers to member states on health services in a multicultural society IN MINISTERS, C. O. (Ed.).Google Scholar
  11. Council of Europe (2011) Recommendation CM/Rec (2011) 13 of the Committee of Ministers to member states on mobility, migration and access to health care IN MINISTERS, C. O. (Ed.).Google Scholar
  12. Deville, W., Greacen, T., Bogic, M., Dauvrin, M., Dias, S., Gaddini, A., Jensen, N. K., Karamanidou, C., Kluge, U., Mertaniemi, R., Riera, R. P., Sarvary, A., Soares, J. J., Stankunas, M., Strassmayr, C., Welbel, M. & Priebe, S. (2011) Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study. BMC Public Health, 11, 699.PubMedCrossRefGoogle Scholar
  13. Dias, S. F., Severo, M. & Barros, H. (2008) Determinants of health care utilization by immigrants in Portugal. BMC Health Serv Res, 8, 207.PubMedCrossRefGoogle Scholar
  14. Eshiett, M. U. & Parry, E. H. (2003) Migrants and health: a cultural dilemma. Clin Med, 3, 229–31.PubMedCrossRefGoogle Scholar
  15. Fassaert, T., De Wit, M. A., Tuinebreijer, W. C., Verhoeff, A. P., Beekman, A. T. & Dekker, J. (2009a) Perceived need for mental health care among non-western labour migrants. Soc Psychiatry Psychiatr Epidemiol, 44, 208–16.CrossRefGoogle Scholar
  16. Fassaert, T., De Wit, M. A., Verhoeff, A. P., Tuinebreijer, W. C., Gorissen, W. H., Beekman, A. T. & Dekker, J. (2009b) Uptake of health services for common mental disorders by first-generation Turkish and Moroccan migrants in the Netherlands. BMC Public Health, 9, 307.CrossRefGoogle Scholar
  17. Fassaert, T., Hesselink, A. E. & Verhoeff, A. P. (2009c) Acculturation and use of health care services by Turkish and Moroccan migrants: a cross-sectional population-based study. BMC Public Health, 9, 332.CrossRefGoogle Scholar
  18. Goodman, N. (1992) Population. Introduction to Sociology. New York, HarperCollins Publishers, Inc.Google Scholar
  19. Hansen, R. (2003) Migration to Europe since 1945: Its History and its Lessons. The Political Quarterly, 74, 25–38.CrossRefGoogle Scholar
  20. Huber, M., Stanciole, A. E., Wahlbeck, K., Tamsma, N., Torres, F., Jelfs, E. & Bremner, J. (2008) Quality in and Equality of Access to Healthcare Services. European Commission.Google Scholar
  21. Jensen, N. K., Nielsen, S. S. & Krasnik, A. (2010) Expert opinion on “best practices” in the delivery of health care services to immigrants in Denmark. Dan Med Bull, 57, A4170.PubMedGoogle Scholar
  22. Jimenez-Rubio, D. & Hernandez-Quevedo, C. (2011) Inequalities in the use of health services between immigrants and the native population in Spain: what is driving the differences? Eur J Health Econ, 12, 17–28.PubMedCrossRefGoogle Scholar
  23. Kirkcaldy, B., Wittig, U., Furnham, A., Merbach, M. & Siefen, R. G. (2006) [Health and migration. Psychosocial determinants]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 49, 873–83.PubMedCrossRefGoogle Scholar
  24. Lanting, L. C., Bootsma, A. H., Lamberts, S. W., Mackenbach, J. P. & Joung, I. M. (2008) Ethnic differences in internal medicine referrals and diagnosis in the Netherlands. BMC Public Health, 8, 287.PubMedCrossRefGoogle Scholar
  25. Lindert, J., Schouler-Ocak, M., Heinz, A. & Priebe, S. (2008) Mental health, health care utilisation of migrants in Europe. Eur Psychiatry, 23 Suppl 1, 14–20.PubMedCrossRefGoogle Scholar
  26. Maier, T., Schmidt, M. & Mueller, J. (2010) Mental health and healthcare utilization in adult asylum seekers. Swiss Med Wkly, 140, w13110.Google Scholar
  27. Norredam, M., Nielsen, S. S. & Krasnik, A. (2009) Migrants’ utilization of somatic healthcare services in Europe–a systematic review. Eur J Public Health, 20, 555–63.PubMedCrossRefGoogle Scholar
  28. Penka, S., Kluge, U., Vardar, A., Borde, T. & Ingleby, D. (2012) The concept of “intercultural opening”: the development of an assessment tool for the appraisal of its current implementation in the mental health care system. Eur Psychiatry, 27 (2), 63–69.CrossRefGoogle Scholar
  29. Razavi, M. F., Falk, L., Bjorn, A. & Wilhelmsson, S. (2011) Experiences of the Swedish healthcare system: an interview study with refugees in need of long-term health care. Scand J Public Health, 39, 319–25.PubMedCrossRefGoogle Scholar
  30. Razum, O. & Spallek, J. (2009) Zugangsbarrieren zur gesundheitlichen Versorgung. Bundeszentrale für politische Bildung.
  31. RKI—Robert-Koch-Institut (2008a) Gesundheit von Kindern und Jugendlichen mit Migrationshintergrund. Beiträge zur Gesundheitsberichterstattung des Bundes.Google Scholar
  32. RKI—Robert-Koch-Institut (2008b) Migration und Gesundheit. Schwerpunktbericht der Gesundheitsberichterstattung des Bundes.Google Scholar
  33. Ruppen, W., Bandschapp, O. & Urwyler, A. (2010) Language difficulties in outpatients and their impact on a chronic pain unit in Northwest Switzerland. Swiss Med Wkly, 140, 260–4.PubMedGoogle Scholar
  34. Scheppers, E., Van dongen, E., Dekker, J. & Geertzen, J. (2006) Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract, 23, 325–48.PubMedCrossRefGoogle Scholar
  35. Schlopker, K., Herrmann, M., Grosser-Kaya, C., Robra, B. P., Dippelhofer-Stiem, B., Schutze, F. & Heintze, C. (2009) [Unresolved problems of undocumented migrants in Germany: an analysis of medical consultations in Berlin, Cologne and Bonn]. Gesundheitswesen, 71, 839–44.PubMedCrossRefGoogle Scholar
  36. Schoevers, M. A., Loeffen, M. J., Van den Muijsenbergh, M. E. & Lagro-Janssen, A. L. (2010) Health care utilisation and problems in accessing health care of female undocumented immigrants in the Netherlands. Int J Public Health, 55, 421–8.PubMedCrossRefGoogle Scholar
  37. Spallek, J., Zeeb, H. & Razum, O. (2011) What do we have to know from migrants’ past exposures to understand their health status? a life course approach. Emerg Themes Epidemiol. , 8:6.Google Scholar
  38. Stanciole, A. E. & Huber, M. (2009) Access to Health Care for Migrants, Ethnic Minorities, and Asylum Seekers in Europe. Policy Brief. European Centre.Google Scholar
  39. Suurmond, J., Uiters, E., DE Bruijne, M. C., Stronks, K. & Essink-Bot, M. L. (2011) Negative health care experiences of immigrant patients: a qualitative study. BMC Health Serv Res, 11, 10.PubMedCrossRefGoogle Scholar
  40. Terraza-Nunez, R., Toledo, D., Vargas, I. & Vazquez, M. L. (2010) Perception of the Ecuadorian population living in Barcelona regarding access to health services. Int J Public Health, 55, 381–90.PubMedCrossRefGoogle Scholar
  41. Toar, M., O’Brien, K. K. & Fahey, T. (2009) Comparison of self-reported health & healthcare utilisation between asylum seekers and refugees: an observational study. BMC Public Health, 9, 214.PubMedCrossRefGoogle Scholar
  42. Zeeb, H. & Razum, O. (2006) [Epidemiological research on migrant health in Germany. An overview]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 49, 845–52.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Carmen Cristina Ciupitu-Plath
    • 1
  • Daniela Gohl
    • 1
  • Christopher Kofahl
    • 2
  • Birgit Babitsch
    • 3
  1. 1.Charité – Universitätsmedizin Berlin, Berlin School of Public HealthBerlinGermany
  2. 2.Center for Psychosocial Medicine, Department of Medical SociologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Department of New Public Health, School of Human SciencesUniversity of OsnabrückOsnabrückGermany

Personalised recommendations