title: Perceived discrimination outside health care settings and health care utilization of Turkish and Moroccan GP patients in the Netherlands.
abstract: BACKGROUND
  Problematic interethnic relationships, expressed by feelings of discrimination, may contribute to ethnic variations in health and health care utilization. The impact of daily perceived discrimination on (mental) health has been shown. Less is known about the effect of everyday discrimination on the health care utilization. We examined the relationship between perceived discrimination of Turkish and Moroccan patients on GP health care utilization in the Netherlands and on health services use in the home country.
  
  
  METHODS
  Cohort study within the second Dutch National Survey of General Practice (2001). Interviews were conducted with 416 Turkish and 381 Moroccan respondents, and repeated in 2005 among respectively 118 and 102 participants. Linear, logistic and zero-inflated binomial regression models were used for the analyses.
  
  
  RESULTS
  Perceived discrimination was associated with non-attendance to the GP. Perceived quality of GP care was not a mediator in this relationship. No evidence was found for substitution of health care utilization in the home country to health care in the host country. GP attenders had higher odds of using health care in the home country than non-attenders. Over time, a lasting discrimination feeling was related to persistent non-attendance at the GP practice.
  
  
  CONCLUSIONS
  Ethnic minority patients who feel discriminated may avoid GP health care. Further research is warranted on magnitude and health effects of such potential underutilization. Information on perceived discrimination within health care settings would increase insight into the profile of non-attenders, and on possible measures to better target interventions at a group at risk of underutilization.
authors: NIVEL-Netherlands Institute for Health Services Research, Utrecht, the Netherlands. m.lamkaddem@amc.uva.nl
authors: Majda
authors: M
authors: Lamkaddem
authors: Marie-Louise
authors: ML
authors: Essink-Bot
authors: Walter
authors: W
authors: Devillé
authors: Marleen
authors: M
authors: Foets
authors: Karien
authors: K
authors: Stronks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004192:Discrimination, Psychological; D054242:Emigrants and Immigrants / Q000523:psychology; D005260:Female; D058006:General Practice / Q000458:organization & administration; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009018:Morocco / Q000208:ethnology; D009426:Netherlands; D010342:Patient Acceptance of Health Care; D010361:Patients / Q000523:psychology*; D010465:Perception; D011787:Quality of Health Care; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014421:Turkey / Q000208:ethnology; D055815:Young Adult