Is there equity in use of healthcare services among immigrants, their descendents, and ethnic Danes?
BACKGROUND
Legislation in Denmark explicitly states the right to equal access to healthcare. Nevertheless, inequities may exist; accordingly evidence is needed. Our objective was to investigate whether differences in healthcare utilisation in immigrants, their descendents, and ethnic Danes could be explained by health status, socioeconomic factors, and integration.


METHODS
We conducted a nationwide survey in 2007 with 4952 individuals aged 18-66 comprising ethnic Danes; immigrants from the former Yugoslavia, Iran, Iraq, Lebanon, Pakistan, Somalia, Turkey; and Turkish and Pakistani descendents. Data were linked to registries on healthcare utilisation. Using Poisson regression models, contacts to hospital, emergency room (ER), general practitioner (GP), specialist in private practice, and dentist were estimated. Analyses were adjusted for health symptoms, sociodemographic factors, and proxies of integration.


RESULTS
In adjusted analyses, immigrants and their descendents had increased use of ER (multiplicative effect 1.19-5.02 dependent on immigrant and descendent group) and less frequent contact to dentist (multiplicative effect 0.04-0.80 dependent on the group). For hospitalisation, GP, and specialist doctor, physical health symptoms had positive but different explanatory effects within groups; however, most immigrant and descendent groups had increased use of services compared with that of ethnic Danes. Socioeconomic factors and integration had no systematic effect on the use in the different groups.


CONCLUSIONS
The Danish healthcare system seems responsive to health across different population groups. We found no systematic pattern of inequity in use of free-of-charge healthcare services, but for dentists, who require co-payment, we found inequity among immigrants and descendents compared with ethnic Danes.
Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark. ssn@sund.ku.dk
Signe S
SS
Nielsen
Nana F
NF
Hempler
Frans B
FB
Waldorff
Svend
S
Kreiner
Allan
A
Krasnik
D000293:Adolescent; D000328:Adult; D000368:Aged; D003718:Denmark / Q000208:ethnology; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012959:Socioeconomic Factors; D055815:Young Adult