title: Use of cross-border healthcare services among ethnic Danes, Turkish immigrants and Turkish descendants in Denmark: a combined survey and registry study.
abstract: BACKGROUND
  Healthcare obtained abroad may conflict with care received in the country of residence. A special concern for immigrants has been raised as they may have stronger links to healthcare services abroad. Our objective was to investigate use of healthcare in a foreign country in Turkish immigrants, their descendants, and ethnic Danes.
  
  
  METHODS
  The study was based on a nationwide survey in 2007 with 372 Turkish immigrants, 496 descendants, and 1,131 ethnic Danes aged 18-66. Data were linked to registry data on socioeconomic factors. Using logistic regression models, use of doctor, specialist doctor, hospital, dentist in a foreign country as well as medicine from abroad were estimated. Analyses were adjusted for socioeconomic factors and health symptoms.
  
  
  RESULTS
  Overall, 26.6% among Turkish immigrants made use of cross-border healthcare, followed by 19.4% among their descendants to 6.7% among ethnic Danes. Using logistic regression models with ethnic Danes as the reference group, Turkish immigrants were seen to have made increased use of general practitioners, specialist doctors, hospitals, and dentists in a foreign country (odds ratio (OR), 5.20-6.74), while Turkish descendants had made increased use of specialist doctors (OR, 4.97) and borderline statistically significant increased use of hospital (OR, 2.48) and dentist (OR, 2.17) but not general practitioners. For medicine, we found no differences among the men, but women with an immigrant background made considerably greater use, compared with ethnic Danish women. Socioeconomic position and health symptoms had a fairly explanatory effect on the use in the different groups.
  
  
  CONCLUSIONS
  Use of cross-border healthcare may have consequences for the continuity of care, including conflicts in the medical treatment, for the patient. Nonetheless, it may be aligned with the patient's preferences and thereby beneficial for the patient. We need more information about reasons for obtaining cross-border healthcare among immigrants residing in European countries, and the consequences for the patient and the healthcare systems, including the quality of care. The Danish healthcare system needs to be aware of the significant healthcare consumption by immigrants, especially medicine among women, outside Denmark's borders.
authors.affiliation: University of Copenhagen, Department of Public Health, Section for Health Services Research, Center for Healthy Aging and Danish Research Centre for Migration, Ethnicity and Health, Øster Farimagsgade 5A, DK-1014, Copenhagen, Denmark. ssn@sund.ku.dk
authors.forename: Signe Smith
authors.initials: SS
authors.lastname: Nielsen
authors.forename: Suzan
authors.initials: S
authors.lastname: Yazici
authors.forename: Signe Gronwald
authors.initials: SG
authors.lastname: Petersen
authors.forename: Anne Leonora
authors.initials: AL
authors.lastname: Blaakilde
authors.forename: Allan
authors.initials: A
authors.lastname: Krasnik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D003718:Denmark; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D057193:Medical Tourism / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D061214:Patient Safety; D012042:Registries; D012923:Social Class; D014421:Turkey / Q000208:ethnology; D055815:Young Adult