Healthcare Utilization Patterns Among Migrant Populations: Increased Readmissions Suggest Poorer Access. A Population-Wide Retrospective Cohort Study

TL;DR

This study analyzes healthcare utilization among migrants in Austria, revealing that some groups have lower hospitalizations due to healthier status while others face access barriers, impacting readmission rates and healthcare equity.

Contribution

It provides a comprehensive population-wide analysis of migrant healthcare access and utilization patterns, highlighting differences across nationalities and the implications of the healthy migrant effect.

Findings

Hungarian, Romanian, and female Turkish migrants show lower readmissions consistent with healthy migrant effect.

Russian, Serbian, and male Turkish migrants have higher readmission rates, indicating access barriers.

Most non-Austrian groups have lower hospitalization rates but varied readmission patterns.

Abstract

Equal access to health ensures that all citizens, regardless of socio-economic status, can achieve optimal health, leading to a more productive, equitable, and resilient society. Yet, migrant populations were frequently observed to have lower access to health. The reasons for this are not entirely clear and may include language barriers, a lack of knowledge of the healthcare system, and selective migration (a "healthy migrant" effect). We use extensive medical claims data from Austria (13 million hospital stays of approximately 4 million individuals) to compare the healthcare utilization patterns between Austrians and non-Austrians. We looked at the differences in primary diagnoses and hospital sections of initial hospital admission across different nationalities. We hypothesize that cohorts experiencing the healthy migrant effect show lower readmission rates after hospitalization compared to migrant populations that are in poorer health but show lower hospitalization rates due to barriers in access. We indeed find that all nationalities showed lower hospitalization rates than Austrians, except for Germans, who exhibit a similar healthcare usage to Austrians. Although around 20\% of the population has a migration background, non-Austrian citizens account for only 9.4% of the hospital patients and 9.79% of hospital nights. However, results for readmission rates are much more divergent. Nationalities like Hungary, Romania, and Turkey (females) show decreased readmission rates in line with the healthy migrant effect. Patients from Russia, Serbia, and Turkey (males) show increased readmissions, suggesting that their lower hospitalization rates are more likely due to access barriers. Considering the surge in migration, our findings shed light on healthcare access and usage behaviours across patients with different nationalities, offering new insights and perspectives.