# Healthcare service utilisation of elderly Ukrainian refugees in Israel: A retrospective cohort study

## TL;DR

Elderly Ukrainian refugees in Israel use fewer healthcare services than local controls, suggesting barriers to access despite full coverage.

## Contribution

This study is the first to compare healthcare utilization patterns of elderly Ukrainian refugees with a matched Israeli population.

## Key findings

- Refugees had significantly fewer doctor visits, specialist consultations, emergency room visits, and hospitalisations.
- Healthcare underutilization persisted across most medical fields except cardiology.
- Findings suggest barriers like language and cultural differences hinder access to care for elderly refugees.

## Abstract

The war in Ukraine led to a flood of refugees consisting mainly of women, children and elderly.

This study aimed to explore healthcare use by elderly Ukrainian refugees.

In this retrospective cohort study, we examined patterns of healthcare services used by elderly Ukrainian refugees in Israel between 30 July 2022 and 1 May 2023 (N = 2269). We compared them to controls, matched for age and gender, among the general Israeli population (N = 2271). We performed Poisson regressions for statistical analysis.

The Ukrainian refugee cohort was predominantly female (77.4%) with a mean age of 71.4 ± 7.1 years. Compared to their controls, the refugees were much less likely to participate in face-to-face, digital and video doctor visits (IRR = 0.838, 0.457 and 0.329, respectively; p value < 0.001). Across almost all medical fields (except cardiology), refugees were less likely to have consultations with specialists. Additionally, refugees had fewer emergency room visits (IRR = 0.42, p value < 0.001), fewer hospitalisations (IRR = 0.54, p value < 0.001) and shorter hospitalisations (IRR = 0.489, p value < 0.001).

In a healthcare system with full coverage, Ukrainian refugees were less likely to utilise healthcare services. These findings suggest that refugees may face significant barriers to access and may be underutilising needed care. Healthcare systems should adopt proactive and culturally responsive approaches to address these disparities and ensure equitable access. This study highlights the need for targeted interventions and further research to better understand and reduce healthcare barriers among refugee populations.

Elderly Ukrainian refugees used significantly fewer healthcare services than matched Israeli controls, despite having full healthcare coverage.

Refugees had lower rates of primary care consultations, specialist visits, emergency room use, hospitalisations, and shorter hospital stays.

Policymakers should address access barriers – including language and cultural differences – through equity-oriented, refugee-specific healthcare programs.