# Healthcare utilisation among migrants in the Netherlands’ unique hybrid healthcare system: the HELIUS study

## TL;DR

The study compares healthcare use among migrants in Amsterdam with the Dutch-origin population, finding higher use of mainstream services among migrants.

## Contribution

This is the first study to examine healthcare utilisation by migrants in the Netherlands' hybrid healthcare system.

## Key findings

- Migrant groups reported higher or similar use of GP services compared to the Dutch-origin population.
- Most migrant groups used specialist and allied health services at similar or higher rates than Dutch-origin individuals.
- Complementary medicine use was higher among Dutch-origin participants than among migrants.

## Abstract

Migrants in Europe often face barriers to healthcare, contributing to poorer health outcomes. While healthcare utilisation has been studied within Beveridge systems (eg, the UK) and Bismarck systems (eg, Germany), less is known about healthcare use by migrants within the Netherlands’ hybrid model. The Dutch model combines a Bismarckian base with Beveridge-like supplements. We investigated the use of general practitioner (GP) services, specialist care, allied health services and complementary medicine among major migrant groups in Amsterdam (South Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin) compared with the Dutch-origin population.

We used pre-pandemic Healthy Life in an Urban Setting data (2015; n=21 614) to avoid biases from intra-COVID-19 and post-COVID-19 healthcare disruptions/alterations. Structured questionnaires assessed healthcare use and reasons for seeking care. Poisson regression with a log link and robust (sandwich) standard errors examined associations between migration background and healthcare utilisation, adjusting for demographics, acculturation, health literacy, lifestyle and chronic conditions. Sensitivity analyses explored motivations for care use and overall health status.

All migrant groups reported higher or similar use of GP services compared with the Dutch-origin population. Most migrant groups (except Ghanaians) also reported higher or similar use of specialist and allied health services. Conversely, use of complementary medicine was higher among Dutch-origin participants than among migrants.

Many migrant groups in Amsterdam show higher use of mainstream healthcare services compared with previous reports from other European settings. Further studies should examine and dissect these patterns to inform improvements in other European settings.