Health Care Utilization among Immigrants in Norway

The first part of the project ? The Immigrant Hospitalization Study ? has made statistical analyses of all contacts (consultations, day treatments, admissions) with somatic hospitals and specialized mental health care 2008-2011. Data come from the Norwegian Patient Register, linked to individual socio-demographic information from Statistics Norway. The Report ?Utilization of hospitals and specialized health care among immigrants and non-immigrants? (NOVA Report 10/2015, 150pp, in Norwegian, English Summary) shows that relative to number and age, migrants had less use of specialized health care than the ?native Norwegians?, in particular mental health services. However, utilization patterns differed considerably between different immigrant groups. Typically, Nordic and Western immigrants had utilization patterns similar to that of the non-immigrants, while some East European work immigrants had low utilization rates. Relatively high utilization rates of somatic services were found among those with a Somali, Iraqi, Iranian, or Pakistani background, but those with a Vietnamese and other Asian origins had low rates. As of March 2017, several scientific articles based on the data material have been published or are in press. A study published in BMC Health Services Research (2016) demonstrates that reason for migration and length of stay in Norway, more than country background, predict utilization levels among recent migrants. However, among long-term migrants who arrived before 1990, utilization rates tended to converge with the rates of non-migrants, regardless of the migrants? background. A study accepted for publication in Social Psychiatry and Psychiatric Epidemiology (2017) has analyzed use of specialist mental health care in different age categories. Immigrants overall had overall relatively low use, but differences within the immigrant population were large, spanning from very low use among women with a Somali background, to quite high use among those with an Iranian background. Immigrant underutilization of mental healthcare is suggested by the findings. A study accepted for publication in Scandinavian Journal of Public Health (2017) found on the other hand rather few differences between immigrants and non-immigrants in somatic healthcare allocated to the last months prior to death. Data have also been analyzed for a book chapter about health inequalities within Oslo. Project findings have been used in the Government White Paper NOU 2017:2 Integration and trust; various findings and preliminary studies have been presented at international conferences and in lectures; the data are used in a master thesis in progress, and access to data have been extended so that further studies will appear in the years to come. The second part of the project ? The Immigrants' Healthcare Seeking Study ? is a PhD project that uses data from qualitative interviews with immigrants from Somalia and Pakistan, undertaken 2013-2016. Further interviews were conducted in 2016 with immigrant organizations in Netherlands. The project focus is especially on how different types of networks, as relatives, immigrant associations, and religious leaders, shape how immigrants experience and utilize health care in Norway. In one study, the main finding is that the combination of immigrant background and knowledge of biomedicine and Norwegian health care constitutes a special form of capital that makes its possessors sought after as intermediaries between the Somali immigrant community and health services in Norway. Norwegian colleagues need their Somali colleagues? language skills and cultural knowledge, and Somali patients need help to orient themselves in the service landscape and to deal with medical terminology. Hence, they constitute an invisible extension of the Norwegian health care system. Another study deals with mental health among Somali women. Statistics show that Norwegian-Somali women have especially little contact with mental health services. The qualitative interviews suggest that part of the explanation is different mechanisms related to the maintenance of gender relations among Norwegian-Somalis. Although many Norwegian-Somalis will think of spirit-possession as an immediate explanation for signs and symptoms of potential mental illness, it is particularly when possession is ruled out that gender roles becomes crucial for mental health contacts. While men through their breadwinner role are in a position where deviant behavior is allowed to be exposed, mental illness in women is more strongly associated with stigma, resulting in collective efforts to hide or return sick women to Somalia, partly because of fear of social consequences for the family. A third planned study will examine the role of immigrant organizations in shaping the immigrants' attitudes towards health care in Norway. The PhD thesis is planned submitted during Summer 2017.

The project will carry out two studies. (1) The Immigrant Hospitalization Study will link individual register data (age, gender, immigrant status, education, etc.) covering the entire population in January 1, 2008 with data on all admissions to hospitals 2008-2010, obtained from Norwegian Patient Register. A quantitative study of hospitalization rates, diagnostic profiles, and survival after hospital stays, among main immigrant groups and native Norwegians will be made, in cooperation with Statistics Norw ay. Substudies will analyze how socio-economic factors and immigrant status influence hospitalization rates; whether readmissions, survival rates, and diagnostic profiles, indicate dysfunctional health-care seeking and substandard primary health care amon g immigrants. (2) The Immigrants' Health Care Seeking Study: The role of Third Parties, a PhD project, will utilize qualitative sociological/anthropological methods. It will study health care behaviours among 40+ immigrant families with Pakistani or Somal i background in two local communities with highly diversified populations. A particular focus will be on how informal networks, i.e. relatives, immigrant associations, religious leaders, and other prominent figures in immigrant milieus ("third parties"), influence how immigrants are integrated, or fail to be integrated, in Norwegian health care. These mediator roles are insufficiently acknowledged in previous studies on immigrants' health care utilization. In addition to interviewing families, the PhD pro ject will also interview third party representatives and staff in municipal health services. - The two studies will be supervised by an Advisory Board with well-qualified members. Results will be published in international scientific journals and dissemi nated to immigrant associations, health administrators, and health care personnel.