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Open Access Research article

Differences between immigrant and non-immigrant groups in the use of primary medical care; a systematic review

Ellen Uiters12*, Walter Devillé1, Marleen Foets3, Peter Spreeuwenberg1 and Peter P Groenewegen1

Author Affiliations

1 NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands

2 RIVM, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

3 Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, The Netherlands

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BMC Health Services Research 2009, 9:76  doi:10.1186/1472-6963-9-76

Published: 11 May 2009



Studies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Therefore, our study aimed to provide a systematic overview of the existing research on differences in primary care utilization between immigrant groups and the majority population.


For this review PubMed, PsycInfo, Cinahl, Sociofile, Web of Science and Current Contents were consulted. Study selection and quality assessment was performed using a predefined protocol by 2 reviewers independently of each other. Only original, quantitative, peer-reviewed papers were taken into account. To account for this hierarchical structure, logistic multilevel analyses were performed to examine the extent to which differences are found across countries and immigrant groups. Differences in primary care use were related to study characteristics, strength of the primary care system and methodological quality.


A total of 37 studies from 7 countries met all inclusion criteria. Remarkably, studies performed within the US more often reported a significant lower use among immigrant groups as compared to the majority population than the other countries. As studies scored higher on methodological quality, the likelihood of reporting significant differences increased. Adjustment for health status and use of culture-/language-adjusted procedures during the data collection were negatively related to reporting significant differences in the studies.


Our review underlined the need for careful design in studies of differences in health care use between immigrant groups and the majority population. The results from studies concerning differences between immigrant and the majority population in primary health care use performed within the US might be interpreted as a reflection of a weaker primary care system in the US compared to Europe and Canada.