Around 20 percent of the domestic population does not have Austrian citizenship. However, this group accounts for only 9.4 percent of hospital patients. Similarly low is the share (9.8 percent) of nights spent in the hospital. They therefore use the healthcare system less, but are more likely to be readmitted, write Vienna researchers in the “Journal of Migration and Health.”
To find out how the domestic healthcare system is used, the team of the Complexity Science Hub (CSH) Vienna and the Medical University (MedUni) Vienna analyzed around 13 million hospital stays of four million people between 2015 and 2019 in Austria. Migrants living here without Austrian citizenship show significantly lower hospitalization rates—with one exception: Germans account for the most hospital stays per capita.
North Macedonians, Croats and Serbs hardly in hospital
Among men, Austrians are ahead of Slovaks and Italians, while according to the analysis North Macedonians, Croats and Serbs are the least often in hospital. Among women, if pregnancy stays are not taken into account, Germans are ahead of Syrians and Austrians, while the lowest hospitalization rates are found among Russians, North Macedonians and Serbs. This rate indicates the likelihood of a person of a certain nationality being admitted to hospital within a year.
In contrast, the readmission rate, meaning how often people are readmitted to hospital within a year, is higher among migrants than among persons with Austrian citizenship. This could be a possible indication that their first hospital visits already occur at more advanced stages of illness, said first author Elma Dervic of CSH in a release.
Readmission rate highest among Syrians
Among men, Syrians are ahead of Russians and Afghans. Only among Hungarians is the readmission rate significantly lower than among Austrians. Among women, this mainly concerns Afghans, Serbs and Germans, with North Macedonians at the bottom. But also among Turks, Italians and other nationalities, the readmission rate is lower than that of Austrians.
To understand why migrants come to hospital less often, the so-called “healthy migrant” effect and possible access barriers were examined. The former is when people who move to another country are relatively young and healthier than the average population there. If this were responsible for lower hospitalization rates, however, readmission rates would also have to be lower.
Access barriers or above-average health?
Access barriers such as linguistic or cultural obstacles could also lead to lower rates of hospital stays. This would explain higher readmission rates, because illnesses are already further advanced. Consistent with the “healthy migrant” effect is that, for example, people from Hungary, Romania and—in the case of women—Turkey have lower readmission rates. Increased rates among patients from Russia, Serbia and—in the case of men—Turkey rather point to access barriers.
“Our study shows that the different use of the Austrian healthcare system by people of different nationalities cannot be explained solely by the ‘healthy migrant’ effect or cultural barriers,” said Peter Klimek of CSH and MedUni Vienna. Rather, differentiation must be made according to nationality. Future measures should facilitate access—especially to outpatient care. Klimek cited translation services or orientation aids in the healthcare system as examples.
Mental illnesses less often diagnosed
An indication that migrant population groups more often suffer from chronic or severe illnesses is provided, according to the study, by the comparison of first admissions: they were less often in general and vascular surgery, but more often in departments of internal medicine, hematology, oncology and radiology. In addition, there are indications that among non-Austrians mental illnesses are underdiagnosed. Among persons with German citizenship, these differences are significantly smaller.
