Dutch citizens of Turkish origin who utilize healthcare services in Turkey: a qualitative study on motives and contextual factors

"Maybe it's an Indo thing": Transnational health experiences of Indonesian women living in Australia

Migrant health-seeking behaviour is understood to be influenced by transnationalism. This paper explores how transnationalism influences health seeking behaviour among Indonesian women living in Perth, Western Australia. Using a participatory action research approach, we conducted five focus groups with 21 women from Indonesia living in Perth. Transnational practices were common amongst Indonesian women. Transnational health-seeking (seeking Indonesian resources in Australia); transnational social support (between countries); and transnational healthcare (return to Indonesia) were common practices amongst Indonesian women. Transnational social networks were a critical source of health information and support. Findings suggest public health interventions may be improved through utilization of transnational social networks.

Health service behaviors of migrants: A conceptual framework

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

Understanding transnational healthcare use in immigrant communities from a cultural systems perspective: a qualitative study of Dutch residents with a Turkish background

OBJECTIVES

Transnational utilisation of healthcare by people with an immigrant background carries risks, including medicalisation and adverse iatrogenic outcomes. We investigated the drivers behind such transnational healthcare use from a cultural perspective on health systems.

DESIGN

Qualitative interview study (2018).

SETTING

Two primary care practices in Amsterdam, the Netherlands.

PARTICIPANTS

Thirteen Dutch patients of Turkish background, who had obtained healthcare in Turkey, and who in general visited the primary care practice more than once a month.

RESULTS

In the respondents' stories, we observed how: (1) cross-border healthcare use was encouraged by cultural mismatches between expected and provided services and by differing explanatory models of illness upheld by patients and Dutch providers; (2) both transnationalism in patients and entitlements to insurance reimbursement facilitated the use of Turkish health services to bypass perceived barriers in the Dutch system; (3) cultural mismatches were reinforced during general practitioner consultations after the patients' return to the Netherlands, thereby inducing further service use abroad.

CONCLUSIONS

Although cultural system influences are difficult to bridge, measures to reduce the unwelcome consequences of transnational healthcare use may include (1) strengthening the provision of culturally sensitive care in the country of residence and (2) restricting the reimbursement of care in the country of origin while maintaining the option to obtain care abroad.

Inherited eye diseases in Turkey: Current approaches and future directions

The aim of this review is to reveal Turkey's current status of medical practice in inherited eye diseases and the necessary steps to improve healthcare services and research activities in this area. Since consanguinity rate is high, disease burden is estimated to be high in Turkey. Universal health insurance system, easily accessible medical specialists, increasing genetic test, and counseling opportunities are the key advantages of Turkey's healthcare system. However, specialized clinics for inherited eye diseases, low-vision rehabilitation services, training of ophthalmologists about the recent developments in ocular genetics, and multidisciplinary translational research are the main headlines needed to be focused for better health services and successful research in Turkey.

Diasporic medical tourism: a scoping review of quantitative and qualitative evidence

Background

There is a growing recognition of the significance of the diasporic dimension of medical travel. Explanations of medical tourism are increasingly presented in a wider context of transnationalism, diaspora and migration. Yet diaspora and cross-border travellers rarely get through the broader narrative of medical travel.

Objective

Our aim in this scoping review was to extend the current knowledge on the emerging subject of diasporic travels for medical purposes. Specifically, we reviewed the existing literature on what is known about the determinants and motivational factors of diasporic medical tourism; its geographic scope and its quantitative estimation.

Methods

Using a scoping review methodology, we conducted the search in seven electronic databases. It resulted in 210 records retrieved. Ultimately, 28 research papers and 6 non-research papers (published between 2002 and 2019) met the following criteria: 1) focus on healthcare and health-related practices, 2) transnational perspective, 3) healthcare consumption in the country of origin (homeland) while being a resident of another country, 4) published in English.

Results

The findings from our review highlighted the importance of diasporic medical patients who had been researched and analysed on four continents. Even though quantitative evidence has been scarce, the data analysed in the scoping review pointed to the existence of non-negligible level of diasporic medical tourism in Northern America, and in Europe. Various motivational factors were enumerated with their frequency of occurrence: medical culture (12), time availability (“by the way of being home”) (9), communication (6), dissatisfaction with the current system (6), healthcare insurance status (5), quality of healthcare (5), second opinion (3), and value for money (3).

Conclusion

Diasporic medical tourists constitute an attractive segment of consumers that is still not well understood and targeted. They are part of transnational communities that cultivate the links between the two nations. They simultaneously participate in bi-lateral healthcare systems via return visits which impact the health systems of sending and receiving countries in a substantial way. In the current globalised, connected and migratory context, transnationalism seems to represent an answer to many local healthcare-related barriers. Sending and receiving countries have put in place an array of programmes and policies addressed to the diasporic medical travellers.

Associations between healthcare consumption in country of origin and in country of residence by people with Turkish and Moroccan backgrounds living in the Netherlands: the HELIUS study

BACKGROUND

In Europe, a substantial percentage of the 22 million inhabitants with histories of migration from non-European countries utilize healthcare in their countries of origin. That could reflect avoidance of healthcare in the country of residence, but this has not been studied previously.

METHODS

We linked Dutch healthcare reimbursement data to the multi-ethnic population-based data from the HELIUS study conducted in Amsterdam. In multivariable logistic regression and negative binomial generalized estimating equation (GEE) analyses, we examined associations between healthcare use in country of origin and in country of residence by people with Turkish and with Moroccan backgrounds (N = 2920 and N = 3031, respectively) in the period 2010-15.

RESULTS

Participants with Turkish and Moroccan backgrounds who utilized healthcare one or multiple times in the country of origin (n = 1335 and n = 558, respectively) were found to be more likely, in comparison with non-users (n = 1585, n = 2473), to be frequent attenders of services by general practitioners, medical specialists and/or allied health professionals in the Netherlands [odds ratios between 1.21 (95% CI 0.91-1.60) and 3.15 (95% CI 2.38-4.16)]. GEE analyses showed similar results.

CONCLUSION

People with Turkish or Moroccan backgrounds living in the Netherlands who use healthcare in their countries of origin are more likely than non-users to be higher users of healthcare in the Netherlands. We thus found no indications for avoidance of healthcare in the country of residence.

[Is healthcare consumption in the country of origin among Moroccan and Turkish migrants of older age (55+) associated with less use of care in the Netherlands?]

A substantial part of all Dutch people of Turkish and Moroccan origin use healthcare in the country of origin when travelling to their country of origin for a shorter or longer period of time (21% and 10%, respectively). If using care in the country of origin leads to avoidance of care in the Netherlands, this could threaten the continuity of care. We linked data of the HELIUS study to health insurance data. We examined the relationship between healthcare utilisation in the country of origin and the Netherlands, in the period of 2010-2015, adjusting for health status as an indicator of need. Contrary to our expectations, Dutch people of Turkish or Moroccan origin using healthcare consumption in the country of origin utilise more care in the Netherlands than individuals that do not utilize healthcare in the country of origin. Thus, our results do not provide any indication for avoidance of healthcare in the Netherlands among this group of older migrants in the Netherlands.