Acculturation and the use of health care services in The Netherlands.

Background: The purpose of this study was to examine to what extent ethnic differences in health care utilisation can be explained by differences in acculturation. The basic premise driving our analyses is the expectation that health care use becomes more similar to the indigenous population as minority groups become more acculturated. Our study aimed to include acculturation, in a very broad sense. We therefore did not only include traditional indicators of acculturation such as length of residence and generational status. We also took into consideration proficiency in Dutch language, social interaction with and participation in the new country, and a scale measuring the degree of acquisition of Western cultural values and norms. Methods: * Health interview surveys in NIVEL’s Dutch National Survey of General Practice-2 (2001). * 12 699 indigenous and 1339 ethnic minorities from Turkey, Morocco, Surinam and the Netherlands Antilles were interviewed. * Independent variables: ethnic background and indicators of acculturation. * Control variables: socio-demographic variables and health status. * Outcome variables: use of health care services (GP services and specialist care) and (non) prescription drug use. * Considering possible clustering on GP level, multilevel analyses were performed. Results: Contrary to our expectation, ethnic differences in health care use do not diminish as the level of acculturation increases. Preliminary results showed that first generation migrants see their GP more often than the indigenous population (B ¼ 0.47, se 0.09, P < 0.01), whereas second generation migrants contacted medical specialists more often (B ¼ 1.20, se ¼ 0.21, P < 0.01). No relation is found between the use of prescription medication and the indicators of acculturation included in this study. Conclusions: Our study showed that the relationship between ethnic background and health care use still holds even when differences in acculturation are taken into account. The most important indicator of acculturation in the explanation of differences in health care use was generational status. (aut.ref.)