Amelie Van Pottelberge

Perceived discrimination In Primary Healthcare in Europe: evidence from the cross‐sectional QUALICOPC study

Recent figures show that discrimination in healthcare is still persistent in the European Union. Research has confirmed these results but focused mainly on the outcomes of perceived discrimination. Studies that take into account socioeconomic determinants of discrimination limit themselves to either ethnicity, income or education. This article explores the influence of several socioeconomic indicators (e.g. gender, age, income, education and ethnicity) on perceived discrimination in 30 European countries. Data from the QUALICOPC study were used. These data were collected between October 2011 and December 2013 in the participating countries. In total, 7183 GPs (general practitioners) and 61932 patients participated in the study, which had an average response rate of 74.1%. Data collection was co-ordinated by NIVEL (Dutch Institute for Research of Health Care). Bivariate binomial logistic regressions were used to estimate the impact of each socioeconomic indicator on perceived discrimination. Multivariate logistic regressions were used to estimate the unique effect of each indicator. Results indicate that in Europe, overall 7% of the respondents felt discriminated, ranging between 1.4% and 12.8% at the country level. With regard to socioeconomic determinants in perceived discrimination, income and age are both important indicators, with lower income groups and younger people having a higher chance to feel discriminated. In addition, we find significant influences of education, gender, age and ethnicity in several countries. In most countries, higher educated people, older people, women and the indigenous population appeared to feel less discriminated. In conclusion, perceived discrimination in healthcare is reported in almost all European countries, but there is large variation between European countries. A high prevalence of perceived discrimination within a country also does not imply a correlation between socioeconomic indicators and perceived discrimination.

Patients' Financially Driven Delay of GP Visits: Is It Less Likely to Occur in Stronger Primary Care Systems?

Available evidence has suggested that strong primary care (PC) systems are associated with better outcomes. This study aims to investigate whether PC strength is specifically related to the prevalence of patients’ financially driven postponement of general practitioner (GP) care. Therefore, data from a cross-sectional multicountry study in 33 countries among GPs and their patients were analyzed using multilevel logistic regression modelling. According to the results, the variation between countries in the levels of patients’ postponement of seeking GP care for financial reasons was large. More than one third of these cross-country differences could be explained by characteristics of the health care system and the GP practices. In particular, PC systems with good accessibility and those systems that offer comprehensive care were associated with lower levels of financially driven delay. Consequently, we can conclude that well-organized PC systems can compensate for the negative influence of individual characteristics (socioeconomic position) on the care-seeking behaviors of patients.

Partner Type Attitudes of Parents and Adolescents: Understanding the Decline in Transnational Partnerships among Turkish Migrants in Flanders

This article describes an unprecedented decline in transnational partnerships among Turkish migrants in Flanders, using population data on all marriages between 2001 and 2008. Studying parental preferences regarding partner selection, we examine attitudinal mechanisms behind this decline. Based on a representative survey, our first result is that (direct) parental involvement in partner selection is lower among the more recent marriage cohorts. Second, parents and adolescents have moved away from a focus on the origin country in partner selection, while ethnic homogamy remains preferred. Third, openness toward mixed partnerships is found among a small but salient proportion of parents and associated with the religious attendance of male parents. We conclude that an attitudinal shift has occurred from a focus on the origin country to an orientation toward the local (ethnic) community. This decline in transnational partnerships is more a product of intense attitudinal change than a reflection of a policy change in the direction of discouraging partner migration and has implications for the integration and demographic characteristics of Turkish ethnic minorities in Flemish society. Additionally, international migration patterns are affected as the character of long-lasting migration from Turkey to Europe is changing and partner migration, one of the most accessible channels to enter Europe, is rapidly decreasing.

Postponing a general practitioner visit : describing social differences in thirty-one European countries

OBJECTIVEnTo describe social differences in postponing a general practitioner visit in 31 European countries and to explore whether primary care strength is associated with postponement rates.nnnDATA SOURCESnBetween October 2011 and December 2013, the multicountry QUALICOPC study collected data on 61,931 patients and 7,183 general practitioners throughout Europe.nnnSTUDY DESIGNnAccess to primary care was measured by asking the patients whether they postponed a general practitioner visit in the past year. Social differences were described according to patients self-rated household income, education, ethnicity, and gender.nnnDATA COLLECTION/EXTRACTION METHODSnData were analyzed using multivariable and multilevel binomial logistic regression analyses.nnnPRINCIPAL FINDINGSnAccording to the variance-decomposition in the multilevel analysis, most of the variance can be explained by patient characteristics. Postponement of general practitioner care is higher for patients with a low self-rated household income, a low education level, and a migration background. In addition, although the point estimates are consistent with a substantial effect, no statistically significant association between primary care strength and postponement in the 31 countries is determined.nnnCONCLUSIONSnDespite the universal and egalitarian goals of health care systems, access to general practitioner care in Europe is still determined by patients socioeconomic status (self-rated household income and education) and migration background.