Impact of immigration on hospital care: utilization, case-mix, and economic effects

OBJECTIVES: To identify the impact of immigration on health services by comparing hospital discharges, case-mix, and economic effects between immigrants and the native population. METHODS: We performed a retrospective longitudinal study of acute-care hospital admissions in Murcia (Spain) registered in the Minimum Data Set from 2004-2005. The groups to be compared, established on the basis of country of birth, were >, > and >. Diagnoses were codified using the ICE-9-CM and were grouped by means of the All Patient-Diagnosis Related Groups (AP-DRG) version 18. Utilization rates were calculated by the time of medical insurance. Economic effects were calculated through DRG weights for 2004. RESULTS: There were 196,275 discharges, with 2,590,376 person-years of insurance. The frequency of discharges was 75.8 per thousand among Spaniards, 64.3 per thousand among immigrants from Europe-25 and 73.8 per thousand among immigrants from the remaining countries. The most frequent causes of admission were related to pregnancy, childbirth and the puerperium. Cost per admission was 3,529 euro in Spaniards, 3,231 euro in persons from Europe-25 and 2,423 euro in persons from the remaining countries. The average cost per year of insurance was 263 euro for Spaniards, 217 euro for immigrants from Europe-25 and 219 euro for those from the remaining countries. CONCLUSIONS: Hospital utilization and costs per admission and for person-year of insurance are higher in Spaniards than in immigrants, especially the group from >. In this group, case-mix is also different.