Use of Primary Care Emergency Services in Norway: Impact of Birth Country and Duration of Residence

Abstract

In Norway, the General Practitioner Scheme was established in 2001. Satisfaction with the system is generally high. However, people often choose to visit community-based emergency wards (EW) for routine care instead. The aim of this paper is to describe which factors influence the choice of seeking care at the EW. Design, setting, and patients: Prior national research on utilization patterns has been based mostly on surveys showing a low response rate. By using merged register data, we analyzed the choice of the EW as a care provider in Oslo (Norway) for 2006 and 2007. Applying 1,934,248 observations of 279,531 different individuals, we estimated the probability of choosing the emergency ward for the Norwegian-born population as well as for the14-largest immigrant groups. Substantial variation between groups was identified. Main outcome: The proportion of EW visits was highest among patients from Somalia (11.7 percent) while the lowest proportion of EW users was among immigrants from Germany and Vietnam (5.3 percent). The results vary substantially within individual migrant groups; gender, age, and the duration of residence each influence the probability of visiting an EW. Conclusions: We found large differences in the probability of using an EW between individuals from immigrant populations, presumably because of barriers in access to primary care. Continuity in the physician–patient relationship is an important policy goal. A suggestion for policy is thus to improve communication about the organization of the Norwegian health-care sector to newly arrived immigrants, as well as to patients at the EW.