Ethnic Differences in Utilization of an Outpatient Clinic in the Netherlands: a study of diabetes patients and patients with gastrointestinal symptoms

This thesis contains studies about ethnic differences in processes and outcomes of outpatient hospital care, with special attention to diabetes mellitus and gastrointesti nal complaints. Currently, about 10% of the population that lives in the Netherlands is of non-western origin. These are persons of which at least one parent is born in a non-western country. As a result of the increasing numbers of immigrant groups, the Netherlands is facing numerous new challenges. One issue of special interest is the consequence for population health. Current knowledge about ethnic differences demonstrates a worse self-reported health among ethnic minorities compared to native Dutch people, and differences in general morbidity and mortality. Explanatory factors are for example genetic factors, cultural behavior, effects of migration, effects of racism, exposure to health promoting and health damaging factors in the country of origin and in the Netherlands. Furthermore, differences are attributed to environmental and economic factors. However, these factors do not fully explain the ethnic differences. Health care itself could be of importance in explaining the ethnic differences, mainly the access and the quality of care. International and national literature did not provide sufficient information about ethnic differences in relation to health care processes in the Netherlands. This is the reason why we formulated a research project to analyze ethnic differences in health care processes. To be specific, in this thesis we compared health care processes and outcomes of outpatient hospital care among immigrant patients and native Dutch patients, with special attention for diabetes mellitus and gastrointestinal complaints. Immigrant patients were restricted to non-western immigrants from Turkish, Moroccan, Surinamese, Cape Verdean and Antillean and Aruban descent.

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