Papers/Bücher auf Deutsch by Alexander Bischoff
Papers by Alexander Bischoff
The Open Pharmacoeconomics & Health Economics Journal
It has been argued that asylum seekers (AS) consume more health care resources than the local Swi... more It has been argued that asylum seekers (AS) consume more health care resources than the local Swiss population. In this study we compare the health care costs of a group of AS who attended an outpatient clinic (OPC) at the University Hospital in Basel, Switzerland, between 2000 and 2003 with a control group of local patients attending the same OPC. Using data routinely collected by the hospital finance department, we measured the monthly health care costs of all the AS at the OPC. The mean costs of health care for the AS were lower than those of the local outpatients. These differences remain significant in multiple analyses controlling for sex and screening in the younger age groups, but not in the older age group. Our study did not confirm the assumption that AS consume more health care resources. Our results suggest that younger and middle aged AS may consume fewer health care resources than the general population.
Swiss Medical Weekly, 2011
The aim of this study was to explore differences in health care costs for asylum seekers from cou... more The aim of this study was to explore differences in health care costs for asylum seekers from countries experiencing violent conflict and those from countries experiencing no violent conflict. METHDODS: Data were collected from a representative sample of refugees in an urban Swiss canton who were assigned to a Health Maintenance Organisation that covered all their health care costs. Cost differences for individuals coming from countries experiencing violent conflicts and from countries experiencing no violent conflict were tested by using multiple regression techniques and by controlling for confounding demographic, clinical and migration-related variables. Health care costs were higher for patients from countries with violent conflict. The higher costs could be attributed in part to increased frequencies of somatic diseases, however, the higher costs were linked primarily to the duration of the asylum seeker's enrolment in the insurance programme, the number of visits to the medical facility, and the procedural status of the person's application for asylum. Despite a higher prevalence of illness in patients from countries with violent conflict, the length of time spent in administrative "asylum seeker" status seemed to be the main driver of health care costs. Language barriers may be skewing results, with respect to the importance of specific diagnoses (especially mental health disorders), in driving costs upward. These results indicate a need for more comprehensive screening strategies for asylum seekers in receiving countries, particularly for those from countries in conflict.
The European Journal of Public Health, 2008
Although the focus of health care for people seeking asylum in Western European countries is usua... more Although the focus of health care for people seeking asylum in Western European countries is usually on communicable diseases, there is little data about the general health care need of this population. In this study, we investigated the actual burden of disease among asylum seekers. Data were collected from a Swiss Health Maintenance Organisation (HMO; a type of managed care organization in which physicians act as gate keepers) that was set up specifically to provide health care for asylum seekers. The data included socio-demographic characteristics, international classification of diseases (ICD-10) diagnoses and number of clinic visits. Descriptive statistics were used to assess the types of health problems and the number of clinic visits. Logistic regression analysis was used to determine whether age, gender or country or region of origin was predictive in terms of incidence of disease as diagnosed by using ICD classifications. The total number of asylum seekers (mean age 22 years; 38% women) enrolled in the HMO from 2000 through 2003 was 979. Half of this group came from the former country of Yugoslavia. The remainder came primarily from sub-Saharan Africa, Turkey, Iraq and Sri Lanka. The most common health problems encountered in the population included musculoskeletal diseases, respiratory diseases, depression and post-traumatic stress disorder. The prevalence of all disease clusters was significantly associated with age. One-fifth of the population did not request health care at all during the time they were enrolled in the HMO. It is not known whether those who did not visit the medical clinic did not require health care or just chose not to request clinic services. The most frequent health problems encountered in the study population were chronic medical conditions, not communicable acute diseases. Although health care services provided to asylum seekers usually focus on episodic acute care, what this group actually needs is continuity of care.
BMC Health Services Research, 2010
Language barriers have a major impact on both the quality and the costs of health care. While the... more Language barriers have a major impact on both the quality and the costs of health care. While there is a growing body of evidence demonstrating the detrimental effects of language barriers on the quality of health care provision, less is known about their impact on costs. This purpose of this study was to investigate the association between language barriers and the costs of health care. The data source was a representative set of asylum seekers whose health care was provided by a Swiss Health Maintenance Organisation (HMO). A cross-sectional survey was conducted: data was collected on all the asylum seekers' health care costs including consultations, diagnostic examinations, medical interventions, stays in the clinic, medication, and interpreter services. The data were analysed using path analysis. Asylum seekers showed higher health care costs if there were language barriers between them and the health professionals. Most of these increased costs were attributable to those patients who received interpreter services: they used more health care services and more material. However, these patients also had a lower number of visits to the HMO than patients who faced language barriers but did not receive interpreter services. Language barriers impact health care costs. In line with the limited literature, the results of this study seem to show that interpreter services lead to more targeted health care, concentrating higher health care utilisation into a smaller number of visits. Although the initial costs are higher, it can be posited that the use of interpreter services prevents the escalation of long-term costs. A future study specially designed to examine this presumption is needed.
Background: Early detection of breast cancer plays a crucial role in survival, and in most devel-... more Background: Early detection of breast cancer plays a crucial role in survival, and in most devel- oped countries immigrant women present for treatment at a later stage of the disease. Com- pared to the indigenous population, immigrant women have a lower uptake of breast cancer pre- vention services. The situation for immigrant women in Switzerland is compounded by the fact
World hospitals and health services : the official journal of the International Hospital Federation, 2009
European cities are characterized by increasing numbers of foreign-born and foreign-language spea... more European cities are characterized by increasing numbers of foreign-born and foreign-language speaking inhabitants. The resulting cultural and linguistic diversity presents a number of challenges to health-care services. This paper describes a European initiative aimed at improving hospitals' responses to the health-care needs of migrants and ethnic minorities. We summarise the current health situation of these groups, describe how the EU initiative began and how it led to the Amsterdam declaration, and conclude by outlining current developments.
Public health nursing (Boston, Mass.)
The purpose of this study was to investigate whether the prevalence of self-reported cardiovascul... more The purpose of this study was to investigate whether the prevalence of self-reported cardiovascular risk factors differs between immigrants and Swiss nationals. This study is a secondary data analysis of the Swiss Health Survey 2002, a cross-sectional survey. In total, 19,249 individuals living in Switzerland were included. The prevalence of hypertension, high cholesterol level, smoking, diabetes, overweight, low fruit and vegetable intake, and physical inactivity were calculated for major immigrant groups and Swiss nationals. Demographic data were used to control for age and socioeconomic status. Major immigrant groups were people from Italy, Germany, former Yugoslavia, Spain, Portugal, France, and Turkey. Compared with Swiss women, women from former Yugoslavia were more likely to have hypertension, and women from Germany were more likely to have high cholesterol levels. Women from Italy, former Yugoslavia, Spain, Portugal, and Turkey were more likely to show physical inactivity an...
Social Science & Medicine, 2004
Social Science & Medicine, 2003
The objective of this study was to determine whether language barriers during the screening inter... more The objective of this study was to determine whether language barriers during the screening interview affected the reporting of asylum seekers' health problems and their referral to further health care. Seven hundred and twenty-three standard screening questionnaires, administered by nurses to asylum-seekers at the time of entry into Geneva/Switzerland between June and December 1998, were reviewed, as well as information pertaining to language use during the interview. Language concordance between nurses and asylum seekers was assessed by considering the presence/absence of an interpreter, the type of interpreter present (trained, untrained), and the nurse's self-assessed proficiency in the language used during the medical interview. Nurses also recorded their own subjective assessment of the overall quality of communication during the interview. More than half of the asylum seekers came from Europe, mainly the Balkan regions, and a third of them from Africa. Most asylum seekers were men (72%). The median age was 26.5 years, and 50% were younger than 25 years. Severe physical and psychological symptoms were reported by 19% and traumatic events prior to migration were reported by 63%. The nurses referred 36% of all refugees to further medical care and 6% to psychological care. Professional interpreters were used in 8% of the interviews and ad hoc interpreters in 16%. Adequate, partial and inadequate language concordance was reported for 54%, 27% and 18% of the consultations respectively. Adequate language concordance was significantly associated with higher reporting of past experience of traumatic events and of severe psychological symptoms, contrasting with much fewer referrals to psychological care when language concordance was inadequate. These results suggest the importance of addressing language barriers in primary care centres in order to adequately detect and refer traumatised refugees. To address this problem, the use of professional interpreters is recommended.
Pflege, 2007
Swiss hospitals are characterized by an increasing diversity, in the sense of personal and social... more Swiss hospitals are characterized by an increasing diversity, in the sense of personal and social differences such as including origin, gender language, skills, age, lifestyles and social status. Diversity is a challenge for hospitals. It is crucial to language barriers and migration and their clinical consequences. In spite of a trend towards interpreter services "going professional", interpreters are only reluctantly used. This is surprising. In this article we deal with three questions: What are clinical consequences of language barriers? How can language barriers be overcome? Should nurses act as interpreters? The literature available clearly shows that due to insufficient flow of information patients speaking a foreign language tend to receive inadequate care. Also, there is a consensus that patients' relatives acting as ad hoc interpreters are ill-equipped or unsuited to overcome language barriers. Conversely, professional interpreters improve most evidently the quality of care of patients speaking a foreign language. However in clinical everyday life the consistent use of interpreters is not always feasible. Thus, the setting-up of a pool of hospital-based ("internal"), trained bilingual health professionals appears to be an acceptable alternative.
Journal of Travel Medicine, 2010
Journal of Travel Medicine, 2008
Research suggests that doctor-patient communication patterns and patient satisfaction are influen... more Research suggests that doctor-patient communication patterns and patient satisfaction are influenced by gender. However, little is known about the effect of gender in consultations with foreign language-speaking patients and in interpreter-mediated consultations. The objective of the study was to explore the effect of doctor-patient gender concordance on satisfaction of foreign language-speaking patients in consultations with and without a professional interpreter. Its design consists of a cross-sectional analysis of patients' reports. A total of 363 consultations with foreign language-speaking patients were included in the analysis. We measured the mean scores of six items on the quality of communication (answer scale 0-10): the doctor's response to the patient's needs, the doctors' explanations, the doctor's respectfulness toward the patient, the quality of communication in general, the overall consultation process, and information provided regarding follow-up. When interpreters were used, mean scores were similar for doctor-patient concordant and discordant pairs. However, in the absence of interpreters, doctor-patient gender discordance was associated with lower overall ratings of the quality of communication (-0.46, p= 0.01). Our results suggest that the presence of a professional interpreter may reduce gender-related communication barriers during medical encounters with foreign language-speaking patients.
Journal of the American Dietetic Association, 1995
Journal of Immigrant and Minority Health, 2008
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Papers/Bücher auf Deutsch by Alexander Bischoff
Papers by Alexander Bischoff