In most European countries the number of immigrants and ethnic minorities are increasing. Ethnic disparities in health care and health outcomes in patients with rheumatic diseases have been described. Recent research has focussed on barriers to health care as a factor contributing to and maintaining health disparities. These barriers occur on system-level, provider-level and individual/patient-level. Barriers may vary from country to country and between ethnic groups.
Access to health care for ethnic minority patients may be restricted because of lack of familiarity with the country's health care system and/or lack of health insurance. Delay in help-seeking among ethnic minorities has been described. Moreover, undocumented immigrants may not be entitled to mainstream health services.
Language barriers may lead to inadequate communication between patients and clinicians, less satisfaction and poor coordination of health care. Patients with low language proficiency may be unable to communicate their health concerns sufficiently, increasing the risk of being misunderstood and misdiagnosed. In several countries the access to trained medical interpreters is scarce. Furthermore, limited health literacy in ethnic minority patients is associated with increased disease severity and functional disability.
Cultural barriers include differences in understandings of illness and treatment, different expressions of aetiology, symptoms and pain and different perceptions of the roles of patients and clinicians, as well as general differences in cultural norms, religious practices and customs. These disparities may influence treatment preferences, adherence to therapies, help-seeking behaviour and the patient-provider relationship in general.
Some ethnic minority patients fear discrimination based on current and previous experiences, which may lead to mistrust of the health care system and delayed treatment seeking. Discrimination on the part of health care providers may lead to poor quality of care.
Awareness of existing barriers is the first step in eliminating disparities in health care for ethnic minority patients with rheumatic diseases. Some interventions have also been proposed, such as improving interpreting services, developing educational programmes and information material for immigrants, training health professionals' cultural awareness, continuity of care and developing guidelines on the care entitlements of different immigrant groups.
Disclosure of Interest None declared