This well-presented study attempts to answer four key questions related to ethnic minorities’ use of primary care services in the Netherlands. The first question examines the extent to which ethnic minorities differ from the indigenous Dutch population regarding health care usage. The latter is measured by primary care usage, the rationale being that general practitioners constitute the gateway to medical care in the Netherlands. The second question examines the degree to which health status can explain ethnic differences in health care use. The third and fourth relate, respectively, to differences in the perceived quality of care and its relationship to the characteristics of patients.
The book’s title uses the general term ‘ethnic minorities’, but the study focuses on only the four largest ethnic minority groups in the Netherlands. Although the reasons for their inclusion are outlined, consideration should be given regarding those missing from the study, their size and reasons for their exclusion.
The comparison of the utilisation of the indigenous Dutch population with certain ethnic minority groups is proposed and an exploration of the potential differences in usage is undertaken with the scrutiny of influences on migrant groups. Usage of primary care within the Dutch population is employed as a baseline of normality; however, more discussion could have been provided about how primary care usage compares with usage in indigenous populations of similar countries. Although it is stated that more health care usage by ethnic minority groups cannot be considered to be over-usage, this is implied by assuming that usage by the Dutch population represents optimum usage.
The study needs to clearly articulate why it differentiates between migrants from industrialised and non-industrialised countries, but excludes migrants from industrialised countries in the systematic review.
The theoretical framework used for the study along with the study design and methods are well considered. The use of independently publishable chapters containing the component parts of the study is useful and, in the main, the chapters are self-contained with each having a full discussion of the methods employed. Chapter 9 contains a summary of the strengths and limitations of the study but these could have been discussed in each chapter, thus making it more specific and increasing the rigour of each of the component parts of the study.
The Tables, although accurate and well spaced, could be presented in a way that makes the information more accessible to the reader. Some tables, for example, on pages 142 and 143, contain too much information to be usefully considered.
The summary in Dutch is interesting but its purpose is unclear. Having two complete versions in English and Dutch would be more useful to readers of those languages.
Overall, this is a useful contribution to a much under-researched area. More research is identified to explore the underlying mechanism explaining the effect of ethnic background on health care use.
