Abstract
Objectives Transnational utilisation of healthcare by people with an immigrant background carries risks, including medicalisation and adverse iatrogenic outcomes. We investigated the drivers behind such transnational healthcare use from a cultural perspective on health systems. Design Qualitative interview study (2018). Setting Two primary care practices in Amsterdam, the Netherlands. Participants Thirteen Dutch patients of Turkish background, who had obtained healthcare in Turkey, and who in general visited the primary care practice more than once a month. Results In the respondents’ stories, we observed how: (1) crossborder healthcare use was encouraged by cultural mismatches between expected and provided services and by differing explanatory models of illness upheld by patients and Dutch providers; (2) both transnationalism in patients and entitlements to insurance reimbursement facilitated the use of Turkish health services to bypass perceived barriers in the Dutch system; (3) cultural mismatches were reinforced during general practitioner consultations after the patients’ return to the Netherlands, thereby inducing further service use abroad. Conclusions Although cultural system influences are difficult to bridge, measures to reduce the unwelcome consequences of transnational healthcare use may include (1) strengthening the provision of culturally sensitive care in the country of residence and (2) restricting the reimbursement of care in the country of origin while maintaining the option to obtain care abroad. BACKGROUND Across the globe, the transnational ties of former migrants and their families are enabling them to retain and pursue private, cultural and economic interests in their countries of origin, including the domain of healthcare. This phenomenon is known as transnationalism.1 2 People with an immigrant background tend to use similar healthcare services in both their country of origin STRENGTHS AND LIMITATIONS OF THIS STUDY ⇒ A first strength is our innovative approach to explore the drivers behind transnational healthcare use from a cultural systems perspective. ⇒ This cultural systems perspective helped us to understand how transnational healthcare use may be encouraged by an interaction of factors in both clinical practice, healthcare system and national culture. ⇒ A second strength is the ethnicconcordant interviewer, familiar with the respondents’ language and cultural expressions, and the biographicnarrative interpretive interview method, together leading to indepth and meaningful information. ⇒ An important limitation is the rather small number of participants in the study, sampled from two primary care practices in one transnational healthcare context, which limits the generalisability of our finding to other populations and contexts and their country of residence.1 3 High transnational healthcare use may increase the risk of medicalisation, defined as expansion of the medical domain.4 Different diagn