Immigrants' clusters and unequal access to healthcare treatments

We focus on caesarean sections (C-sections) to examine access to appropriate medical care for immigrants in the Italian tax-funded universal National Health Service. We use a detailed micro-dataset to analyse whether non-native women receive different treatments compared to natives and whether there are differences between groups of non-natives defined by citizenship. For identification, we control for hospital fixed effects and maternal characteristics, and we compare the different groups by exploiting the clustering of non-natives of different nationalities in different urban areas. We find no significant differences between natives and non-natives in terms of C-sections and inappropriate C-sections. However, we do find significant differences between different groups of immigrants. In addition, we find that linguistic and socio-cultural distances are significant drivers of inequalities among non-native women. As language, habits, traditions, and beliefs can affect communication between the woman and the medical staff in many ways, we interpret our findings in terms of the ability to process and understand information between the two parties. In support of this interpretation, we find evidence of a “segregation effect”: women linguistically and socio-culturally more distant from Italy experience the greatest difficulties in accessing appropriate care when living in urban areas characterized by the presence of large immigrant communities of the same nationality. Moreover, we find that the role of linguistic and socio-cultural barriers is stronger for first-time mothers and women with non-native partners. • The focus is on inequalities in access to and use of health services by immigrants. • We consider the choice between natural deliveries and C-sections. • There are no differences between natives and non-natives in C-sections use. • There are differences between immigrant nationalities. • Linguistic and socio-cultural distance measures explain inequalities.