Utilization profile of emergency department by irregular migrants and hospitalization rates: lessons from a large urban medical center in Tel Aviv, Israel.

BACKGROUND: Irregular migrants (IMM) are excluded from the National health insurance in most developed countries and may use the emergency department (ED) as a source for medical care. This study aims to compare the use of ED by IM with that of Israeli citizens (IC) in a large urban hospital in Tel Aviv, including socio-demographic characteristics, hospitalization proportion and medical conditions on admission. METHODS: This cross-sectional study included all IM and IC patients older than 18 years who attended the ED between 2007 and 2011, and compared their socio-demographic characteristics, the administrative details of the visit and clinical variables upon admission. Hospitalization proportion was calculated by dividing the number of patients who were admitted to the hospital ward by the number of all patients who attended the ED. RESULTS: IM who attended the ED were younger compared to IC (mean 39 ± 17 versus 52 ± 22 years, respectively), mostly males (1.4 Male/Female ratio) and mainly originated from developing countries. IM were more commonly self-referred, more likely to attend the ED during evening hours and weekends, complained of occupational injuries and frequented the surgical rather the medical ward of the ED compared with IC. IM stayed at the ED for longer periods than IC, yet the proportion of their hospitalization was lower than that of IC (19.4% versus 23.5%, respectively). CONCLUSION: IM stayed in the ED for longer periods and were less likely to be admitted to the hospital wards, suggesting presentation of non-severe medical conditions or possible barriers in ensuring care continuity in the community following discharge. Minimizing the barriers of IM to primary care in the community can reduce unnecessary referrals to the ED. Additionally, hospitals managements should respond to the high-volume of IM by shifting staff to busy hours and improving the communication with IM.

Changing the current health system's vision for disease prevention and health promotion.

AIM: Using the case of Israel, we examine the confluence of current philosophies of health care along with the historical trends of health promotion/disease prevention services to consider strategies for increasing inclusiveness and for updating and improving their service delivery. BACKGROUND: Health services in Israel are at a crossroads. Plans to integrate the historic, nurse-operated, nationwide programme, providing health promotion/disease prevention services to pregnant women and young children for all residents (Tipat Halav) into the National Health Service System's existing Sickness Funds are under discussion. SOURCES OF EVIDENCE: Using a discourse approach, this paper examines the current and historical context of health promotion/disease prevention services. Our history shows an increasingly treatment-based perspective and dwindling support for inclusive services. In the current health system, Tipat Halav nurses solely provide inclusive health promotion/disease prevention services to pregnant women and young children. Informed by the World Health Organization, a reorientation to health promotion/disease prevention is essential in an ageing society where chronic rather than infectious diseases are the reigning health problems. CONCLUSION: Israel needs to reorganize the health system using a public health approach that both incorporates existing structures and establishes new ones, such as creating a network to elicit community input, and instituting nurse-operated clinics designed to provide health promotion/disease prevention services for all ages and all residents. IMPLICATIONS FOR HEALTH AND NURSING POLICY: The newly created health system framework demands activism among all health professionals to legislate for an inclusive, holistic orientation. Master's level clinical programmes in community health nursing are vital to ensure the provision of optimal health promotion/disease prevention services.