Exploring experiences and perceptions of medical overuse among migrant health professionals in Norway: A qualitative study

Abstract

Medical overuse is an issue gaining increasing attention by governments, health sectors, and researchers globally. It is known to occur in countries of varying economic standings and in all domains of medicine. Management of overuse varies between healthcare settings and systems, which affects how it is perceived by health professionals who have studied or practiced in these contexts. When migrant health professionals move to Norway, they undergo acculturation – a process in which migrants adjust to a new culture. No studies have addressed perceptions of overuse early in the acculturation process and contextual differences in health systems between the home country and host country of migrant health professionals have largely been ignored. This thesis explores the subjective experiences and perceptions regarding medical overuse of migrant health professionals after migrating to Norway and considers the relevance of overuse for migrants looking to work in the Norwegian healthcare system. We conducted a qualitative study with thematic analysis of group discussions and semi-structured interviews with migrant health professionals who were awaiting authorization to work in their respective health-related fields in Norway. A total of 13 individuals participated in the group discussions. Of these, 7 participated in a semi-structured individual interview in the following months. Prior to this study, the participants had not heard of medical overuse. After being introduced to the concept, they were gradually able to describe experiences of overuse from their home country. Despite complimenting the Norwegian health system for some of its regulations that reduce overuse, the participants struggled with reconciling this perspective with their negative experiences utilizing health services in Norway. The migrant health professionals considered medical overuse to be more problematic in their home country compared to Norway, had negative experiences with Norwegian healthcare, and were confident in their education and professional skills. Familiarity with general practitioners in the two-tiered healthcare system was linked to a more positive perception of the Norwegian health system. As several of the participants had worked in a privileged part of their own society before migrating to Norway, we hypothesize that they may have experienced less exposure to some of the negative aspects of inequitable health systems with underdeveloped universal health care, and that this may have further influenced their perspectives on overuse. Acculturative stress and adjustment to the Norwegian healthcare system is intertwined with the participants’ evolving perceptions of overuse. Addressing medical overuse and integrating migrant health professionals requires greater understanding and consideration of the contextual factors of migration.