Children of Immigrant Parents in Spain See Specialists, Psychologists and Dentists Far Less Often, National Survey Reveals

A sweeping analysis of Spain’s most recent national health survey has uncovered a stark and quietly troubling pattern: children whose parents were both born outside Spain are significantly less likely to see medical specialists, psychologists, or dentists than children of native-born parents, even though the two groups report similar levels of health and chronic illness. The findings, drawn from the Spanish National Health Survey 2023 and published in BMC Public Health, offer one of the clearest national snapshots to date of how migration background shapes pediatric healthcare use in a country with universal public coverage.

The research team, led by Clara Maestre-Miquel of the University of Castilla-La Mancha and José J. Zamorano-León of the Universidad Complutense de Madrid, took an unusually rigorous approach to the question. Rather than simply comparing all children with immigrant parents to all children with native-born parents, they used a matched design: each child aged 0 to 14 whose mother and father were both born abroad was paired one-to-one with a child of the same age, sex, and autonomous community of residence whose parents were both Spanish-born. This matching strategy controls for some of the most powerful confounders in health services research, since age, sex, and regional health system variation all strongly influence how often families encounter the healthcare system. The final analytical sample comprised 1,320 children, 660 in each group.

The data source itself deserves attention. The Spanish National Health Survey 2023, conducted by the Spanish Ministry of Health together with the National Statistics Institute, collected information through computer-assisted web interviewing and computer-assisted personal interviewing, reaching a population-based sample rather than a convenience sample of clinic visitors. For the child questionnaire, parents reported on six categories of healthcare use during the previous twelve months: primary care visits, specialist consultations, psychologist visits, dentist visits, emergency room visits, and hospital admissions. The researchers then applied conditional logistic regression, a statistical method suited to matched data, to estimate adjusted odds ratios with 95 percent confidence intervals for each outcome.

The socioeconomic portrait that emerged from the comparison was markedly uneven. Children with immigrant parents came from households with lower income and lower parental educational attainment, and they were far less likely to be covered by private health insurance, an important detail in Spain, where private coverage often functions as a fast lane around public waiting lists. Their lifestyle profiles also differed: they engaged in less physical activity, spent more time on screens, and had a higher prevalence of obesity. Yet when it came to self-rated health and the presence of chronic conditions, the two groups were statistically indistinguishable. This equivalence is analytically crucial, because it means the differences in healthcare use cannot be explained away by the immigrant-origin children simply being sicker or healthier on these measured dimensions.

The utilization gaps were substantial and consistent. Specialist consultations had been used by 30.3 percent of children with immigrant parents in the previous year, compared with 44.8 percent of matched children with native-born parents. Psychologist visits showed an even steeper relative difference, at 4.4 percent versus 10.0 percent, meaning children of native-born parents were more than twice as likely to have seen a psychologist. Dental services, which in Spain involve a mix of public pediatric coverage and out-of-pocket or privately insured care, were used by 39.7 percent of the immigrant-parent group versus 57.6 percent of the native-parent group. All three differences were highly statistically significant, with p values below 0.001.

Crucially, the gaps did not extend across the board. Primary care visits, emergency room visits, and hospital admissions showed no statistically significant differences between the two groups. This pattern is telling. Primary care and emergency services are typically the most accessible entry points to any health system, and their equivalent use suggests that families with immigrant parents are not avoiding the healthcare system altogether. Instead, the disparity concentrates in services that tend to require more navigation: referrals to specialists, continuity of care, discretionary spending on dental visits, and the specific trust, language comfort, and health literacy needed to seek psychological support for a child. The inequality, in other words, is not about whether families reach the system, but about how far into it they get.

When the researchers moved from raw percentages to fully adjusted conditional logistic regression models, the picture held firm. Children with native-born parents had significantly higher odds of using specialist consultations, with an adjusted odds ratio of 1.40 and a 95 percent confidence interval of 1.03 to 1.98. For psychologist visits, the odds ratio was 1.98, with a confidence interval of 1.01 to 3.89, meaning that even after accounting for the socioeconomic and lifestyle differences between the groups, native-parent children had roughly double the odds of receiving psychological care. Dental visits showed an adjusted odds ratio of 1.48, with a confidence interval of 1.01 to 2.19. The fact that these associations persisted after adjustment suggests that the disparities are not merely a mechanical consequence of income or education, but likely reflect structural and informational barriers that operate independently of socioeconomic status.

The team also took steps to guard against one of the classic weaknesses of survey-based utilization research: missing data. Nonresponse on key variables can silently distort estimates if it occurs non-randomly, so the researchers performed a sensitivity analysis using multiple imputation, a technique that generates several plausible filled-in versions of the incomplete dataset and pools the results. The conclusions survived this test unchanged, strengthening confidence that the observed gaps are genuine rather than artifacts of how missing answers happened to fall.

From a methodological standpoint, the study has clear strengths and acknowledged limits. The matched design, the population-based national sample, and the use of conditional regression all reduce bias and confounding relative to naive comparisons. However, the data are cross-sectional and self-reported by parents, which means they capture a single moment in time and depend on recall and willingness to report. The survey also cannot fully disentangle why the gaps exist, whether from language barriers, documentation status, discrimination, differing cultural expectations about psychological and dental care, or practical obstacles such as appointment systems and waiting lists. The authors note that the findings point to persistent inequalities in healthcare utilization and support the need for targeted interventions to improve healthcare equity for families with immigrant parents.

What makes the results resonant beyond Spain is the tension they expose at the heart of universal health coverage. Spain guarantees healthcare access regardless of legal or economic status, yet access on paper does not guarantee equal use in practice. As children of immigrant parents make up a growing share of the Spanish pediatric population, the services where gaps appear, specialist care, mental health support, and dentistry, are precisely those with long-term consequences for child development and adult health. A childhood gap in psychological care or dental treatment can compound quietly for decades. The study’s message to policymakers is that the next frontier of health equity is not the clinic door, but everything that determines who walks through it, and how often.

Subject of Research: Healthcare utilization disparities among children with immigrant parents in Spain

Article Title: Healthcare utilization among children with immigrant parents in Spain: a matched cross-sectional study using data from the Spanish National Health Survey 2023

Article References: Maestre-Miquel, C., Zamorano-León, J. J., Jiménez-Garcia, R., Merida, D. M., Cuadrado-Corrales, N., Carabantes-Alarcon, D., Bodas-Pinedo, A., Jiménez-Sierra, A., López-de-Andrés, A., & Fuentes-Arroyo, L. (2026). Healthcare utilization among children with immigrant parents in Spain: a matched cross-sectional study using data from the Spanish National Health Survey 2023. BMC Public Health. https://doi.org/10.1186/s12889-026-29897-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29897-3

Keywords: children, immigrant parents, healthcare utilization, health inequalities, Spain, National Health Survey, pediatrics, public health, migrant families, specialist care, mental health, dental care