Healthcare utilization patterns to inform health system design

Background As with many other parts of Canada, New Brunswick (NB) has experienced rapid demographic growth driven by immigration, with many newcomers arriving from regions with healthcare systems that differ significantly from Canada’s. Understanding healthcare utilization patterns among immigrant populations is important not only for service planning but also for assessing how healthcare system design supports access, navigation, and use within an increasingly diverse population. Purpose This study examines and compares healthcare utilization patterns among newcomers (defined to be non-Canadian-born, residing in NB <5 years), longer-term immigrants (non-Canadian-born, ≥5 years), and non-immigrants (Canadian-born or interprovincial migrants), interpreting observed differences as indicators of how different user groups access and navigate a complex healthcare socio-technical system. Methods A retrospective cohort study (2017–2021) was conducted using linked Provincial administrative and Federal immigration data accessed through the New Brunswick Institute for Research, Data, and Training. Age-standardized utilization rates per 100 individuals were calculated for four domains: walk-in clinic visits, general practitioner (GP) visits, emergency department (ED) visits, and hospital admissions. Adjusted logistic regression models controlled for age, sex, health zone, socioeconomic status, and length of residence. Results Newcomers demonstrated higher use of walk-in clinics and lower use of GP and ED than non-immigrants, particularly in their early years of residence. Over time, utilization patterns shifted toward greater engagement with GP services and reduced reliance on episodic care services, suggesting gradual integration into primary care pathways. Refugees consistently demonstrated the highest ED visit rates, while international students and temporary foreign workers (TFWs) exhibited the lowest overall engagement, indicating potential underutilization and/or unmet needs. Conclusions Healthcare utilization patterns in NB varied by immigration status and duration of residence, reflecting differences in how population groups interact with available care pathways. The observed reliance of episodic care among some newcomer groups suggests misalignment between healthcare system design and user needs during early settlement. Addressing these patterns requires culturally responsive, equity-oriented care models, and system-level design interventions that better align healthcare structures, access pathways, and organizational workflows with the needs of diverse user groups.