Health care for the uninsured: why it’s important and next steps

Recently, the Wellesley Institute participated in the Seeking Solutions Symposium, a conference that addressed access to health care for people living in Canada without health insurance.

Even though we in Canada like to think that everyone has access to free health care, this is not the case. The fact is, people who lack documentation do not have public health coverage. Moreover, in some provinces, including Ontario, newcomers and returning Canadians must wait 3 months before they are eligible for public health coverage. And this has negative – and inequitable – health impacts.

We know from Canadian and international evidence that people who lack health insurance:

  • Delay or forgo seeking health care;
  • Delay or forgo prenatal care;
  • Are sometimes denied care when it is sought; and
  • Are sometimes discriminated against when care is sought.

This means higher rates of infectious diseases, more serious triage assessments in emergency rooms, higher rates of complications in pregnancy, labour and delivery and newborn anomalies; greater exposure to hazardous and preventable conditions; and negative mental health consequences. And this leads to greater costs to the health system over the medium- to long-term.

One theme that was repeated across the conference was that high costs of using health care services mean that uninsured people do not seek care, even when it is required. Recently the CBC carried a report about an uninsured Scottish woman giving birth in a motel room across the street from a hospital.

We also heard about how Ontario’s medical professionals are frustrated by the current system. Doctors have to develop different care plans for the uninsured because they cannot be sure that their patients will have access to tests, follow-up appointments, and the right drugs. The Ontario Medical Association found no possible medical reasons for the 3 month wait period placed on newcomers to the province and are encouraging the government to eliminate this “unreasonable barrier to accessing health care.”

The Wellesley Institute’s Bob Gardner argued that extending access to health care for the uninsured requires both local innovation and higher level policy engagement. At a local level, there are many examples of ‘work-around’ solutions where care is provided in an ad hoc fashion. While this is not the ideal way for care to be provided, and these solutions are always vulnerable to change, it makes a tremendous difference to people needing care.

At a policy level, we need to look for the opportunities that offer immediate ‘wins’ and can act as levers for more substantive longer-term change – eliminating the 3 month wait period is a good example. We need to gather and disseminate evidence that shows that providing health care to all is not unsustainable. And we need to work with the broadest range of allies, like the Ontario Medical Association.The Wellesley Institute has blogged on issues facing the uninsured, including ending the 3 month wait period and ‘welcome to Canada – don’t get sick!’, and our St. James Town Initiative website has research and resources related to immigrant health. We’ll continue to be active in this issue via our involvement in the Women’s College Network on Uninsured Clients and by encouraging policy-makers to consider the health of vulnerable populations – including the uninsured.