by Nadha Hassen, Dhvani Katakia, Rebecca Cheff, Juan Sanchez
In Canada we do not want to exclude people who are living and working here, whether or not they are Canadians. However, many people in Ontario do not have access to health care for a number of reasons. One is that new immigrants, returning Canadians, and Canadians moving between provinces have to wait three months before being covered by the Ontario Health Insurance program (OHIP). Because of this policy over 80,000 new permanent residents a year are left without health care for at least three months.
Most provinces in Canada provide immediate health care to new immigrants. British Columbia, Quebec, New Brunswick, Manitoba, and Ontario have a wait period. In Ontario, doctors, health care coalitions, researchers, and newcomers themselves are concerned about the negative health impacts of the three-month wait. A recent study conducted by three Toronto physicians – Ritika Goel, Gary Bloch, and Paul Caulford – shows the impact the three month wait can have on people coming to Ontario. In the study they told the story of how the three month wait affected a new Nigerian origin mother. Three years after applying to emigrate to Canada, her application was accepted. By the time she arrived in Canada she was in the third trimester of her pregnancy. She was denied private health insurance because she was pregnant. She had her baby through caesarean section in an Ontario hospital and then received a $12,000 bill for the surgery.
There are many similar stories of families and individuals left with large medical bills for urgent health care issues out of their control.
We conducted a scoping review to determine how the three-month wait impacts the health of new permanent residents in Ontario. We found that:
- Most newcomers arrive in Canada healthy. But health can be unpredictable and new permanent residents have health needs during the first 3 month, just like the rest of Ontario’s population. New permanent residents are often unable to get private insurance during their first three months either because it is too costly or because they have a preexisting health condition including being pregnant
- New permanent residents may put off seeing a doctor even if they are sick, injured or pregnant during the three month wait because they are unable to afford large out-of -pocket health care bills
- The three-month wait prevents new permanent residents from receiving the essential health care that other Ontarians receive
- Although there is evidence that the three-month wait can create barriers to accessing health care for some new PRs, there has not been enough research done to know whether the three month wait results in different health outcomes for new PRs. The three-month wait may result in worse health outcomes for some newcomers, especially those who have urgent health problems and are not able to receive good quality health care
When newcomers are in the three-month wait, they cannot go to an emergency room if their child is injured, they cannot receive prenatal care from a doctor if they are pregnant, and they cannot see a nurse if they have diabetes without being left with large medical bills.
The three-month wait may worsen the health conditions of some newcomers. We predict that due to this delay in care, these individuals will require more complex and costly health care down the road once they are covered by OHIP. Wellesley Institute will be doing new research to determine the financial and health impacts of the three month wait for newcomers in Ontario.
The three-month wait builds inequity into our health care system by preventing newcomers from having the same access to health care as the rest of Ontarians. It is time to re-examine this policy.
Nadha Hassen, Dhvani Katakia, Rebecca Cheff and Juan Sanchez are Wellesley Junior Fellows. You can learn more about the program and their work here.