Welcome to Canada – don’t get sick!

Canadians pride themselves on the universality of our health care system. Despite the obvious room for innovation and the need for improved health equity, we let out a sigh of relief because at least no one has to pay for care. Ever since the days of Tommy Douglas, Canadian governments have covered all medically necessary services. We scoff at our neighbors down south, grimacing at horror stories of leukemic children whose parents can’t afford the chemo, of uninsured diabetics who are refused routine check-ups. Thank goodness we live in Canada, right?

The truth is that we’re not quite as different from our neighbors as we think we are. Canada, too, has a very real, and very unhealthy, population of medically uninsured individuals. And the worst part is that here, hardly anyone knows.

People are uninsured for various reasons, dividing the uninsured population into different groups. There are legal citizens who are not covered by public health insurance because they are waiting to be eligible for the provincial plan, visitors who stay longer than their visas allow, and rejected refugee claimants who remain in the country during the appeal process. Because there are different reasons for being uninsured, the policy solutions for breaking through the access barriers for each of these groups are also different.

What a lot of people don’t know is that permanent, landed immigrants do not have access to our universal health care system right away. Four provinces in Canada, including Ontario, impose a three-month waiting period before new immigrants can become eligible for the provincial health insurance plan. Welcome to Canada! You better not get sick for the next three months.

And possibly even more than three months. According to the Canadian Medical Association Journal (CMAJ), it actually takes over two years, on average, to receive a provincial health card. Without an OHIP card, citizens of Ontario have very little access to health care services if they cannot afford to pay for private insurance.

Due to the three-month waiting period, the health needs of new Canadian immigrants are left unmet. There are some clinics that allow uninsured patients to see medical professionals for free, but this is a short-term, band-aid solution. Basic primary care can be provided in this manner, but without an OHIP card, diagnostic tests and other essential medical services cannot be ordered. Community Health Centers (CHCs) have some funds for covering a portion of the hospital bills of the uninsured, but this, too, isn’t a comprehensive solution. We need to start by increasing capacity at CHCs so that they can properly serve patients who may not yet have their government health cards. Most importantly, we need to follow in the footsteps of other provinces and eliminate the inequitable three-month waiting period.

Welcoming new Canadians to our country but denying them access to government health insurance has resulted in a clear gap in coverage. We like to say that we treat health care as a right, but our actions towards newcomers reflect quite the opposite. It’s time to stop pretending that Medicare reaches everyone and to start formulating concrete solutions for improving the health status of one of Canada’s most vulnerable populations.

Update:

In February 2010, the Women’s College Hospital Network on the Uninsured, in partnership with the Wellesley Institute, York University,  and Lawrence S. Bloomberg Faculty of Nursing University of Toronto, convened the first-ever Research Conference on Healthcare for the Undocumented and Uninsured.  Innovative research was presented that identified the most vulnerable groups, analyzed the harmful impact on their health of being denied access, and set out organizational and policy directions to address these barriers.