The Wellesley Institute, along with researchers, representatives from Community Health Centres (CHCs), Toronto Public Health, Women’s College, Association of Ontario Midwives, and frontline physicians and midwives were at City Hall yesterday to address the Toronto Board of Health on a Toronto Public Health report on medically uninsured residents. The tone of the meeting was set by midwife Jay MacGillivray who called on the Board to ”ferociously support,” the report and act on the issue of medically uninsured residents living in Toronto.
It is estimated that there are 75 000 – 300 000 uninsured residents in the Greater Toronto Area alone. Uninsured residents include individuals who have lost their identification, people in the three month OHIP wait period, temporary visa holders (ex. students, visitors), some refugees and undocumented residents.
Presently, essential health care services are extremely limited and inadequate for uninsured residents. Research indicates that priority health needs include obstetrical, newborn, and mental health care; without action, the most vulnerable of this already disadvantaged group, such as children – who do not have a say in where they are living – continue to face dire and inequitable health outcomes.
Dr. Michaela Hynie, a Wellesley Institute Board member, presented her research demonstrating that there are significant costs of a large uninsured population:
- uninsured clients – very limited access to primary and preventative care, sicker before they seek treatment and less likely to receive care
- health care system – staff time lost in scrambling to find care, increased and preventable costs because of delayed care, and costly visits to the emergency room due to lack of access to primary care
- health care workers – forced into difficult ethical situations and increased stress and workload
Frontline doctors and midwives shared their firsthand experiences while working with uninsured individuals. Midwife Jay MacGillivray spoke of an expectant mother of eight months who declined her offer of a piece of gum because it reminded her of how hungry she was. She was saving her money to feed her other child, and since she was unable to pay for the costs associated with ultrasounds and other earlier checkups, the visit was her first prenatal care during this pregnancy. However, it was stressed that the sharing of firsthand experiences was not merely to evoke emotions and be “sob stories,” but to demonstrate the reality of many individuals’ situation, and importantly, that policy action is needed and can make a difference.
Bob Gardner presented the Wellesley Institute brief, outlining our recommended policy solutions. One of the greatest challenges for local government and public health is that they don’t control most of the policy levers that can drive change on health inequities and determinants of health. But they do provide significant programs directly and can ensure that these are geared to enhancing equity, and Toronto Public Health does have considerable credibility and influence to collaborate and advocate for change with provincial and federal governments. We highlighted policy changes needed:
- Create equitable and effective policies – the Wellesley Institute supports the report’s recommendation to work with the health sector to ensure Access Without Fear policies are consistently in place
- Address inequitable policies – cuts to the Interim Federal Health Program are having adverse and inequitable consequences for refugees and should be rescinded; also, the three month wait for OHIP eligibility is one of the most significant barriers for immigrants to accessing health care, and should be rescinded as well
- Build on what is working – the innovative services and “work-arounds” developed by community-based practitioners is remarkable and more funding is needed for CHCs, specialized clinics and midwifery practices to provide greater quantity and quality of care to the uninsured
- Monitor impact – collect comprehensive and accurate information on the health of uninsured people to better assess gaps and service needs.
All members of the Toronto Board of Health voted to move this issue forward to the Toronto City Council.
We are living in an increasingly globalized world; human migration will not be ending or declining anytime soon. Uninsured residents are real and in Toronto, they are our family, friends, neighbours, community members, and colleagues. It is time to come together and offer our “ferocious” support.