Emergency Room Visits by Uninsured Child and Adult Residents in Ontario, Canada: What Diagnoses, Severity and Visit Disposition Reveal About the Impact of Being Uninsured
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Canadian immigrants can be without health insurance for many reasons but limited data exists regarding uninsured health outcomes. Uninsured Canadian residents were identified in the National Ambulatory Care Reporting System for all visits to emergency departments in Ontario, Canada between 2002/3 and 2010/11 (N = 44,489,750). Frequencies for main diagnoses, severity (triage), and visit disposition were compared. Ambulatory care sensitive conditions were identified in a 10 % subsample. The uninsured (N = 140,730; 0.32 %) were more likely to be diagnosed with mental health (insured: 3.48 %; uninsured: 10.47 %) or obstetric problems (insured: 2.69 %; uninsured: 5.56 %), be triaged into the two most severe categories (insured: 11.2 %; uninsured 15.6 %), leave untreated (insured: 3.1 %; uninsured: 5.4 %), or die (insured: 2.8 %; uninsured: 3.7 %). More ACSC visits were made by uninsured children and youth. Insurance status is associated with more serious health status on arrival to emergency departments and more negative visit outcomes.
KeywordsHealthcare access Emergency department Health equity Social determinants Immigration
Funding for this project was provided by Women’s College Hospital. We would like to thank Dr. David B. Flora for statistical consulting and an anonymous reviewer for helpful comments on earlier drafts of this manuscript.
Compliance with Ethical Standards
The first and third authors are members of the Network for Uninsured Clients. This network was coordinated by Women’s College Hospital at the time that the hospital provided funding for this research. The third author was the chair of this committee and employed by Women’s College Hospital at the time this funding was awarded. She has since changed employment.
Conflict of interest
The second author as no conflicts of interest to disclose.
Human and Animal Rights Statement
This research was approved by the institutional ethics review board (Human Participants Review Committee) at the first and second authors’ institution. This article does not contain any studies with human participants performed by any of the authors. It was based entirely on anonymized records obtained from a centralized database of hospital data.
- 3.Elgersma S. Immigration status and legal entitlement to insured health services. No. PRB 08-28E. Ottawa, Canada: Parliamentary Information and Research Service, Canada; 2008.Google Scholar
- 4.Goldring L, Berinstein C, Bernhard J. Institutionalizing precarious immigration status in Canada. (No. 61). CERIS Working Paper Series; 2007.Google Scholar
- 7.Steele Gray C, Hynie M, Gardner L, et al. Qualitative research project on health-care access for the uninsured, 2010. Research report for Women’s College Hospital Network on uninsured clients. https://doi.org/www.womenscollegehospital.ca/assets/legacy/wch/pdfs/WCHNUC-Qualitative-Research-Project-on-Health-Care-Access-for-Uninsured-july-15-2010.pdf. Accessed 15 March 2015.
- 12.Bodenmann P, Vaucher P, Wolff H, et al. Screening for latent tuberculosis infection among undocumented immigrants in Swiss healthcare centres: a descriptive exploratory study. BMC Infect Dis. 2009;24:9–34.Google Scholar
- 14.Bernhard JK, Goldring L, Young J, et al. Living with precarious legal status in Canada: implications for the well-being of children and families. Refuge. 2007;24(2):101–14.Google Scholar
- 18.Levinton C, Lacroix J, Choy L, et al. Ambulatory care sensitive conditions technical summary. Hospital Report 2006: Acute Care, 2006. https://doi.org/www.hospitalreport.ca/downloads/2006/acute_2006.html. Accessed 15 March 2015.
- 19.Statistics Canada. Table 051-0005—estimates of population, Canada, provinces and territories, quarterly (persons), CANSIM (database). Accessed 29 December 2015.Google Scholar
- 20.Statistics Canada. Immigrant population by place of birth, by province and territory (2006 Census). 2007. Accessed 29 December 2015.Google Scholar
- 21.Bonikowska A, Hou F, Picot G. Changes in the regional distribution of new immigrants to Canada. Statistics Canada: Analytical Studies Branch Research Paper Series; 2015. p. 366.Google Scholar
- 23.Canadian Institute for Health Information. Data quality documentation for external users: discharge abstract database, 2010–2011. Ottawa, Canada: Canadian Institute for Health Information; 2011.Google Scholar
- 24.Canadian Institute for Health Information. CIHI data quality study of Ontario emergency department visits for 2004–2005. Ottawa, Canada: Canadian Institute for Health Information; 2007.Google Scholar
- 25.Beveridge R, Clarke B, Janes L, et al. Implementation guidelines. Canadian Association of Emergency Physicians, 2015. https://doi.org/caep.ca/resources/ctas/implementation-guidelines#triage-acuity-scale-definitions. Accessed 30 December 2015.
- 26.Patychuk D, Smith K. Demographic analysis of Ontario’s sub-LHIN populations. Report prepared for AOHC, 2010. https://doi.org/www.ruralontarioinstitute.ca/file.aspx?id=face11e6-30f9-4a8d-a59d-8a55dfdcc0ac. Accessed 15 March 2015.
- 27.Canadian Institute for Health Research Canadian coding standards for version 2012 ICD-10-CA and CCI. Ottawa, Canada: Canadian Institute for Health Information; 2012.Google Scholar
- 28.Government of Canada, 2012. Facts and figures 2011—immigration overview: permanent and temporary residents. https://doi.org/www.cic.gc.ca/english/resources/statistics/facts2011/temporary/12.asp. Accessed 12 August 2015.
- 29.Office of the Parliamentary Budget Officer Temporary foreign workers in Canada. A look at regions and occupational skill. Government of Canada, 2015. https://doi.org/www.pbo-dpb.gc.ca/files/files/TFW_EN.pdf. Accessed 12 August 2015.
- 32.Ontario Ministry of Health and Long Term Care 2013. Ontario Temporary Health Program for refugee claimants. https://doi.org/www.health.gov.on.ca/en/pro/programs/othp/. Accessed 10 July 2015.
- 33.Citizenship and Immigration Canada Interim federal health program. Summary of benefits, 2015. https://doi.org/www.cic.gc.ca/english/refugees/outside/summary-ifhp.asp. Accessed 10 July 2015.
- 34.Canadian Council for Refugees. Refugee health care: impacts of recent cuts, 2013. https://doi.org/oppenheimer.mcgill.ca/IMG/pdf/Canadian_Council_for_Refugees_-_Refugee_Health_Care_-_Impacts_of_Recent_Cuts.pdf. Accessed 10 July 2015.