Hospital care for patients uninsured due to immigration status during the COVID-19 pandemic in Toronto: Lessons from front-line knowledge translation
“The [Health Network for Uninsured Clients]’s pandemic response group had a clear and unambiguous goal: to ensure that uninsured patients were able to access medically necessary hospital care without charge” (p. 27).
Immigration status is a foundational determinant of health for people who are undocumented or who have precarious immigration status in Canada.
Migrants living in Canada are often excluded from universal health care coverage, creating significant barriers to health care and public health services and resulting in avoidable health inequities.
In response to these gaps in universal health coverage, the Ontario Ministry of Health provided dedicated funding to hospitals, from 2020 to 2023, to cover the cost of medically necessary care for anyone living in Ontario regardless of immigration status or health care coverage.
In practice, implementation of this policy was not consistent, which resulted in continued barriers to hospital services including but not limited to COVID treatment, perinatal care and emergency care.
This article describes a knowledge translation approach taken by the Health Network for Uninsured Clients to address this policy implementation gap at a local level and improve access to health services. This approach included:
- developing multilingual, plain language materials for clients and providers;
- establishing a rapid response team to provide support to individual patients;
- communicating directly with hospital leadership; and
- holding frequent meetings and webinars to share information.
The report authors provide recommendations for public health and health care actors when implementing policies and programs that intend to improve access to health and social services, particularly for communities and individuals who face xenophobia, racism and exclusion.
Their eight recommendations to improve access to health and social services (p. 26 –28):
- Maximize flexibility for front-line workers.
- Value long-term relationships and commitments.
- Articulate and maintain clear values and goals.
- Develop and maintain the ability to assess local context and possible harms.
- Put the patient’s well-being at the centre and never give up.
- Document and share best practices.
- Operate simultaneously at different scales using a “looped” knowledge translation approach.
- Do not expect local groups with limited resources to systematically address province-wide implementation processes.
Use this resource to:
- understand the barriers to health services access experienced by migrants without health coverage,
- advocate for inclusive and responsive health care and public health services for migrants across Canada, and
- develop long-term strategies and partnerships with migrant-led organizations and health care partners to improve access to health care and permanent resident status for precarious migrants.
Disrupting migrant work (Mind the Disruption, Season 1, Episode 4)
Katz, A., Agahbanaei, N., Cheff, R., Harris, T., Hwang, S. W., & Schmidt, C. (2023). Hospital care for patients uninsured due to immigration status during the COVID-19 pandemic in Toronto: Lessons from front-line knowledge translation. Healthcare Quarterly, 26(2): 24–31. https://doi.org/10.12927/hcq.2023.27144