Download Answering questions that emerged from the Network

Partnering for equity:
Advocacy, knowledge, and access
through the Health Network for
Uninsured Clients
Michaela Hynie
York University
Steve Barnes
Wellesley Institute
Health Network for Uninsured
Clients
HOW DOES ONE BECOME
UNINSURED?
REFUGEES?
REFUSED REFUGEE
CLAIMS
SPONSORSHIP
BREAKDOWN
UNINSURED
Eligible but denied
Were eligible but lost eligibility
Eventually eligible
Never eligible
Health Network for Uninsured Clients
• The Network was established as a reformation of the Women’s
College Hospital Network on Uninsured Clients.
• Goals:
– To be a forum for health care and allied professionals working in
the Greater Toronto Area to discuss the delivery of care and to
map out pathways to access for uninsured clients;
– To inform and support research on issues related to improving
access to high quality health care services for uninsured clients;
and
– To identify and address structural barriers to health care services
for uninsured clients. This includes policy and operational change
within health care institutions and advocacy at the LHIN and
Ministry levels.
Activities
• Listserv for sharing information, needs and
updates
• Bi-monthly Network meetings to share updates,
needs and opportunities
• Guest speakers at Network meetings
• Organize symposia and conferences for multiple
stakeholders
• KM through website, fact sheets and conference
reports
• Policy advocacy
The Triangle that Moved the Mountain
Activists/
Community
Academics
Relevant
Research
Knowledge
Social
Movement/
Learning
Political
Involvement
Prawase Wasi, 2000
Government
/Courts
6
How do the uninsured access care?
ANSWERING QUESTIONS THAT
EMERGED FROM THE NETWORK
Steele Gray, Hynie, Gardner, & Robertson, 2010
Informal Networks/ Relationships
Formal Agreements
Hospital
Cost
Availability
Discrimination
Culture/ Language
Knowledge/ Information Gaps
Funded by
Faculty of
Health, York
University
Fear
Uninsured/
Undocumented
Client
Private
Physicians
Community
Health Centre
Midwives
Toronto Public
Health
How many uninsured are there in Ontario?
ANSWERING QUESTIONS THAT
EMERGED FROM THE NETWORK
LHIN % Uninsured Visits by % Immigrants
(Arrived within Last 15 years, as of 2010)
0.7
30
0.6
25
0.5
20
0.4
15
0.3
10
0.2
0.1
5
0
0
Funded by WCH
% Uninsured
%Immigrants
Hynie, Ardern, & Robertson, 2016
Percent Uninsured Visits and Temporary
Migrant Workers (Canada) Over Time
0.5
120000
0.45
%
0.4
0.35
100000
80000
0.3
0.25
60000
0.2
0.15
0.1
40000
% Uninsured
#TMW
20000
0.05
0
0
Hynie, Ardern & Robertson, 2016
How many uninsured in Ontario?
• If visits to the emergency room occur at about
the same rate for insured and uninsured
• For 2010/2011:
.44% of visits are by uninsured so…
.44% of Ontario population = approximately 58,500
What are the consequences of being
uninsured?
ANSWERING QUESTIONS THAT
EMERGED FROM THE NETWORK
Hynie, Ardern, & Robertson, 2016
Top Five Complaints in ER by Insurance
Status, plus Obstetric
Insured
%
Uninsured
%
Injury (S/T)
24.5
Injury (S/T)
28.4
Other Clinical/Lab (R)
18.4
Other Clinical/Lab (R)
17.0
Respiratory (J)
11.2
Mental/Behavioural (F)
10.5
(I: 3.48)
Social/Environmental (Z)
7.5
Respiratory (J)
8.1
Digestive (K)
5.9
(UI: 5.4)
Social/Environmental (Z)
7.2
Obstetric (O)*
2.7
Obstetric (O)*
5.6
*women only
Emergency Room Visits by the Uninsured:
Triage Severity by Insurance Status
100
90
80
70
60
50
Severe
40
Not Severe
30
20
10
0
Insured
Uninsured
Hynie, Ardern, & Robertson, 2016
Select Emergency Room Visit
Outcomes by Insurance Status
12
10
8
%
Insured
6
Uninsured
4
2
0
Admitted
Left Untreated
Died
Hynie, Ardern, & Robertson, 2016
The Triangle that Moved the Mountain
Activists/
Community
Academics
Relevant
Research
Knowledge
Social
Movement/
Learning
Political
Involvement
Prawase Wasi, 2000
Government
/Courts
17
For more information
• Sign up for the listserv
• Visit our website:
– http://www.wellesleyinstitute.com/topics/healthequity/health-network-on-uninsured-clients/
• Contact us:
– [email protected]
– [email protected]