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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]