Report: A Bridge to Universal Healthcare

In March 2020, in response to the COVID-19 pandemic, the Ontario Ministry of Health (MOH) issued a directive to extend funding for all medically necessary hospital care to residents without health insurance. Members of the Health Network for Uninsured Clients (HNUC) have observed significant improvements to healthcare access for uninsured clients since the MOH directive has been in place.

To capture the directive’s impacts, the HNUC surveyed members who work directly with uninsured clients and interviewed key informants with several years of experience working with uninsured clients. Eighteen healthcare professionals responded to the survey, and six key informants participated in interviews, including a midwife, a nurse, a hospital-based physician, two client care coordinators at community health centres, and the coordinator of a primary care clinic for uninsured clients. This report highlights their observations and stories about how the directive has changed access to healthcare and its impacts on the wellbeing of people without health insurance.

KEY FINDINGS

Survey respondents unanimously agreed that the directive has improved health outcomes and reduced financial hardship for uninsured clients who need hospital-based services.

The directive has allowed for a more timely access to care, without the need for lengthy negotiations with hospitals or advocacy work to find sources of funding to pay for care. Clients who are aware of the directive are also less likely to wait until their medical issues become severe or life threatening before seeking care. This is a major improvement from pre-directive, when uninsured people often faced worsening health outcomes to the point of critical severity, and at times death, due to unnecessary delays to accessing care. Earlier access to care contributes to better outcomes for serious conditions like cancer and HIV.

Findings also highlight improved access and care experiences for those who need emergency, mental health, end-of-life, and maternal/perinatal care.

Healthcare providers consistently noted that the directive has led to reduced stress and improved well-being for their clients who need to access hospital care, including less financial stress. Before the directive, uninsured clients often accrued significant debt due to the costs of medical treatment, at times impacting people’s ability to pay for basic necessities such as housing and food.

Providers also emphasized the directive’s overall benefits to the health system. Providers experienced decreased administrative burden in their workload, without having to use their time to advocate for their clients or seek out funding for services. In addition, enabling access to earlier treatment for serious medical conditions is beneficial for the health system as it reduces the need for more complex and costly acute care when conditions worsen.

Despite the many benefits of the directive, providers observed that the implementation of the program has had critical gaps. It has been unevenly implemented across hospitals which has often resulted in confusion and lack of knowledge among staff. At times, this has led to uninsured people either being asked to pay for necessary medical care or being turned away due to the lack of funds.

RECOMMENDATIONS

The MOH directive has been an important step forward to ensure everyone in the province has the basic human right to health. It has led to improvements in access to necessary care and to health outcomes among uninsured people in Ontario. However, the directive remains a precariously temporary measure, and more significant action is needed to fully realize commitments to ensuring health for all.

Immediate policy and program changes through the Ontario Ministry of Health:

1. Make the directive permanent.
   The creation of the permanent program should include measures to address implementation issues, including standardizing the program across hospitals, establishing clearer processes for billing, and increasing awareness of the program.

2. Improve access to primary healthcare for uninsured people.
   This can be achieved through more funding for community health centres and uninsured health clinics. In addition, the billing codes created to cover primary care services for uninsured people should be made permanent and expanded to cover more services.

3. Educate healthcare professionals about healthcare options for uninsured clients.
   Education can occur through professional development and training opportunities within healthcare organizations.

Long-term policy changes through provincial and federal governments:

• OHIP for all in Ontario.
  The simplest and most effective approach to ensure all residents can access needed healthcare is by expanding OHIP coverage and having one system for everyone.

• Status for all residents in Canada.
  To remove the many structural barriers affecting people with precarious immigration status, the federal government must implement a broad and inclusive regularization program that provides real access to permanent residence for all residents, including those on study and work permits and those without status. Beyond access to healthcare, this would improve social determinants of health for many uninsured immigrants and support overall well-being.