New Report
Two Steps Back: The Impact of Ontario’s Rollback on Healthcare Access for Uninsured Residents
To capture the impacts of the cuts to this important program, the Health Network for Uninsured Clients (HNUC) surveyed members working directly with uninsured people and interviewed key informants about their experiences providing care to their uninsured clients since the removal of the PHSUP policy. Between January and March 2024, a total of 66 service providers responded to the survey, and 15 providers participated in interviews. Participants represented different professions, including midwives, physicians, social workers, care navigators, nurses, and nurse practitioners, as well as health institutions, including hospitals, community health centres, midwifery clinics, non-profit organizations and specialty health clinics.
Health and social service workers reported concerning impacts on their clients’ access to health services and general well-being, as well as an increase in their workload in supporting their clients, because of the end of the PHSUP program. A number of access and system barriers were noted, including poorer coordination between community-based care and hospitals, higher service fees, and increased discriminatory practices toward uninsured clients. Participants linked these barriers to worsened health outcomes among their clients who are uninsured. Emergency care, reproductive care and non-acute care for severe or chronic conditions were highlighted as areas that have been particularly impacted by the cuts. Practitioners also noted increased overall workload and moral distress due to the difficulties in providing equitable and medically appropriate care for uninsured clients within the context of these barriers. Overall, findings underscore grave implications for uninsured people as a result of the cuts due to barriers to accessing life-saving and health-promoting care, increased financial stress, and discriminatory experiences in the health system.
RECOMMENDATIONS
We envision a society where all Ontario residents can access the healthcare and social programs vital to their health and well-being. We call on the provincial and federal governments to ensure that all residents of Ontario and beyond have full and comprehensive access to the healthcare and services they need to live healthy and dignified lives.
Policy changes through the Ontario Ministry of Health:
1. Establish OHIP for all.
A comprehensive OHIP for all policy would eliminate many of the administrative barriers that continue to create current and worsening inequities in access to healthcare.
2. Immediately reinstate the PHSUP program.
In the reinstatement of a permanent PHSUP program, the Government of Ontario and the Ministry of Health should consider adequate coverage and proper roll-out of the program:
Expand billing codes used by primary care and establish clearer billing processes to improve access to healthcare for uninsured clients. Billing codes should be expanded to cover more services and should be made permanent with clearer direction so that they can be better utilized.
Ensure the program is standardized within and across Ontario hospitals. Standardizing the program across hospitals is necessary to ensure hospitals can fully implement the program and work effectively with other care providers in the community to provide comprehensive care for uninsured clients.
Educate healthcare professionals about healthcare options for uninsured people. General education and awareness of uninsured care issues are vitally important for healthcare professionals so that they can better meet the healthcare needs of this population.
Ontario Health Teams should work with hospitals and health services in the community to ensure care is coordinated in compliance with the PHSUP program. Ontario Health Teams (OHTs) are regional health organizations established throughout the province, tasked with the ground-level coordination of care between hospitals and communities for all people living in this province. OHTs will play a vital role in ensuring services are accessible to those who are uninsured.
3. Ontario Health Teams should advocate and work towards OHIP for all.
OHTs are key players in calling for healthcare access for all residents in their regions, including those without OHIP. OHTs should use the levers they have at their disposal to ensure that all residents in the province, including those without OHIP, can justly access care in each region.
Recommendations to the Federal Government:
4. Status for all.
We join the calls for a broad, inclusive regularization program for all residents without permanent status, including easier access to permanent residence for all residents on temporary work and study permits. This would eliminate the confusing and discriminatory eligibility criteria for healthcare access, and help to reduce other inequities currently experienced by non-permanent residents in Canada.
Executive Summary
Endorsed by:
Report: A Bridge to Universal Healthcare
Executive Summary
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:
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.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.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.
