1. 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

2. HOW DOES ONE BECOME UNINSURED?

3. UNINSURED REFUSED REFUGEE CLAIMS OVERSTAYED VISA 3 MONTH WAIT SPONSORSHIP BREAKDOWN VISITOR / VISA W NO COVER WORK PERMIT VIOLATION LOST DOCUMENTS PARENTS WITHOUT STATUS REFUGEES? Eligible but deniedWere eligible but lost eligibility Eventually eligibleNever eligible

4. 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.

5. 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

6. The Triangle that Moved the Mountain 6 Prawase Wasi, 2000 Social Movement/ Learning Relevant Research Knowledge Political Involvement Academics Activists/ Community Activists/ Community Government /Courts

7. ANSWERING QUESTIONS THAT EMERGED FROM THE NETWORK How do the uninsured access care? Steele Gray, Hynie, Gardner, & Robertson, 2010

8. Uninsured/ Undocumented Client Toronto Public Health Community Health Centre Hospital Private Physicians Midwives Fear Cost Knowledge/ Information Gaps Discrimination Culture/ Language Availability Informal Networks/ Relationships Formal Agreements Funded by Faculty of Health, York University

9. ANSWERING QUESTIONS THAT EMERGED FROM THE NETWORK How many uninsured are there in Ontario?

10. LHIN % Uninsured Visits by % Immigrants (Arrived within Last 15 years, as of 2010) Hynie, Ardern, & Robertson, 2016 Funded by WCH

11. Percent Uninsured Visits and Temporary Migrant Workers (Canada) Over Time Hynie, Ardern & Robertson, 2016

12. 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

13. ANSWERING QUESTIONS THAT EMERGED FROM THE NETWORK What are the consequences of being uninsured? Hynie, Ardern, & Robertson, 2016

14. Top Five Complaints in ER by Insurance Status, plus Obstetric Insured%Uninsured% Injury (S/T)24.5Injury (S/T)28.4 Other Clinical/Lab (R)18.4Other Clinical/Lab (R)17.0 Respiratory (J)11.2Mental/Behavioural (F)10.5 (I: 3.48) Social/Environmental (Z)7.5Respiratory (J)8.1 Digestive (K)5.9 (UI: 5.4) Social/Environmental (Z)7.2 Obstetric (O)*2.7Obstetric (O)*5.6 *women only

15. Emergency Room Visits by the Uninsured: Triage Severity by Insurance Status Hynie, Ardern, & Robertson, 2016

16. Select Emergency Room Visit Outcomes by Insurance Status Hynie, Ardern, & Robertson, 2016

17. The Triangle that Moved the Mountain 17 Prawase Wasi, 2000 Social Movement/ Learning Relevant Research Knowledge Political Involvement Academics Activists/ Community Activists/ Community Government /Courts

18. For more information Sign up for the listserv Visit our website: – http://www.wellesleyinstitute.com/topics/health- equity/health-network-on-uninsured-clients/ Contact us: – mhynie@yorku.ca mhynie@yorku.ca – steve@wellesleyinstitute.com steve@wellesleyinstitute.com