Immigration as a social determinant of health: Waiting for OHIP

In Canada, health falls under the mandate of provincial governments and when immigrants land in the country, they have to apply for their health cards from the province they land. Ontario, one of the provinces where most immigrants choose to land, do not give them Ontario Health Insurance Plan (OHIP) on arrival. Immigrants have to wait for three months before they are eligible for health care in their adopted country.

In the mean time, what do most immigrants do? A few who are financially very stable and know the pitfalls of living here with no insurance, purchase private health insurance. The rest of the immigrant population will continue on with life without a health card and no private insurance. When they fall sick, they either pay out of their pockets, or worse, choose not to visit a health care provider.

I did a pilot study a few years ago, based on a few immigrants living in Ottawa on what they did during this interim period when they were not eligible for the health card.Of the seven interviewed, only one had purchased private insurance.

S.R. and her family, which consisted of husband and two children under the age of 12, migrated from India and arrived in Ottawa. They decided to go without private insurance during the first three months when they were not eligible for OHIP. S.R. remembers clearly the day her little son fell down and broke his arm. This required a trip to CHEO, and this newly arrived family who did not have a job back then, incurred considerable medical expenses.

Singh and his family moved to Ottawa in 2002. He had lived in the Middle East for more than a decade and had some savings when he moved to Canada. When he arrived in Canada with his pregnant wife and young daughter, he purchased private insurance. Unfortunately, the insurance did not cover his wife's "pre-existing condition" and Singh found himself holding a very hefty bill along with his newly arrived baby daughter. This bill ate into the savings which he had been hoping to use in the months when he was unemployed in Canada. Singh was upset and angry that immigrants are not given information on how health care works in Canada, before they land here. He says that had he known, he would have arrived a few months later after his baby was born and saved himself a lot of money.
Read a CBC story here of another immigrant who faced a similar woe: Babies cost 22K

Canadian provinces follow different policies when it comes to providing health insurance to newly arrived immigrants. Alberta, PEI, Newfoundland, Saskatchewan, Nova Scotia and Northwest Territories provide comprehensive health coverage to all newly arrived immigrants.While the province of Quebec does have a waiting period before health coverage is given to new immigrants, it provides coverage for certain conditions. These include pregnancy, childbirth, abortion, domestic violence and infectious diseases.

The rationale behind this waiting period is that it saves the provinces money. The Ontario Medical Association in a policy paper however disputes the notion that denying health insurance for three months is a cost saving measure for the health care system. The OMA finds that this is one of the reasons why those who do not have insurance coverage land in the hospital emergency departments (which tends to be more costlier health care than primary health care). OMA argues that it is high time to extend health insurance coverage to newly landed immigrants.

It is interesting that landed immigrants who have to pay taxes from the day they arrive in Canada, are denied this basic right to health care. Time for a change, Ontario!