Waiting for public health care: How provincial policies contribute to health-care inequity for immigrants

Access to universal health care is ingrained in Canadian identity and one of the main reasons immigrants are attracted to Canada. A little-known mandatory waiting period immigrants undergo before accessing Ontario’s provincial health insurance causes unexpected financial and emotional strain, according to new research.

The collaborative study, involving CERC Migration senior research associate Ashika Niraula, examines how immigrants navigate Ontario’s waiting period and its impact on their financial and emotional well-being.

Since 1994, Ontario has required immigrants to wait three months before they are covered under the Ontario Health Insurance Plan (OHIP). This waiting period was temporarily waived in March 2020 as a pandemic measure, but it has since been reinstated.

“In 2020, the government wanted to remove the financial barriers that immigrants have accessing health care,” said Ashika, the research paper’s main author. “The waiting period has a negative impact on immigrants’ lives and integration experiences. Now is the time to permanently eliminate it.”

Ashika worked with researchers at the University of Toronto, Queen’s University and the Newcomer Centre of Peel to better understand the impact of Ontario’s waiting period. The research team interviewed 46 immigrants who experienced the full waiting period prior to the pandemic. Participants arrived in Ontario three months to just over one year prior to the study.

The researchers found 35 per cent of immigrants were unaware of the waiting period before arriving in Ontario. Among those who reported awareness of the waiting period, 63 per cent only knew because of word of mouth from family or friends. They also found the waiting period added to the financial burden of immigrating either through private insurance costs or out-of-pocket expenses. The waiting period was also found to have had a negative impact on emotional well-being through increased anxiety and behaviour changes.

“It's already scary for an immigrant to come to a new country, and then when immigrants don't have the health coverage that they thought they would, it has a negative impact on their lives and integration experiences,” said Ashika.

During the interviews, participants described making assessments of their conditions to determine if seeking care was urgent enough to justify the financial cost. If their condition was urgent, they would use their savings to pay for medications and hospital stays. At other times they described delaying seeking care until it became necessary.

Many participants also reported increased emotional strain accompanied by anxiety attacks, feelings of fear and vulnerability and increased stress. Some participants described increased risk aversion, such as not letting children partake in certain activities to avoid injury or illness.

Ashika and the research team recommend that provinces like Ontario, which have mandatory waiting periods, reevaluate their policies and move to permanently end them as Canada increases its immigration targets.

“We have this goal of bringing 500,000 people to Canada by 2025, and when we look at those numbers, I think we really need to eliminate not only this waiting period but all policies that discourage immigration,” said Ashika.

Read “Negotiating precarity: Recent immigrants’ perceptions of waiting for public healthcare in Ontario, Canada (external link) ” in the journal Health Policy.