A Comparison of Health Access Between Permanent Residents, Undocumented Immigrants and Refugee Claimants in Toronto, Canada

Abstract

Understanding the immigrant experience accessing healthcare is essential to improving their health. This qualitative study reports on experiences seeking healthcare for three groups of immigrants in Toronto, Canada: permanent residents, refugee claimants and undocumented immigrants. Undocumented immigrants who are on the Canadian Border Services Agency deportation list are understudied in Canada due to their precarious status. This study will examine the vulnerabilities of this particular subcategory of immigrant and contrast their experiences seeking healthcare with refugee claimants and permanent residents. Twenty-one semi-structured, one-on-one qualitative interviews were conducted with immigrants to identify barriers and facilitators to accessing healthcare. The open structure of the interviews enabled the participants to share their experiences seeking healthcare and other factors that were an integral part of their health. This study utilized a community-based participatory research framework. The study identifies seven sections of results. Among them, immigration status was the single most important factor affecting both an individual’s ability to seek out healthcare and her experiences when trying to access healthcare. The healthcare seeking behaviour of undocumented immigrants was radically distinct from refugee claimants or immigrants with permanent resident status, with undocumented immigrants being at a greater disadvantage than permanent residents and refugee claimants. Language barriers are also noted as an impediment to healthcare access. An individual’s immigration status further complicates their ability to establish relationships with family doctors, access prescriptions and medications and seek out emergency room care. Fear of authorities and the complications caused by the above factors can lead to the most disadvantaged to seek out informal or black market sources of healthcare. This study reaffirmed previous findings that fear of deportation forestalls undocumented immigrants from seeking out healthcare through standard means. The findings bring to light issues not discussed in great depth in the current literature on immigrant health access, the foremost being the immigration status of an individual is a major factor affecting that person’s ability to seek, and experience of, healthcare services. Further, that undocumented immigrants have difficulty gaining access to pharmaceuticals and so may employ unregulated means to obtain medication, often with the assistance of a doctor. Also, there exists two streams of healthcare access for undocumented immigrants—from conventional healthcare facilities but also from informal systems delivered mainly through community-based organizations. Finally, within the umbrella term ‘immigrant’ there appears to be drastically different healthcare utilization patterns and attitudes toward seeking out healthcare between the three subgroups of immigrants addressed by this study.

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Acknowledgments

I offer my deepest thanks to all of the participants in this study. I am indebted to your strength, resilience and willingness to share openly in order that others can learn from your experiences. I thank the community-based organization for welcoming me into their confidence and allowing this research study to take place. Thank you to Dr. Thomas Stewart and Mr. Joseph Mapa for their support of this study. Angela Robertson played a pivotal role in this research study and I am grateful for her on-going guidance through every stage. I am also indebted to the reviewer for the Journal of Immigrant and Minority Health who critiqued this manuscript, your suggestions significantly improved the caliber of the paper.

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Correspondence to Ruth M. Campbell.

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RC conducted all one-on-one interviews with study participants and worked with the community-based organization to plan the research study. BH, DF and SK assisted RC with the study and interview design. RC and BH coded the transcripts. SK guided the study framework and the method of analyzing data. RC wrote the manuscript, with input and comments from all authors. AK was responsible for helping RC shape the manuscript into a comprehensive document. All authors read and approved the final version.

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Campbell, R.M., Klei, A.G., Hodges, B.D. et al. A Comparison of Health Access Between Permanent Residents, Undocumented Immigrants and Refugee Claimants in Toronto, Canada. J Immigrant Minority Health 16, 165–176 (2014). https://doi.org/10.1007/s10903-012-9740-1

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Keywords

  • Immigrant Health
  • Health access
  • Health services research
  • Health disparities
  • Barriers to healthcare
  • Women’s health
  • Undocumented immigrants
  • Refugees
  • Refugee claimants
  • Illegal immigrants
  • Permanent residents
  • Landed immigrants
  • Immigration
  • Canada