Emergency Room Visits by Uninsured Child and Adult Residents in Ontario, Canada: What Diagnoses, Severity and Visit Disposition Reveal About the Impact of Being Uninsured
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Canadian immigrants can be without health insurance for many reasons but limited data exists regarding uninsured health outcomes. Uninsured Canadian residents were identified in the National Ambulatory Care Reporting System for all visits to emergency departments in Ontario, Canada between 2002/3 and 2010/11 (N = 44,489,750). Frequencies for main diagnoses, severity (triage), and visit disposition were compared. Ambulatory care sensitive conditions were identified in a 10 % subsample. The uninsured (N = 140,730; 0.32 %) were more likely to be diagnosed with mental health (insured: 3.48 %; uninsured: 10.47 %) or obstetric problems (insured: 2.69 %; uninsured: 5.56 %), be triaged into the two most severe categories (insured: 11.2 %; uninsured 15.6 %), leave untreated (insured: 3.1 %; uninsured: 5.4 %), or die (insured: 2.8 %; uninsured: 3.7 %). More ACSC visits were made by uninsured children and youth. Insurance status is associated with more serious health status on arrival to emergency departments and more negative visit outcomes.
KeywordsHealthcare access Emergency department Health equity Social determinants Immigration
Funding for this project was provided by Women’s College Hospital. We would like to thank Dr. David B. Flora for statistical consulting and an anonymous reviewer for helpful comments on earlier drafts of this manuscript.
Compliance with Ethical Standards
The first and third authors are members of the Network for Uninsured Clients. This network was coordinated by Women’s College Hospital at the time that the hospital provided funding for this research. The third author was the chair of this committee and employed by Women’s College Hospital at the time this funding was awarded. She has since changed employment.
Conflict of interest
The second author as no conflicts of interest to disclose.
Human and Animal Rights Statement
This research was approved by the institutional ethics review board (Human Participants Review Committee) at the first and second authors’ institution. This article does not contain any studies with human participants performed by any of the authors. It was based entirely on anonymized records obtained from a centralized database of hospital data.
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