Source
# Executive Summary
To capture the impacts of the cuts to this important program, the Health Network for Uninsured Clients (HNUC) surveyed members working directly with uninsured people and interviewed key informants about their experiences providing care to their uninsured clients since the removal of the PHSUP policy. Between January and March 2024, a total of 66 service providers responded to the survey, and 15 providers participated in interviews. Participants represented different professions, including midwives, physicians, social workers, care navigators, nurses, and nurse practitioners, as well as health institutions, including hospitals, community health centres, midwifery clinics, non-profit organizations and specialty health clinics.
Health and social service workers reported concerning impacts on their clients’ access to health services and general well-being, as well as an increase in their workload in supporting their clients, because of the end of the PHSUP program. A number of access and system barriers were noted, including poorer coordination between community-based care and hospitals, higher service fees, and increased discriminatory practices toward uninsured clients. Participants linked these barriers to worsened health outcomes among their clients who are uninsured. Emergency care, reproductive care and non-acute care for severe or chronic conditions were highlighted as areas that have been particularly impacted by the cuts. Practitioners also noted increased overall workload and moral distress due to the difficulties in providing equitable and medically appropriate care for uninsured clients within the context of these barriers. Overall, findings underscore grave implications for uninsured people as a result of the cuts due to barriers to accessing life-saving and health-promoting care, increased financial stress, and discriminatory experiences in the health system.
# RECOMMENDATIONS
We envision a society where all Ontario residents can access the healthcare and social programs vital to their health and well-being. We call on the provincial and federal governments to ensure that all residents of Ontario and beyond have full and comprehensive access to the healthcare and services they need to live healthy and dignified lives.
# Policy changes through the Ontario Ministry of Health:
# 1. Establish OHIP for all.
A comprehensive OHIP for all policy would eliminate many of the administrative barriers that continue to create current and worsening inequities in access to healthcare.
# 2. Immediately reinstate the PHSUP program.
In the reinstatement of a permanent PHSUP program, the Government of Ontario and the Ministry of Health should consider adequate coverage and proper roll-out of the program:
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Expand billing codes used by primary care and establish clearer billing processes to improve access to healthcare for uninsured clients. Billing codes should be expanded to cover more services and should be made permanent with clearer direction so that they can be better utilized.
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Ensure the program is standardized within and across Ontario hospitals. Standardizing the program across hospitals is necessary to ensure hospitals can fully implement the program and work effectively with other care providers in the community to provide comprehensive care for uninsured clients.
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Educate healthcare professionals about healthcare options for uninsured people. General education and awareness of uninsured care issues are vitally important for healthcare professionals so that they can better meet the healthcare needs of this population.
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Ontario Health Teams should work with hospitals and health services in the community to ensure care is coordinated in compliance with the PHSUP program. Ontario Health Teams (OHTs) are regional health organizations established throughout the province, tasked with the ground-level coordination of care between hospitals and communities for all people living in this province. OHTs will play a vital role in ensuring services are accessible to those who are uninsured.
# 3. Ontario Health Teams should advocate and work towards OHIP for all.
OHTs are key players in calling for healthcare access for all residents in their regions, including those without OHIP. OHTs should use the levers they have at their disposal to ensure that all residents in the province, including those without OHIP, can justly access care in each region.
# Recommendations to the Federal Government:
# 4. Status for all.
We join the calls for a broad, inclusive regularization program for all residents without permanent status, including easier access to permanent residence for all residents on temporary work and study permits. This would eliminate the confusing and discriminatory eligibility criteria for healthcare access, and help to reduce other inequities currently experienced by non-permanent residents in Canada. See the full report here.