The patients described here have been seriously harmed because they were denied access when they needed healthcare. They reside here, work here and pay Ontario taxes. They live in your community as nannies to your children, as waitresses in restaurants, as migrant farm workers and as crossing guards. 


Ontario Health Insurance Plan (OHIP) funded healthcare services are available to the majority of people living in Ontario. However there are several resident populations that do not have access to publicly funded provincial healthcare, including people who have lost their identification, people in the three month OHIP wait period, temporary visa holders (e.g., students, visitors), some refugees and undocumented residents. The majority of uninsured residents are immigrants and within this group the most vulnerable are undocumented immigrants. Undocumented residents are not authorised to be in Canada. The vast majority of undocumented residents arrived in Canada through authorised channels, but their immigration status has changed over time. 

This report describes groups that do not have access to OHIP funded healthcare and identifies their priority health needs, including obstetrical, newborn care and mental health. Children have unique and essential health needs that impact on their health in the short and long-term. Healthcare practitioners and agencies have developed a limited system to serve the uninsured population. At present, the demand for this care exceeds the capacity of the services available and few healthcare agencies receive dedicated funding to treat uninsured residents. The current healthcare system does not provide adequate access to essential healthcare services for uninsured residents.

Immigrants and refugees are a vulnerable population in any country. Global migration has produced some 17 million “people of concern” worldwide, of whom well over half (10 million) are refugees. That there is a great potential for health problems in this population is evident: many have left countries that have limited health care resources and where diseases such as tuberculosis may be endemic. Further compounding their plight is the fact that many are not granted public health insurance in the countries that receive them and cannot afford to pay for health care expenses out of pocket. In this article, we discuss the mounting problem of medically uninsured immigrants, both globally and in Canada — an issue that gained prominence after the 2004 publication of a United Nations report.

It is well established that refugees are one of the most vulnerable populations. Many have left home because of conflict or hopeless poverty and have had no access to healthcare. Others fleeing war and persecution are making arduous journeys in poor living conditions where overcrowding and lack of basic sanitation, water, and food cause a myriad of health problems. Compounding their difficulties is the fact that many refugees are not granted public health insurance in the countries that receive them, so they are left with no means to pay for needed healthcare after relocation.1 The complex vulnerability of these groups is largely absent from the health ethics literature, despite the growth in asylum seekers and migrant numbers globally. In this chapter, we discuss ethical concerns related to caring for refugees, new immigrants, and uninsured immigrant women in Canada. Case examples from our clinic illustrate systemic barriers many refugees and uninsured immigrant women face when attempting to access healthcare. We show how systemic barriers to healthcare result in delayed diagnosis, underdiagnosis, and inappropriate use of emergency services by refugees and undocumented immigrants.