Exploring the Impact of Ontario's Health Insurance Plan on New Permanent Residents and Healthcare Providers
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Western University Scholarship@Western Electronic Thesis and Dissertation Repository 9-13-2013 12:00 AM "Oh, so we're not insured?": Exploring the impact of Ontario's Health Insurance Plan on new permanent residents and healthcare providers Andrea Bobadilla The University of Western Ontario Supervisor Dr. Treena Orchard The University of Western Ontario Graduate Program in Health and Rehabilitation Sciences A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Science © Andrea Bobadilla 2013 Follow this and additional works at: https://ir.lib.uwo.ca/etd Recommended Citation Bobadilla, Andrea, ""Oh, so we're not insured?": Exploring the impact of Ontario's Health Insurance Plan on new permanent residents and healthcare providers" (2013). Electronic Thesis and Dissertation Repository. 1646. https://ir.lib.uwo.ca/etd/1646 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. “Oh, So We’re Not Insured?”: Exploring the Impact of Ontario’s Health Insurance Plan on New Permanent Residents and Health Care Providers (Thesis format: Monograph) by Andrea Bobadilla Graduate Program in Health and Rehabilitation Sciences A thesis submitted in partial fulfillment of the requirements for the degree of Masters of Science The School of Graduate and Postdoctoral Studies The University of Western Ontario London, Ontario, Canada © Andrea Bobadilla 2013 Abstract Annually, Ontario welcomes 100,000 new immigrants, who must go through the government-mandated three-month waiting period before becoming eligible for the Ontario Health Insurance Plan (OHIP). The objective of this qualitative inquiry was to explore the effects of the three-month wait period on new immigrants’ experiences of accessing health services in Ontario. Drawing on data gathered from in-depth field observations and semi- structured interviews with new permanent residents (n=10) and health care providers (n=4), this study examines the lived experience of this complex policy for those seeking health coverage and those struggling to provide it. The findings from this study highlight the socio- economic and cultural tensions experienced by those in the three-month wait period as they navigate care, along with the impact of the structural impediments posed by the policy on the ability of healthcare providers to deliver sound, equitable, and ethical health care to these vulnerable populations. Keywords Three-month wait period; immigrant healthcare; access to care; health inequalities; Ontario Health Insurance Plan; service providers ii Acknowledgements I would like to thank my incredibly dedicated supervisor, Dr. Treena Orchard, for her commitment to this project and her belief in the importance of this issue. Thank you for believing in my potential enough to challenge me and help me realize it, your guidance has been truly amazing and the ways in which you have contributed to deepening my understanding of the research process will continue to inform my work for years to come. I would also like to thank my advisory committee for their consistent support and encouragement throughout each step of this process. I could not have done this without the extraordinary help from all of the staff at the Scarborough Community Volunteer Clinic who managed to make time during each busy night at the clinic to assist me with recruitment and participate in interviews. This study also would not have been possible without all of the participants who took the time to share their stories and experiences with me - thank you for trusting me with them. To my family, especially my Mom, Dad, and brother, for always providing me with all of the tools I have ever needed to achieve my goals and helping me to envision them for myself. I would also like to thank my friends whose support and patience with me has been unwavering. To Christian, Anthony, and Cecile, whose spirits continue to rest in our hearts and have been a powerful inspiration for me to see through this project. iii Table of Contents Abstract ..................................................................................................................................... ii Acknowledgements .................................................................................................................. iii Table of Contents ..................................................................................................................... iv List of Tables .......................................................................................................................... vii List of Figures ........................................................................................................................ viii List of Appendices ................................................................................................................... ix Chapter 1 ................................................................................................................................... 1 1 Introduction ......................................................................................................................... 1 1.1 Introduction ............................................................................................................................... 1 1.2 Organization of Thesis .............................................................................................................. 4 Chapter 2 ................................................................................................................................... 7 2 A Systematic Review of the Literature and Empirical Evidence on the Impact and Effects of the Three-Month Wait Period for New Permanent Residents to Ontario ............................. 7 2.1 Introduction ............................................................................................................................... 7 2.2 Aims and Objectives ................................................................................................................. 7 2.3 Search Mechanism .................................................................................................................... 7 2.4 Results ..................................................................................................................................... 10 2.5 Overview of the Literature ...................................................................................................... 11 2.5.1 Descriptive Analysis ........................................................................................................ 11 2.6 Literature Review Findings ..................................................................................................... 12 2.6.1 Introduction ...................................................................................................................... 12 2.6.2 Health Impacts ................................................................................................................. 13 2.6.3 Economic Factors............................................................................................................. 16 2.6.4 Legal Issues ...................................................................................................................... 20 2.6.5 Equity and Human Rights Issues ..................................................................................... 23 2.6.6 Stakeholder Views ........................................................................................................... 24 2.6.7 Inductive Themes ............................................................................................................. 27 2.7 Discussion ............................................................................................................................... 32 2.7.1 Health Impact of the Three-Month Wait Period .............................................................. 32 iv 2.7.2 Public Health Impact of the Three-Month Wait Period ................................................... 33 2.7.3 Benefits of Maintaining the Three-Month Wait Policy ................................................... 33 2.7.4 Rationale for the Implementation and Maintenance of the Three-Month Wait Period ... 34 2.8 Conclusion............................................................................................................................... 34 Chapter 3 ................................................................................................................................. 36 3 Methodology ..................................................................................................................... 36 3.1 Introduction ............................................................................................................................. 36 3.2 Ontology and Epistemology .................................................................................................... 36 3.3 Methodology ........................................................................................................................... 38 3.4 Theoretical Framework ........................................................................................................... 39 3.5 Methods ..................................................................................................................................