La intervención psicosocial como estrategia para la integralidad

Objectives of this review were initially identified as follows:

assess the health impact of the three-month wait period on new permanent residents

assess the public health impact of the three-month wait period identify benefits of maintaining the three-month wait policy

determine the rationale for the implementation and maintenance of the three- month wait period

2.7.1

Health Impact of the Three-Month Wait Period

The most common health issues presented by clients within the three-month wait period, as reported by healthcare providers, were pregnancy and mental health issues (Gray et al., 2011; Steele et al., 2002). Due to lack of affordability or difficulty qualifying for private health insurance, numerous new permanent residents described delaying or foregoing care to avoid incurring significant debts from paying for services out-of-pocket

(Elgersma, 2008). Delaying care was found to have several adverse health consequences for new permanent residents, including complications during pregnancy, increased rates of infections, progression of diseases, preventable acute episodes, and even death (OMA, 2011). When new permanent residents were able to seek and receive care, physicians commented on revising treatment plans because they were aware that the patients would not have access to follow-up care, tests, or drug medications (Gray et al., 2011). The quality and standard of care, that all other residents of Ontario receive, can be said to be compromised because of the three-month wait period.

The psychological impacts of the three-month wait period found in the literature review was significant stress from delaying care or incurring financial burden and experiences of both structural and personal discrimination (Sansom, 1997). New

permanent residents have reported limiting their family’s exposure to activity outside of the home to prevent injury from fear of having to pay for health services out-of-pocket (Barnes, 2012). The three-month wait period produces anxiety and fear for new

permanent residents during their initial period of settlement, which is an already

significantly stressful time (RNAO, 2011). New permanent residents have also described feeling alienated and ignored by Ontario’s health care system during this time after having gone through the entire immigration process to prove their commitment to Canada (Central East Local Health Integration Network, 2010).

2.7.2

Public Health Impact of the Three-Month Wait Period

Most healthcare providers considered the public health impact of the three-month wait period a major concern. The spread of infectious and communicable diseases, such as TB, was reported as more difficult to control due to the three-month wait period. The delay to diagnosis of TB also results in increasing the infectiousness of the diseases, which could be transferred through the air, leaving all residents of Ontario susceptible. Services, such as TB-UP were also found to be inadequate to fully diagnose and treat TB (McKeown, 2011). Healthcare providers were forced to recommend new permanent resident to delay getting complete tests for diagnosis of TB because of the enormous costs that would be incurred, especially due to private health insurance providers considering TB a pre- existing condition and refusing to cover treatment for it. Once diagnosed, however, new permanent residents in the three-month wait period were also found to be in a precarious position because of the legal obligation to receive care.

2.7.3

Benefits of Maintaining the Three-Month Wait Policy

No medical benefits of the three-month wait period have been identified by the OMA and this claim has been supported by the RNAO, AOM, Toronto Board of Health, and Ottawa Board of health. The long-term costs of delaying care for new permanent residents has also been found to be more expensive than the short-term savings to Ontario’s healthcare

system that has been suggested by the MOHLTC and Health Minister Deb Matthews. From compounding costs at inappropriate access points for care, particularly the

emergency department, and allowing diseases to advance without primary or preventative care, the long-term fiscal impact of the three-month wait period has been discovered as detrimental to Ontario’s health care system. The public health of Ontario is also not protected by the three-month wait period because it fails to prevent the spread of infectious and communicable diseases.

2.7.4

Rationale for the Implementation and Maintenance of the Three-

Month Wait Period

The only statements to provide support for the implementation and maintenance of the exclusion period that were found in the literature review consisted of former Health Minister Ruth Grier’s introduction of the policy changes in 1994, estimates of the policy’s cost-savings by current Health Minister Deb Matthews, and the regulations outlined on the MOHLTC and CIC websites. Despite several calls from major

stakeholders such as the OMA, RNAO, AOM, Toronto Board of Health, Ottawa Board of Health, and the Right to Healthcare Coalition, as well as a petition presented by NDP MPP France Gelinas, the MOHLTC is still yet to offer any further information regarding the maintenance of the three-month wait period. The basis of the rationale, besides cost savings, is to protect health services in Ontario from being taken advantage of by medical tourists, although no evidence to prove incidences of this happening with new permanent residents who undergo the immigration process has been found in this literature review. With no research to suggest that the accusations of new permanent residents as medical tourists is legitimate or well-founded and without detailed figures of the Health

Minister’s estimate of $90 million savings per year (Barnes, 2011), the rationale provided by the MOHLTC is yet to fully justify its implementation and maintenance of the three- month wait period.