Table 4 Health outcomes reported in uninsured population
First author & year of publication | Health outcome | Main results |
|---|---|---|
Cloos, Ndao, Aho, et al., (2020) [23] | -Self-perceived health (bad, fair, good, very good, excellent) -Psychological distress measured by the Kessler 6 scale -Health issues in the last year | -527 (68.9%) uninsured migrants reported unmet health needs -348 (44.6%) of all migrants perceived their health as negative -192 (26.3%) of migrants reported mental distress -652 (83.5%) of migrants had a health problem within the past 12Â months |
Ridde, Aho, Ndao, et al., (2020) [22] | -Self-perceived health -Psychological distress measured by the Kessler 6 scale -Unmet healthcare needs | -36.9% of the migrants reported receiving a diagnosis by a healthcare professional. Among these individuals, the most frequently reported diagnosis included cardiovascular and circulatory disease (34%), mental health issues (14%), endocrine system complications (26%), and musculoskeletal system complications (11%) |
Darling, Bennett, Burton, et al., (2019) [47] | -Gestational age at birth -Mode of birth -Type of labour -Reasons for induction -Fetal health surveillance -Pharmacological pain management -Intrapartum complications -Preterm birth weight -Rate of small for gestational age -Exclusive breastfeeding at 6 months | -Uninsured participants had higher rates of spontaneous labour than insured (82.1% vs. 77.3%) and spontaneous vaginal birth (81.1% vs. 78.1%) -Uninsured had lower rates of induction of labour than insured (13.5% vs. 17%), electronic fetal monitoring (12.6% vs. 14.6%), assisted vaginal birth (4.7% vs. 5.8%) and Cesarean Sects. (13.9% vs. 15%) -Uninsured more likely to not use pain medication during labour than insured (46.7% vs. 37.1%) -Uninsured compared to insured had postpartum hemorrhage (3.4% vs. 2.9%), preterm birth (5% vs. 4.4%) and gave birth to small for-gestational-age babies (2.1% vs. 1.7%) -At 6 weeks, exclusive breastfeeding was lower among the uninsured (75.1% vs. 78.1%) -Uninsured compared to insured had gestational age at birth < 29 weeks (0.5% vs. 0.3%), 29–33 weeks (0.7% vs. 0.7%), 34–36 weeks (3.9% vs. 3.4%), 37–38 weeks (18.9% vs. 17.8%), 39–41 weeks (74.7% vs. 76.2%) and > 41 weeks (1.4% vs. 1.6%) |
Hynie, Ardern, & Robertson (2016) [48] | -Severity of diagnosis: hypertension, chronic obstructive pulmonary disease, coronary heart failure, diabetes, angina -Mental/behavioural health -Obstetrics outcomes, death, injury | -Uninsured compared to insured in Ontario: -Diagnosis for ambulatory care sensitive conditions was higher: 4.55% vs. 3.18% -Mental health diagnosis were three times higher: 10.5% vs. 3.5% -Obstetric complications were higher: 5.6% vs. 2.7% -More likely to die on arrival or in the emergency room: 3.7% vs. 2.8% -The three most common diagnoses among the insured were: injury (24.5%), other clinical/lab (18.4%), and respiratory (11.2%) -The three most common diagnoses among uninsured were injury (28.4%), other clinical/lab (17.0%), and mental health (10.5%) |
Bunn, Fleming, Rzeznikiewiz, et al., (2013) [41] | -Specific diagnosis including hypertension, type 2 diabetes, HIV, tuberculosis, substance addiction, or mental health disorder | -Hypertension (14% insured vs. 16% uninsured; p-value(p) = 0.831) -Type 2 diabetes (6% insured vs. 11% uninsured; p = 0.470) -HIV (4% insured vs. 24% uninsured; p = 0.004) -Tuberculosis (6% insured vs. 13% uninsured; p = 0.300) -Substance addiction (6% insured vs. 4% uninsured; p > 0.99) -Mental health disorders (14% insured vs. 16% uninsured; p = 0.831) |
Gagnon, Merry, & Haase (2013) [42] | -Emergency Cesarean delivery -Planned Cesarean or vaginal delivery | -Among migrant women, no health insurance coverage compared to health insurance coverage (provincial, IFHP, or private) was associated with higher risk for emergency Cesarean delivery (Odds Ratio (OR), 2.8; 95% Confidence Interval (CI): 1.2–6.3) -Compared to immigrants, being an asylum seeker (OR = 0.3; 95% CI: 0.2–0.6) or refugee (OR = 0.5; 95% CI: 0.2–1.0) was protective |
Rousseau, Laurin-Lamothe, Rummens, et al., (2013) [43] | -Triage level of emergency care -Medical and social problems reported -Treatment and follow-up | Compared to refugee claimant children, uninsured children presented more often for: -Musculoskeletal injuries or lacerations (12.1% refugee vs. 20.7% uninsured; p < 0.001) -Depression (0.4% refugee vs. 3% uninsured; p < 0.001) -Post-traumatic stress disorder (0% refugee vs. 0.4% uninsured; p < 0.001) -Suicidal thoughts (0.8% refugee vs. 2.3% uninsured; p = 0.008) -Substance abuse (0.2% refugee vs. 0.9% uninsured; p = 0.048) Compared to uninsured children, refugee claimant children were more frequently diagnosed with: -Respiratory virus infection (30.2% refugee vs. 23.4% uninsured; p = 0.001) -Abdominal pain (4% refugee vs. 2.3% uninsured; p = 0.035) -Sickle cell anaemia (3.5% refugee vs. 1.4% uninsured; p = 0.005) -Appendicitis (1.3% refugee vs. 0.2% uninsured; p = 0.009) Non-significant differences were: -Gastroenteric virus (9.6% refugee vs. 7.7% uninsured) -Bacterial infection (6.1% refugee vs. 6.3% uninsured) -Eczema/rash (3.4% refugee vs. 2.4% uninsured) -Asthma (1.8% refugee vs. 1.6% uninsured) -Behavioural problems such as opposition and relational problems (1.6% refugees vs. 2.5% uninsured) -Pervasive developmental disorder (1.5% refugee vs. 0.8% uninsured) -Negligence (0.1% refugee vs. 0.1% uninsured) |
Wilson-Mitchell & Rummens, (2013) [43] | -Cesarean section rate -Maternal and neonatal complications -Low birth weight -Small for gestational age -Preterm birth -Newborn intensive care unit admission -Exclusive breastfeeding at discharge -Intrapartum care | -There were no significant differences between uninsured and insured women for low birth weight, preterm birth, maternal complications, intrapartum care and exclusive breastfeeding -Newborns of uninsured mothers had a significantly higher incidence (9.7% vs. 4.3% with chi-squared statistic (x2) = 5.174) of neonatal resuscitation. The difference in newborn intensive care unit admission was not significant (15.16% insured; CI: 10.94–19.39 vs. 14.37% uninsured; CI: 9.16–19.58) -Cesarean sections occurred more in the insured group than the uninsured (35.6% vs. 26.3%; x2 = 4.292) but uninsured women had a significantly higher rate of Cesarean sections due to abnormal fetal heart rate (35% vs. 21.7%; x2 = 5.405) whereas most common reason for C-section in insured women was labor dystocia |
Jarvis, Munoz, Graves, et al., (2011) [46] | -Perinatal outcomes such as gestational age and birth weight of insured and uninsured participants’ baby -Route of delivery (vaginal birth, Cesarean section) | -Uninsured migrant women had lower gestational age at birth than their insured counterparts (39.0 weeks vs. 39.2 weeks) and gave birth to babies with lower birth weight than their insured counterparts (3,379 g vs. 3,387 g rams) -Vaginal birth was higher in uninsured women (71.4% vs. 69.5%; not statistically significant) and Cesarean sections were lower (28.6% vs. 30.5%; not statistically significant). In terms of delivery interventions, epidural use was lower among uninsured (71.4% vs. 73.3%; not statistically significant) and induction was higher (25.4% vs. 20%; not statistically significant) |