The barriers to healthcare access and their impact on health outcomes for people medically uninsured in Canada: A scoping review

Objective: The objective of the scoping review was to summarize the current literature on the barriers to healthcare access and its impact on health outcomes for people who are medically uninsured (including those with precarious or no immigration status) in Canada; identify gaps in the existing knowledge; and highlight implications for practice and policy. Methods: We undertook a systematic search in the electronic databases of PsycInfo, MEDLINE (Ovid), CINAHL, ProQuest Nursing and Allied Health, Web of Science and ProQuest Dissertations and Theses Global. Inclusion criteria consisted of articles published in English reporting information about barriers to healthcare access or its impact on health among people with precarious immigration status in Canada. Relevant themes emerging from the included studies were reviewed by the research team and organized into three levels of barriers to accessing healthcare. Results: Ten articles were included in this scoping review. Our review found that individuals living with precarious or no immigration status and being denied public health insurance experienced significant obstructions to accessing healthcare services, the result of policy, interpersonal and intrapersonal-level barriers. These barriers include ineligibility for provincial or federal healthcare insurance, negative interactions with healthcare providers, fear of interacting with public services and lack of sufficient income to pay for out-of-pocket healthcare expenses. This resulted in unmet healthcare needs, negative and worsening health outcomes, avoidance of formal healthcare institutions and reliance on emergency care services caused by delays in help-seeking. Conclusions: People who are medically uninsured in Canada experience avoidable negative health outcomes, including higher risk of death because of barriers to access to healthcare. Provincial healthcare insurance should be available for these vulnerable groups to avoid unnecessary health problems and complications and to reduce the burden on the healthcare system. New (im)migrants should receive education on their right to receive health services, and healthcare providers must receive training on how to best support the health and wellbeing of this population.